Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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The Efficacy of the Cystatin C Based Glomerular Filtration Rate in the Estimation of Safe Contrast Media Volume

  • Yoon, Hyuck-Jun (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Kim, Hyungseop (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Lee, Jae-Pil (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Choi, Sang-Woong (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Cho, Hyun-Ok (Department of Cardiology, Andong Medical Group) ;
  • Shin, Hong-Won (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Park, Hyoung-Seob (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Cho, Yun-Kyeong (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Nam, Chang-Wook (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Hur, Seung-Ho (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Kim, Yoon-Nyun (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Kim, Kwon-Bae (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center)
  • Published : 2013.09.30
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Abstract

Background and Objectives: The risk of contrast-induced nephropathy (CIN) is significantly influenced by baseline renal function and the amount of contrast media (CM). We evaluated the usefulness of the cystatin C (CyC) based estimated glomerular filtration rate (eGFRCyC) in the prediction of CIN and to determine the safe CM dosage. Subjects and Methods: We prospectively enrolled a total of 723 patients who received percutaneous coronary intervention (PCI) and investigated the clinical factors associated with the development of CIN. Renal function was calculated as eGFRCyC and a modified diet in the renal disease (MDRD) equation, respectively. Systemic exposure of CM was calculated as CM volume to eGFR ratio. We conducted a regression analysis to evaluate the predictive role of CM volume to eGFRCyC for the risk of CIN. Results: The incidence of CIN was 4.0% (29/723). The patients with CIN had a lower hemoglobin level, decreased renal function, and a higher CyC value, and had greater CM exposure. Through multivariate regression analyses, hemoglobin {odds ratio (OR) 0.743, p=0.032}, CM volume/eGFRCyC (OR 1.697, p=0.006) and CM volume/MDRD (OR 2.275, p<0.001) were found to be independent predictors for CIN. In the receiver operating characteristic curve analysis, fair discrimination for CIN was found at a CM volume/eGFRCyC level of 4.493 (C-statics= 0.814), and at this value, the sensitivity and specificity were 79.3% and 80.0%, respectively. Conclusion: Both the CM volume/MDRD and CM volume/eGFRCyC method would be simple, useful indicators for determining the safe CMdose based on eGFR value before PCI. However, there was no significantly different predictive value between creatinine and CyC based GFR estimations.

Keywords

References

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