Author + information
- Received October 30, 2013
- Revision received January 10, 2014
- Accepted January 13, 2014
- Published online April 15, 2014.
- Mauro Maioli, MD∗∗ (, )
- Anna Toso, MD∗,
- Mario Leoncini, MD∗,
- Nicola Musilli, MD∗,
- Francesco Bellandi, MD∗,
- Mitchell H. Rosner, MD†,
- Peter A. McCullough, MD, MPH‡,§ and
- Claudio Ronco, MD‖
- ∗Division of Cardiology, New Prato Hospital, Prato, Italy
- †Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia
- ‡Baylor Healthcare System, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
- §Heart Hospital, Plano, Texas
- ‖Department of Nephrology, International Renal Research Institute, St. Bortolo Hospital, Vicenza, Italy
- ↵∗Reprint requests and correspondence:
Dr. Mauro Maioli, Division of Cardiology, Prato Hospital, Via Ugo Foscolo, Prato PO 59100, Italy.
Objectives The aim of this study was to evaluate the relationship between pre-procedural fluid status assessed by bioimpedance vector analysis (BIVA) and development of contrast-induced acute kidney injury (CI-AKI).
Background Accurate fluid management in patients undergoing angiographic procedures is of critical importance in limiting the risk of CI-AKI. Therefore, establishing peri-procedural fluid volume related to increased risk of CI-AKI development is essential.
Methods We evaluated the fluid status by BIVA of 900 consecutive patients with stable coronary artery disease (CAD) immediately before coronary angiography, measuring the resistance/height (R/H) ratio and impedance/height (Z/H) vector. CI-AKI was defined as an increase in serum creatinine ≥0.5 mg/dl above baseline within 3 days after contrast administration (iodixanol).
Results CI-AKI occurred in 54 patients (6.0%). Pre-procedural R/H ratios were significantly higher in patients with CI-AKI than without CI-AKI (395 ± 71 Ohm/m vs. 352 ± 58 Ohm/m, p = 0.001 for women; 303 ± 59 Ohm/m vs. 279 ± 45 Ohm/m, p = 0.009 for men), indicating lower fluid volume in the patients with CI-AKI. When patients were stratified according to R/H ratio, there was an almost 3-fold higher risk in patients with higher values (odds ratio [OR]: 2.9; 95% confidence interval [CI]: 1.5 to 5.5; p = 0.002). The optimal receiver-operating characteristic curve analysis threshold values of R/H ratio for predicting CI-AKI were 380 Ohm/m for women and 315 Ohm/m for men. R/H ratio above these thresholds was found to be a significant and independent predictor of CI-AKI (OR: 3.1; 95% CI: 1.8 to 5.5; p = 0.001).
Conclusions Lower fluid status evaluated by BIVA immediately before contrast medium administration resulted in a significant and independent predictor of CI-AKI in patients with stable CAD. This simple noninvasive analysis should be tested in guiding tailored volume repletion.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 30, 2013.
- Revision received January 10, 2014.
- Accepted January 13, 2014.
- American College of Cardiology Foundation