Diabetes is an important risk factor for the development of contrast-induced AKI. Strategies to reduce the risk of contrast-induced AKI in patients with diabetes are discussed in Section 4.4. Cardiovascular disease is the leading cause of death in women in the United States and Europe,766 and an estimated 35% of PCIs in the United States are performed in women.767,768 Women undergoing PCI usually have more risk factors (including hypertension, advanced age, elevated cho- lesterol, and more significant and diffuse CAD) compared with men.769 Women with STEMI are also less likely to receive early medical treatments and experience longer de- lays to reperfusion therapy.770,771 In subgroup analyses of clinical trials, use of DES appears to be similarly efficacious in women and men.772 5.9.4. CKD: Recommendation Class I 1. In patients undergoing PCI, the glomerular filtration rate should be estimated and the dosage of renally cleared medications should be adjusted.298 300 (Level of Evidence: B) CKD is an independent risk factor for the development and progression of CAD,773,774 and is also associated with worse prognosis after MI or PCI.369,775 A glomerular filtration rate of body surface area should be considered abnormal. Patients with CKD undergoing PCI have a higher risk of complications, including bleeding,776 AKI, and death,236,777 but CKD is not a strong predictor of restenosis after BMS or DES.778 Strategies to reduce the risk of contrast-induced AKI in patients with CKD are discussed in Section 4.4. Platelet dysfunction and overdosing of anti- platelet and antithrombin drugs350 in patients with CKD contribute to the increased risk of bleeding. The Cockcroft- Gault formula is commonly used as a surrogate marker for estimating creatinine clearance, which in turn estimates glomerular filtration rate.298,299,779,780 Medications that require dosage adjustments in patients with CKD include eptifibatide, tirofiban, bivalirudin, enoxaparin, and fondaparinux.781 5.9.5. 