12: 50 Boudou - Prevention of contrast - induced nephropathy

Prevention of contrast-induced nephropathy

Nicolas Boudou, MD,Cardiology department

Rangueil university hospitalToulouse, France

Pôle Cardiovasculaire et Métabolique

Pôle Cardiovasculaire et Métabolique

Potential conflicts of interest

Speaker's name: Dr Nicolas Boudou

I do not have any potential conflict of interest

Contrast-induced nephropathy (CIN)

Iatrogenic disease

• Impairment of renal function

• 25% serum creatinine (SCr) from baseline or 44 μmol/L in

absolute value

• 48-72 hrs after contrast administration

• SCr levels peak between 2- 5 days

• Usually return normal in 14 days

Epidemiology: Frequence decline over the past decade ≈ 15% to ≈ 7%

Consequences: mortality, MACE and length of hospitalization

P McCullough et al. Am J Cardiol 2006; 98

M T James et al. Circ Cardiovasc Interv. 2013;6:37-43

Risk ratio for mortality associated with contrast-induced acute kidney injury (CI-AKI)

N: 139 603 pts; 34 studies

Pooled ajusted RR= 2.39

(95% CI, 1.98-2.90; p<0.001)

Risk ratio for MACE with contrast-induced acute kidney injury (CI-AKI)

N: 70 031 pts; 14 studies

Pooled ajusted RR= 2.42

(95% CI, 1.62-3.64; p<0.001)

M T James et al. Circ Cardiovasc Interv. 2013;6:37-43

Especially if Glomerular filtration rate (GFR) <40 mL/min/1.73 m2

• Preventive hydratation 12hrs before, continuated for at least 24hrs

• Hydratation with isotonic saline

• Short term high dose statin therapy

• Volume constrat media should be minimized

< 350 mL or < 4 mL/kg or total volume contrast/GFR ratio <3.4

W Laskey et al. J Am Coll Cardiol 2007;50:584-90

Independant predictor of an

abnormal increase in SCr

V/ CrCl > 3.7

Marenzi et al. J Am Coll Cardiol Intv 2012;5:90-7

Michael et al. Catheter Cardiovasc Interv 2014 [Epub ahead of print]

Patel et al. J Am Coll Cardiol Intv 2013;6:128-36

Contrast nephropathy: 3.8%

Lin et al. Eurointervention 2014;9:1173-80

516 ptsIncidence of CIN 5.4% (28/516)

Mehran et al. J ACC 2004;44;1393-1399

Lin et al. Eurointervention 2014;9:1173-80

Conclusion

How to prevent CIN

– Hydratation with isotonic saline

– Minimize volume contrast media

• V/ CrCl < 4 or 6

• or <4 mL/kg

• or <350 mL,

– Furosemide with matched hydratation can be an option ( CrCl< 60mL)

Conclusion

How to minimize volume contrast media

– Coronary angiogram to assess CTO and collaterals

– No CTO-PCI ad hoc

– Define your strategy (according to anatomy, renal function…)

– Selective injection in a collateral than in main artery

– IVUS

– Stop the procedure before V/ CrCl >8 ?