Impact of Contrast Dose Reduction on Incidence of Acute Kidney Injury (AKI) Among Patients Undergoing PCI: A Modeling Study.

OBJECTIVE: Acute kidney injury is a common complication associated with angiography and percutaneous coronary intervention (PCI). Increasing doses of contrast are associated with an increase in the likelihood of AKI. The objective of our study was to estimate projected reduction in the burden of AKI in association with varying degrees of contrast media dose reduction among patients undergoing PCI.
METHODS: We assessed the relationship between contrast volume to creatinine clearance among consecutive patients undergoing PCI in the state of Michigan between January 2010 and September 2013. Computational modeling was used to estimate the anticipated reduction in risk of AKI across varying degrees of reduction in contrast volume.
RESULTS: The risk of AKI was significantly and substantially increased in patients in whom the contrast dose exceeded 2.99 times the creatinine clearance. The benefit of contrast dose reduction was most evident in those at greater predicted risk of AKI. An across the board 30% reduction in contrast dose would be expected to prevent one-eighth of AKI cases, although clinical benefits could also be anticipated with smaller dose reductions.
CONCLUSION: Our study provides estimates of reduction in AKI that could be achieved with contrast dose reduction in clinical practice. These data should help guide planning of clinical trials and the application of contrast-saving strategies to routine clinical practice.