Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention

• Published in: PloS one Vol. 13; no. 9; p. e0203352
• Main Authors: Kuno, Toshiki, Numasawa, Yohei, Sawano, Mitsuaki, Katsuki, Toshiomi, Kodaira, Masaki, Ueda, Ikuko, Suzuki, Masahiro, Noma, Shigetaka, Negishi, Koji, Ishikawa, Shiro, Miyata, Hiroaki, Fukuda, Keiichi, Kohsaka, Shun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.09.2018; Public Library of Science (PLoS)
• Subjects: Acute kidney failure; Acute Kidney Injury - blood; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Aged; Analysis; Angioplasty; Balloon angioplasty; Biology and Life Sciences; Body mass; Body Mass Index; Body size; Cardiac patients; Cardiology; Cardiovascular disease; Contrast Media - adverse effects; Creatinine; Creatinine - blood; Female; Health aspects; Heart attacks; Heart failure; Hospitals; Humans; Incidence; Injury prevention; Intervention; Kidneys; Male; Medical personnel; Medical research; Medicine; Medicine and Health Sciences; Mortality; Obesity; Patients; People and Places; Percutaneous Coronary Intervention; Physicians; Postoperative Complications - blood; Postoperative Complications - epidemiology; Prospective Studies; Renal function; Risk analysis; Risk factors; Studies; Therapeutic applications; Weight control; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0203352

Limiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus. We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). We evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database. CI-AKI was defined as an absolute serum creatinine increase of 0.3 mg/dL or a relative increase of 50%. The effect of the V/CrCl ratio relative to CI-AKI incidence was evaluated within the low- (≤25 kg/m2) and high- (>25 kg/m2) BMI groups, with a V/CrCl ratio > 3 considered to be a risk factor for CI-AKI. A V/CrCl ratio > 3 was predictive of CI-AKI, regardless of BMI (low-BMI group: odds ratio [OR], 1.77 [1.42-2.21]; P < 0.001; high-BMI group: OR, 1.67 [1.22-2.29]; P = 0.001). The relationship between BMI and CI-AKI followed a reverse J-curve relationship, although baseline renal dysfunction (creatinine clearance <60 mL/min, 46.9% vs. 21.5%) and V/CrCl ratio > 3 (37.3% vs. 20.4%) were predominant in the low-BMI group. Indeed, low BMI was a significant predictor of a V/CrCl ratio > 3 (OR per unit decrease in BMI, 1.08 [1.05-1.10]; P < 0.001). A V/CrCl ratio > 3 was strongly associated with the occurrence of CI-AKI. Importantly, we also identified a tendency for physicians to use higher V/CrCl ratios in lean patients. Thus, recognizing this trend may provide a therapeutic target for reducing the incidence of CI-AKI.