The changing definition of contrast-induced nephropathy and its clinical implications: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

Nicklaus K. Slocum, P. Michael Grossman, Mauro Moscucci, Dean E. Smith, Herbert D. Aronow, Simon R. Dixon, David Share, Hitinder S. Gurm

Research output: Contribution to journalArticle

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Abstract

Background: The traditional definition of contrast-induced nephropathy (CIN) has been an absolute rise of serum creatinine (Cr) of ≥0.5 mg/dL, although most recent clinical trials have included a ≥25% increase from baseline Cr. The clinical implication of this definition change remains unknown. Methods and Results: We compared the association of the two definitions with risk of death or need for dialysis among 58,957 patients undergoing percutaneous coronary intervention in 2007 to 2008 in a large collaborative registry. Patients with a preexisting history of renal failure requiring dialysis were excluded. Contrast-induced nephropathy as defined by a rise in Cr ≥0.5 mg/dL (CIN Traditional) developed in 1,601, whereas CIN defined either as Cr ≥0.5 mg/dL or ≥25% increase in baseline Cr (CIN New) developed in 4,308 patients. Patients meeting the definition of CIN New but not CIN Traditional were classified as CIN Incremental (n = 2,707). Compared with CIN New, CIN Traditional was more commonly seen in patients with abnormal renal function, which was more likely to develop in patients with normal renal function at baseline. Compared with CIN Incremental, patients meeting the definition of CIN Traditional were more likely to die (16.7% vs 1.7%) and require in-hospital dialysis (9.8% vs 0%). Conclusions: Our data suggest that the traditional definition of CIN (a rise in Cr of ≥0.5 mg/dL) in patients undergoing PCI is superior to ≥25% increase in Cr at identifying patients at greater risk for adverse renal and cardiac events.

Original languageEnglish
Pages (from-to)829-834
Number of pages6
JournalAmerican Heart Journal
Volume163
Issue number5
DOIs
StatePublished - May 1 2012

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Blue Cross Blue Shield Insurance Plans
Creatinine
Dialysis
Kidney
Percutaneous Coronary Intervention
Renal Insufficiency
Registries
Clinical Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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The changing definition of contrast-induced nephropathy and its clinical implications : Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). / Slocum, Nicklaus K.; Grossman, P. Michael; Moscucci, Mauro; Smith, Dean E.; Aronow, Herbert D.; Dixon, Simon R.; Share, David; Gurm, Hitinder S.

In: American Heart Journal, Vol. 163, No. 5, 01.05.2012, p. 829-834.

Research output: Contribution to journalArticle

Slocum, Nicklaus K. ; Grossman, P. Michael ; Moscucci, Mauro ; Smith, Dean E. ; Aronow, Herbert D. ; Dixon, Simon R. ; Share, David ; Gurm, Hitinder S. / The changing definition of contrast-induced nephropathy and its clinical implications : Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). In: American Heart Journal. 2012 ; Vol. 163, No. 5. pp. 829-834.
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abstract = "Background: The traditional definition of contrast-induced nephropathy (CIN) has been an absolute rise of serum creatinine (Cr) of ≥0.5 mg/dL, although most recent clinical trials have included a ≥25{\%} increase from baseline Cr. The clinical implication of this definition change remains unknown. Methods and Results: We compared the association of the two definitions with risk of death or need for dialysis among 58,957 patients undergoing percutaneous coronary intervention in 2007 to 2008 in a large collaborative registry. Patients with a preexisting history of renal failure requiring dialysis were excluded. Contrast-induced nephropathy as defined by a rise in Cr ≥0.5 mg/dL (CIN Traditional) developed in 1,601, whereas CIN defined either as Cr ≥0.5 mg/dL or ≥25{\%} increase in baseline Cr (CIN New) developed in 4,308 patients. Patients meeting the definition of CIN New but not CIN Traditional were classified as CIN Incremental (n = 2,707). Compared with CIN New, CIN Traditional was more commonly seen in patients with abnormal renal function, which was more likely to develop in patients with normal renal function at baseline. Compared with CIN Incremental, patients meeting the definition of CIN Traditional were more likely to die (16.7{\%} vs 1.7{\%}) and require in-hospital dialysis (9.8{\%} vs 0{\%}). Conclusions: Our data suggest that the traditional definition of CIN (a rise in Cr of ≥0.5 mg/dL) in patients undergoing PCI is superior to ≥25{\%} increase in Cr at identifying patients at greater risk for adverse renal and cardiac events.",
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