PMID- 16392608
OWN - NLM
STAT- MEDLINE
DCOM- 20060216
LR  - 20191026
IS  - 0284-1851 (Print)
IS  - 0284-1851 (Linking)
VI  - 46
IP  - 8
DP  - 2005 Dec
TI  - Contrast-medium-Induced nephropathy correlated to the ratio between dose in gram 
      iodine and estimated GFR in ml/min.
PG  - 830-42
AB  - PURPOSE: To suggest a more precise tool when assessing the risk of 
      contrast-medium-induced nephropathy (CIN), i.e. the ratio between contrast medium 
      (CM) dose expressed in grams of iodine (g-I) and estimated glomerular filtration 
      rate in ml/min (eGFR; based on equations using serum-creatinine (s-Cr), weight, 
      height, age, and/or sex), here named I-dose/GFR ratio. MATERIAL AND METHODS: A 
      Medline search of published CIN investigations reporting mean eGFR and mean dose 
      of low-osmolality CM (LOCM) identified 10 randomized controlled prophylactic and 
      2 cohort coronary investigations, and 3 randomized and 1 cohort computed 
      tomographic (CT) investigation. From the randomized trials, data were collected 
      only from the placebo or control arms, unless there was no significant difference 
      between the control and test groups. The mean I-dose/GFR ratio of each study was 
      correlated with the mean frequency of CIN-1 (s-Cr rise> or =44.2 micromol/l or > 
      or =20-25%) and CIN-2 (oliguria or requiring dialysis). A maximum dose according 
      to an I-dose/GFR ratio= 1 in patients with s-Cr ranging from 100 to 300 
      micromol/l was compared with that of CIGARROA'S formula and with a "European 
      consensus" threshold published by the European Society of Urogenital Radiology, 
      both using s-Cr alone to predict renal function. McCullough's formula was used to 
      assess the risk of CIN requiring dialysis at an I-dose/GFR ratio= 1 with LOCM. 
      RESULTS: The coronary investigations revealed a linear correlation with a 
      correlation coefficient between the I-dose/GFR ratio and the frequency of CIN-1 
      and CIN-2 of 0.91 (P<0.001) and 0.84 (P=0.001), respectively. At a mean 
      I-dose/GFR ratio= 1, the regression line indicated a 10%) risk of CIN-1 and a 1% 
      risk of CIN-2. At a mean I-dose/ GFR ratio=3, the risk of CIN-1 and CIN-2 
      increased to about 50% and 15%, respectively. Pooled weighted data from the CT 
      investigations revealed a 12% risk of CIN-1 at a mean I-dose/GFR ratio = 1.1 and 
      no cases of CIN-2. The maximum CM dose according to an I-dose/GFR ratio= 1 was 
      about 30-50% of that of both Cigarroa's formula and the "European consensus" in 
      elderly low-weight individuals, while it was similar for middle-aged individuals 
      weighing about 90 kg. McCullough's formula suggests that there will be an 
      exponentially increasing risk of CIN requiring dialysis, but at an I-dose/GFR 
      ratio= 1 and using LOCM it will not exceed 1% until GFR decreases below 30 ml/min 
      in diabetics and below 20 ml/min in non-diabetics. CONCLUSION: Using the 
      I-dose/GFR ratio may be a more expedient way of improving risk assessment of CIN 
      than today's common practice of estimating CM dose from volume alone and renal 
      function from s-Cr alone. Prospective studies based on individual patient data 
      are encouraged to define the risk of CIN at various I-dose/GFR ratios and 
      correlated to type of CM, examination, risk factors, etc.
FAU - Nyman, U
AU  - Nyman U
AD  - Department of Radiology, Lasarettet Trelleborg, Trelleborg, Sweden. 
      ulf.nyman@skane.se
FAU - Almen, T
AU  - Almen T
FAU - Aspelin, P
AU  - Aspelin P
FAU - Hellstrom, M
AU  - Hellstrom M
FAU - Kristiansson, M
AU  - Kristiansson M
FAU - Sterner, Gunnar
AU  - Sterner G
LA  - eng
PT  - Journal Article
PL  - England
TA  - Acta Radiol
JT  - Acta radiologica (Stockholm, Sweden : 1987)
JID - 8706123
RN  - 0 (Contrast Media)
RN  - 9679TC07X4 (Iodine)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Algorithms
MH  - Body Size
MH  - Contrast Media/administration & dosage/*adverse effects/*chemistry
MH  - Coronary Angiography
MH  - Creatinine/blood
MH  - Female
MH  - *Glomerular Filtration Rate
MH  - Humans
MH  - Iodine/*administration & dosage/analysis
MH  - Male
MH  - Middle Aged
MH  - Renal Insufficiency/*chemically induced
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Sex Factors
MH  - Tomography, X-Ray Computed
EDAT- 2006/01/06 09:00
MHDA- 2006/02/17 09:00
CRDT- 2006/01/06 09:00
PHST- 2006/01/06 09:00 [pubmed]
PHST- 2006/02/17 09:00 [medline]
PHST- 2006/01/06 09:00 [entrez]
AID - 10.1080/02841850500335051 [doi]
PST - ppublish
SO  - Acta Radiol. 2005 Dec;46(8):830-42. doi: 10.1080/02841850500335051.