From Nationwide Children's Hosp. Presented at PICS 2010 Chicago.
Cath Cardiovasc Interv 2010 July; 76(1):S9
Intro: Recommendations for maximum dose is outdated and not made for current contrast agents and current procedure lengths.
Methods: 2006-9, 135 procedures requiring ICU care after cath.
Study population: 60 procedures where non-ionic contrast (Optiray) was used, pre- and post-procedural data were available, etc.
2/3rd of patients had renal parameters measured at least 3 times for 72 hrs.
Age: 1 day - 18 yrs. Median = 6 months.
95% were < 1 year.
Results:
Contrast used: 0.6 - 6.1 ml/kg (median 3 ml/kg) Contrast used per hour of procedure: 0.1 - 7.4 ml/kg/hr (median 1.7 ml/kg/hr) 3 pts. received large amount of contrast (> 10 ml/kg). But, this was administered over longer procedures (<4.5 ml/kg/hr).
No change in median values of Creatinine or Creatinine clearance between pre- and post-procedure values.
6 pts(10%) had increase in creatinine > 150% &/or decrease in Creatinine clearance >25%.
1 pt (1.7%) had increase in creatinine >200% and decrease in Creatinine clearance >50%.
All these pts. rec'd < 6 ml/kg and < 4.1 ml/kg/hr.
Risk factors were (i) pre-procedural renal impairment (n=3) & (ii) procedure-related hemodynamic instability during the procedure.
No one needed RRT.
Conclusion: Large amounts of contrast (>10 ml/kg) is tolerated provided it is administered over a longer period. Pre-procedural renal impairment and procedure-related hemodynamic instability are risk factor for development of renal compromise (Increase in creatinine and Decrease creatinine clearance).
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