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

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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.

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

ASJC Scopus subject areas

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

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    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, 13(9), [e0203352]. https://doi.org/10.1371/journal.pone.0203352