The evaluation of creatinine clearance, estimated glomerular filtration rate and serum creatinine in predicting contrast-induced acute kidney injury among patients undergoing percutaneous coronary intervention☆☆☆

Abstract 

Purpose

The purpose of the study was to compare creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) in predicting contrast-induced acute kidney injury (CI-AKI), dialysis and death following percutaneous coronary intervention (PCI).

Methods and Materials

Data were prospectively collected on 7759 consecutive patients within the Dartmouth Dynamic Registry undergoing PCI between January 1, 2000, and December 31, 2006. Renal function was measured at baseline and within 48 h after PCI using three methods: CrCl using the Cockcroft–Gault equation, eGFR using the abbreviated Modification of Diet in Renal Disease equation and SCr. We compared CrCl, eGFR and SCr in predicting CI-AKI, post-PCI dialysis-dependent renal failure and in-hospital mortality. Areas under the receiver operating characteristic curve (ROC) were calculated using logistic regression and tested for equality.

Results

On univariable analysis, CrCl [ROC: 0.69; 95% confidence interval (CI): 0.67–0.72] predicted CI-AKI better than eGFR (ROC: 0.67; 95% CI: 0.64–0.70) (P=.013) and SCr (ROC: 0.64; 95% CI: 0.61–0.67) (P<.001). Creatinine clearance (ROC: 0.73; 95% CI: 0.69–0.77) and eGFR (ROC: 0.70; 95% CI: 0.65–0.74) outperformed SCr for predicting in-hospital mortality. On multivariable analysis, CrCl (ROC: 0.77; 95% CI: 0.75–0.80), SCr (ROC: 0.78; 95% CI: 0.76–0.80) and eGFR (ROC: 0.77; 95% CI: 0.75–0.80) predicted CI-AKI well. Creatinine clearance (ROC: 0.88; 95% CI: 0.85–0.90) and eGFR (ROC: 0.87; 95% CI: 0.85–0.90) were strong independent predictors of in-hospital mortality.

Conclusions

Creatinine clearance, eGFR and SCr predict CI-AKI equally well. Creatinine clearance and eGFR are strong independent predictors of in-hospital mortality.

Keywords: Angioplasty, Contrast media, Kidney, Contrast-induced nephropathy