Clinical Research
Interventional Cardiology
Pre-Procedural Bioimpedance Vectorial Analysis of Fluid Status and Prediction of Contrast-Induced Acute Kidney Injury

https://doi.org/10.1016/j.jacc.2014.01.025Get rights and content
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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.

Key Words

angiography
contrast media
contrast-induced nephropathy
renal insufficiency

Abbreviations and Acronyms

BIVA
bioimpedance vector analysis
CAD
coronary artery disease
CI-AKI
contrast-induced acute kidney injury
eGFR
estimated glomerular filtration rate
LVEDP
left ventricular end-diastolic pressure
R/H
resistance/height ratio
Z/H
impedance/height

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All authors have reported that they have no relationships relevant to the contents of this paper to disclose.