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

Toshiki Kuno, Yohei Numasawa, Mitsuaki Sawano, Toshiomi Katsuki, Masaki Kodaira, Ikuko Ueda, Masahiro Suzuki, Shigetaka Noma, Koji Negishi, Shiro Ishikawa, Hiroaki Miyata, Keiichi Fukuda, Shun Kosaka

Research output: Contribution to journalArticle

Abstract

Background 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. Objective We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). Methods 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. Results 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). Conclusions 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.

Original languageEnglish
Article numbere0203352
JournalPLoS One
Volume13
Issue number9
DOIs
Publication statusPublished - 2018 Sep 1

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Percutaneous Coronary Intervention
Acute Kidney Injury
Creatinine
creatinine
kidneys
body mass index
Body Mass Index
incidence
odds ratio
Incidence
Odds Ratio
physicians
risk factors
Databases
Physicians
therapeutics
Serum

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention. / Kuno, Toshiki; Numasawa, Yohei; Sawano, Mitsuaki; Katsuki, Toshiomi; Kodaira, Masaki; Ueda, Ikuko; Suzuki, Masahiro; Noma, Shigetaka; Negishi, Koji; Ishikawa, Shiro; Miyata, Hiroaki; Fukuda, Keiichi; Kosaka, Shun.

In: PLoS One, Vol. 13, No. 9, e0203352, 01.09.2018.

Research output: Contribution to journalArticle

Kuno, T, Numasawa, Y, Sawano, M, Katsuki, T, Kodaira, M, Ueda, I, Suzuki, M, Noma, S, Negishi, K, Ishikawa, S, Miyata, H, Fukuda, K & Kosaka, S 2018, 'Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention', PLoS One, vol. 13, no. 9, e0203352. https://doi.org/10.1371/journal.pone.0203352
Kuno, Toshiki ; Numasawa, Yohei ; Sawano, Mitsuaki ; Katsuki, Toshiomi ; Kodaira, Masaki ; Ueda, Ikuko ; Suzuki, Masahiro ; Noma, Shigetaka ; Negishi, Koji ; Ishikawa, Shiro ; Miyata, Hiroaki ; Fukuda, Keiichi ; Kosaka, Shun. / Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention. In: PLoS One. 2018 ; Vol. 13, No. 9.
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abstract = "Background 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. Objective We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). Methods 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. Results 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). Conclusions 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.",
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AU - Kuno, Toshiki

AU - Numasawa, Yohei

AU - Sawano, Mitsuaki

AU - Katsuki, Toshiomi

AU - Kodaira, Masaki

AU - Ueda, Ikuko

AU - Suzuki, Masahiro

AU - Noma, Shigetaka

AU - Negishi, Koji

AU - Ishikawa, Shiro

AU - Miyata, Hiroaki

AU - Fukuda, Keiichi

AU - Kosaka, Shun

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N2 - Background 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. Objective We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). Methods 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. Results 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). Conclusions 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.

AB - Background 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. Objective We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). Methods 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. Results 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). Conclusions 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.

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