1
|
Min A, Roy S, Chaturvedi A, Choxi R, Wasilewski M, Arora P, Perera RA, Jovin IS. Acute Kidney Injury in Patients Undergoing Both Right and Left Heart Catheterization with Coronary Angiography Vs Right Heart Catheterization Only. Am J Med 2024; 137:442-448. [PMID: 38307150 DOI: 10.1016/j.amjmed.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Recent studies have challenged the reported causal association between acute kidney injury and iodinated contrast administration, ascribing some cases to changes in renal function that are independent of contrast administration. METHODS We studied 1779 consecutive patients undergoing right heart catheterization (RHC) at a Veterans Administration Medical Center. We compared the incidence of acute kidney injury and of nephropathy at 3 months in veterans undergoing right and left heart catheterization and coronary angiography (R&LHC) to the incidence of acute kidney injury and of nephropathy at 3 months in patients undergoing RHC only. RESULTS The incidence of acute kidney injury at 3 days was 47 (9.7%) in the R&LHC group and 58 (9.6%) in the RHC group (P = .99). The incidence of nephropathy at 3 months was 115 (17%) in the L&RHC group and 141 (19.2%) in the RHC group (P = 0.31). In a propensity score-paired analysis of 782 patients and after adjustment for baseline characteristics, the odds ratio for acute kidney injury at 3 days among patients undergoing R&LHC was 1.25 (95% confidence interval, 0.65-2.42; P = .50), and the odds ratio for nephropathy at 3 months was 0.69 (95% confidence interval, 0.46-1.04; P = .08). CONCLUSION The incidence of changes in creatinine consistent with acute kidney injury at 3 days and of nephropathy at 3 months was not significantly different in patients undergoing R&LHC compared with patients undergoing RHC only. This supports the thesis that not all changes in creatinine after procedures involving administration of contrast are caused by the contrast.
Collapse
Affiliation(s)
- Annette Min
- McGuire Veterans Administration Medical Center (VAMC), Richmond, Va; Virginia Commonwealth University, Richmond, Va
| | - Sumon Roy
- McGuire Veterans Administration Medical Center (VAMC), Richmond, Va; Virginia Commonwealth University, Richmond, Va
| | - Abhishek Chaturvedi
- McGuire Veterans Administration Medical Center (VAMC), Richmond, Va; Virginia Commonwealth University, Richmond, Va
| | - Ravi Choxi
- McGuire Veterans Administration Medical Center (VAMC), Richmond, Va; Virginia Commonwealth University, Richmond, Va
| | - Melissa Wasilewski
- McGuire Veterans Administration Medical Center (VAMC), Richmond, Va; Virginia Commonwealth University, Richmond, Va
| | | | | | - Ion S Jovin
- McGuire Veterans Administration Medical Center (VAMC), Richmond, Va; Virginia Commonwealth University, Richmond, Va.
| |
Collapse
|
2
|
Ye C, Ma X, Shi B, Yan R, Fu S, Wang K, Jia S, Yan R, Cong G. Obesity is associated with acute kidney injury in ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention: A national representative cohort study. Catheter Cardiovasc Interv 2024. [PMID: 38654635 DOI: 10.1002/ccd.31030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent and potentially life-threatening complication after percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI). However, the relationship between obesity and the risk of AKI in this specific patient population has not been previously examined. METHODS We queried the National Inpatient Sample (2016-2019) using ICD-10 codes to obtain a sample of adults with STEMI undergoing PCI. All patients were further subcategorized into obese and nonobese cohorts. The primary outcome was the incidence of AKI. Multivariate regression analysis was performed to assess the impact of obesity on AKI. The consistency of this correlation between subgroups was investigated using subgroup analysis and interaction testing. RESULTS A total of 62,599 (weighted national estimate of 529,016) patients were identified, of which 9.80% (n = 6137) had AKI. Obesity comprised 19.78% (n = 1214) of the AKI cohort. Obese patients were on average younger, male, white, and had more comorbidities. Additionally, there was a significant positive association between obesity and AKI incidence (adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.15-1.34), which was more pronounced in female patients (aOR: 1.56, 95% CI: 1.33-1.82, p < 0.001, p-interaction = 0.008). The AKI incidence in these patients increased steadily during the 4-year study period, and it was consistently higher in obese patients than in nonobese patients (p-trend < 0.001 for all). CONCLUSIONS Obesity was independently associated with a greater risk of AKI among adults with STEMI undergoing PCI, particularly in female patients.
Collapse
Affiliation(s)
- Congyan Ye
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xueping Ma
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
- Institute of Cardiovascular Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Cardiology, General Hospital of Ningxia Medical University, Ningxia Medical University, Yinchuan, China
| | - Bo Shi
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Rui Yan
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Shizhe Fu
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Kairu Wang
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Shaobin Jia
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
- Institute of Cardiovascular Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Cardiology, General Hospital of Ningxia Medical University, Ningxia Medical University, Yinchuan, China
| | - Ru Yan
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
- Institute of Cardiovascular Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Cardiology, General Hospital of Ningxia Medical University, Ningxia Medical University, Yinchuan, China
| | - Guangzhi Cong
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, China
- Institute of Cardiovascular Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Cardiology, General Hospital of Ningxia Medical University, Ningxia Medical University, Yinchuan, China
| |
Collapse
|
3
|
Shuka N, Hasimi E, Kristo A, Simoni L, Gishto T, Shirka E, Zaimi Petrela E, Goda A. Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients. Cureus 2023; 15:e51283. [PMID: 38288173 PMCID: PMC10823194 DOI: 10.7759/cureus.51283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
AIM This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclature contrast-associated acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN. Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity. Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients. CONCLUSIONS The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.
Collapse
Affiliation(s)
- Naltin Shuka
- Cardiovascular Medicine, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Endri Hasimi
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Artan Kristo
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Leonard Simoni
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Taulant Gishto
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Ervina Shirka
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| | | | - Artan Goda
- Cardiovascular Diseases, University Hospital Center "Mother Teresa", Tirana, ALB
| |
Collapse
|
4
|
Eitzman EA, Kroll RG, Yelavarthy P, Sutton NR. Predicting Contrast-induced Renal Complications. Interv Cardiol Clin 2023; 12:499-513. [PMID: 37673494 DOI: 10.1016/j.iccl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Chronic kidney disease is an independent risk factor for the development of coronary artery disease and overlaps with other risk factors such as hypertension and diabetes. Percutaneous coronary intervention is a cornerstone of therapy for coronary artery disease and requires contrast media, which can lead to renal injury. Identifying patients at risk for contrast-associated acute kidney injury (CA-AKI) is critical for preventing kidney damage, which is associated with both short- and long-term mortality. Determination of the potential risk for CA-AKI and a new need for dialysis using validated risk prediction tools identifies patients at high risk for this complication. Identification of patients at risk for renal injury after contrast exposure is the first critical step in prevention. Contrast media volume, age and sex of the patient, a history of chronic kidney disease and/or diabetes, clinical presentation, and hemodynamic and volume status are factors known to predict incident contrast-induced nephropathy. Recognition of at-risk patient subpopulations allows for targeted, efficient, and cost-effective strategies to reduce the risk of renal complications resulting from contrast media exposure.
Collapse
Affiliation(s)
- Emily A Eitzman
- Cardiovascular Research Center, 7301A MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0644, USA
| | - Rachel G Kroll
- Cardiovascular Research Center, 7301A MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0644, USA
| | | | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| |
Collapse
|
5
|
Özveren O, Tanalp AC, Tanboğa İH, Karagöz A, Saygı M, Birdal O, Türkyılmaz E, Durmuş E, Oduncu V. A new marker for the prediction of contrast induced-acute kidney injury following primary percutaneous coronary intervention: logarithm of haemoglobin-albumin product. Acta Cardiol 2023; 78:901-909. [PMID: 36942879 DOI: 10.1080/00015385.2023.2187126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of STEMI. The study aimed to assess the predictive value of a new marker, logarithm of haemoglobin and albumin product (LHAP) on the risk of CI-AKI development after primary percutaneous coronary intervention (p-pcı). METHOD We retrospectively enrolled 3057 patients with ST-elevation acute myocardial infarction who were treated with p-PCI. The primary outcome was CI-AKI, defined as >25% or >0.5 mg/dl increase of baseline creatinine values during post-procedural 48 h. RESULTS First, a baseline model was produced to determine the predictors of CI-AKI, then haemoglobin, albumin and LHAP were included in the base model and the performances of all models were compared. The predictive accuracy (Likelihood ratio χ2 and R2) and discrimination (ROC-AUC) of the model including LHAP were significantly higher than that of models including both albumin and Hgb. LHAP best cut-off value for the development of CI-AKI was 9.26 (sensitivity 68% and specificity 66%). CONCLUSION LHAP values were the most important predictor of CI-AKI, followed by creatinine value and Killip class. LHAP values are significantly associated with CI-AKI after p-PCI.
Collapse
Affiliation(s)
- Olcay Özveren
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Ali Cevat Tanalp
- Department of Cardiology, Gebze Medicalpark Hospital, Gebze, Turkey
| | | | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Saygı
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Oğuzhan Birdal
- Department of Cardiology, Ataturk University, Yakutiye, Turkey
| | | | - Erdal Durmuş
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Vecih Oduncu
- Department of Cardiology, Bahçeşehir University, Istanbul, Turkey
| |
Collapse
|
6
|
Zebrauskaite A, Ziubryte G, Mackus L, Lieponyte A, Kairyte E, Unikas R, Jarusevicius G. A Simple Strategy to Reduce Contrast Media Use and Risk of Contrast-Induced Renal Injury during PCI: Introduction of an "Optimal Contrast Volume Protocol" to Daily Clinical Practice. J Cardiovasc Dev Dis 2023; 10:402. [PMID: 37754831 PMCID: PMC10531638 DOI: 10.3390/jcdd10090402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN prevention (statin prescription, prehydration, contrast media (CM) clearance from the blood system, and decrease amounts of contrast volume). The CM volume to patient's creatinine clearance ratio is the main factor to predict the risk of CIN development. The safe CM to creatinine clearance ratio limits have been established. The usage of CM amount depends on personal operators habits and inside center regulations. There is no standardized contrast usage protocol worldwide. The aim of this study was to establish an easy to use, cheap, and efficient protocol to estimate a personalized safe CM dose limit for every patient based on their kidney function. These limits are announced during the "Time Out" before the procedure. Our study included 519 patients undergoing interventional coronary procedures: 207 patients into the "Optimal Contrast Volume" arm and 312 into the control group. Applying the protocol into a daily clinical practice leads to a significant reduction in CM volume used for all type of procedures and the development of CIN in comparison with a control group.
Collapse
Affiliation(s)
- Aiste Zebrauskaite
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
- Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Greta Ziubryte
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Lukas Mackus
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Austeja Lieponyte
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Evelina Kairyte
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Ramunas Unikas
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
- Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Gediminas Jarusevicius
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
- Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| |
Collapse
|
7
|
Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J 2022; 18:73-85. [PMID: 36132584 PMCID: PMC9461685 DOI: 10.14797/mdcvj.1136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.
Collapse
Affiliation(s)
- Tea Isaac
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Salima Gilani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| |
Collapse
|
8
|
Prevention and Management of AKI in ACS Patients Undergoing Invasive Treatments. Curr Cardiol Rep 2022; 24:1299-1307. [PMID: 35925513 DOI: 10.1007/s11886-022-01742-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of patients presenting with acute coronary syndrome (ACS) includes invasive procedures that may increase the risk of acute kidney injury (AKI). AKI adversely affects the outcomes of such procedures and complicates the management of ACS. We have summarized several strategies for the prevention and management of AKI in this critical patient group including in the pre-procedural, intraprocedural, and post-procedural settings. RECENT FINDINGS Definitive prevention and management strategies for AKI in patients presenting with ACS requiring invasive management can be confounded by the variation in data outcomes. Pre-procedural hydration with normal saline when accounting for time to catheterization, radial artery access, contrast stewardship, and close monitoring of renal function after catheterization should be implemented.
Collapse
|
9
|
Moitinho MS, Silva Junior JRD, Cunha MDB, Barbosa DA, Caixeta AM, Pimpinato AG, Junglos AF, Belasco AGDS, Fonseca CDD. Contrast-induced acute kidney injury in patients submitted to coronary angioplasty: prospective cohort. Rev Esc Enferm USP 2022; 56:e20210435. [PMID: 35781323 DOI: 10.1590/1980-220x-reeusp-2021-0435en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/20/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the incidence, risk factors, and associations of clinical outcomes for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after coronary angioplasty. METHOD Prospective cohort of 182 patients followed for three months after undergoing angioplasty, from July 2020 to June 2021. The analyzed variables were sociodemographic, clinical, and those related to the procedure. RESULTS The incidence of CI-AKI was 35.7% (n = 65) and was associated with old age, diabetes mellitus, and chronic kidney disease (p = 0.004, p < 0.001, and p = 0.009, respectively). Out of the 17 patients who died within 90 days, 76.5% had CI-AKI (n = 13), the odds ratio between death and CI-AKI was approximately 7.2 times (95% confidence interval (CI), [2.41;26.36]; p = 0.001). The decrease of one unit in the patient's baseline hemoglobin showed a 6.5% increase for CI-AKI (95% CI, [-0.089; -0.040]; p < 0.0001). CONCLUSION CI-AKI is prevalent in patients with ACS after angioplasty and is related to diabetes mellitus and chronic kidney disease, showing high mortality rates.
Collapse
Affiliation(s)
- Matheus Santos Moitinho
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Jumar Reis Da Silva Junior
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Maximina De Barros Cunha
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Dulce Aparecida Barbosa
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Adriano Mendes Caixeta
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cardiologia Intervencionista, São Paulo, SP, Brazil
| | - Attilio Galhardo Pimpinato
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cardiologia Intervencionista, São Paulo, SP, Brazil
| | - Alana Francine Junglos
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | | | - Cassiane Dezoti da Fonseca
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil.,Universidade Federal de Sergipe, Programa de Pós-Graduação em Enfermagem, São Cristóvão, SE, Brazil
| |
Collapse
|
10
|
van der Molen AJ, Dekkers IA, Bedioune I, Darmon-Kern E. A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2-intra-arterial administration. Eur Radiol 2022; 32:5546-5558. [PMID: 35312791 PMCID: PMC9279267 DOI: 10.1007/s00330-022-08637-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/21/2022]
Abstract
Objectives To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intra-arterial (IA) administration of ioversol. Methods and materials A systematic literature search was performed (1980–2021) and studies documenting IA use of ioversol, and reporting safety outcomes were selected. Key information on study design, patients’ characteristics, indication, dose, and type of safety outcome were extracted. Results Twenty-eight studies (including two pediatric studies) with 8373 patients exposed to IA ioversol were selected. Studies were highly heterogenous in terms of design, PC-AKI definition, and studied population. PC-AKI incidence after coronary angiography was 7.5–21.9% in a general population, 4.0-26.4% in diabetic patients, and 5.5–28.9% in patients with chronic kidney disease (CKD). PC-AKI requiring dialysis was rare and reported mainly in patients with severe CKD. No significant differences in PC-AKI rates were shown in studies comparing different iodinated contrast media (ICM). Based on seven studies of ioversol clinical development, the overall ADR incidence was 1.6%, comparable to that reported with other non-ionic ICM. Pediatric data were scarce with only one study reporting on PC-AKI incidence (12%), and one reporting on ADR incidence (0.09%), both after coronary angiography. Conclusions After ioversol IA administration, PC-AKI incidence was highly variable between studies, likely reflecting the heterogeneity of the included study populations, and appeared comparable to that reported with other ICM. The rate of other ADRs appears to be low. Well-designed studies are needed for a better comparison with other ICM. Key Points • PC-AKI incidence after IA administration of ioversol appears to be comparable to that of other ICM, despite the high variability between studies. • The need for dialysis after IA administration of ioversol is rare. • No obvious difference was found regarding the safety profile of ioversol between IA and IV administration.
Collapse
Affiliation(s)
- Aart J van der Molen
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands.
| | - Ilona A Dekkers
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands
| | - Ibrahim Bedioune
- Clinical Development Department, Guerbet, Roissy CDG Cedex, France
| | | |
Collapse
|
11
|
Moitinho MS, Silva Junior JRD, Cunha MDB, Barbosa DA, Caixeta AM, Pimpinato AG, Junglos AF, Belasco AGDS, Fonseca CDD. Lesão renal aguda induzida por contraste em pacientes submetidos à angioplastia coronariana: coorte prospectiva. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0435pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Analisar a incidência, os fatores de risco e as associações dos desfechos clínicos para Lesão Renal Aguda Induzida Por Contraste (LRA-IC) em pacientes com Síndrome Coronariana Aguda (SCA) após angioplastia coronariana. Método: Coorte prospectivo de 182 pacientes seguidos por três meses após angioplastia, entre julho de 2020 e junho de 2021. As variáveis foram sociodemográficas, clínicas e relacionadas ao procedimento. Resultados: A incidência de LRA-IC foi de 35,7% (n = 65) e esteve associada à idade avançada, diabetes mellitus e doença renal crônica (respectivamente p = 0,004, p < 0,001 e p = 0,009). Dos 17 pacientes que faleceram em até 90 dias, 76,5% tiveram LRA-IC (n = 13), a razão de chances entre óbito e LRA-IC foi de aproximadamente 7,2 vezes (intervalo de confiança (IC) 95%, [2,41;26,36]; p = 0.001). A diminuição de uma unidade na hemoglobina basal do paciente demonstrou um aumento de 6,5% para LRA-IC (IC 95%, [–0,089; –0,040]; p < 0,0001). Conclusão: Em pacientes com SCA após angioplastia, a LRA-IC tem alta incidência e está relacionada com diabetes mellitus e doença renal crônica, apresentando altos índices de mortalidade.
Collapse
|
12
|
Schweitzer J, Horn P, Voss F, Kivel M, Wolff G, Jung C, Zeus T, Kelm M, Westenfeld R. Incidence of Acute Kidney Injury Is Lower in High-Risk Patients Undergoing Percutaneous Coronary Intervention Supported with Impella Compared to ECMO. J Cardiovasc Transl Res 2021; 15:239-248. [PMID: 34324156 PMCID: PMC8983546 DOI: 10.1007/s12265-021-10141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
Acute kidney injury (AKI) is a common complication post-PCI. Here, in a single-center observational registry, we compared the frequency of AKI in patients at elevated risk for AKI (based on Mehran risk stratification scoring) who underwent VA-ECMO- or Impella-supported high-risk PCI. A total of 28 patients scheduled for elective high-risk PCI with mechanical circulatory support were studied prospectively. All patients were turned down for surgery due to exceedingly high risk. Allocation to VA-ECMO (n=11) or Impella (n=17) was performed according to site-specific restrictions on the daily availability of the VA-ECMO platform as a prospective enrollment and performed prior to initiation of PCI. We analyzed AKI incidence as our primary endpoint, as well as PCI success, duration, and peripheral complications. All patients were successfully revascularized and had MCS weaned at the end of the procedure. Baseline GFR and procedural contrast media were similar. Despite similar risks for AKI as calculated by the Mehran score (35 ± 18.9 vs. 31 ± 16.6 %; p=0.55), patients supported by Impella during PCI demonstrated a reduced incidence of AKI (55 vs. 12 %; p=0.03). MCS-assisted high-risk PCI with VA-ECMO or Impella is feasible. However, Impella is associated with a shorter procedure time and a lower incidence of AKI.
Collapse
Affiliation(s)
- Julian Schweitzer
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Fabian Voss
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Milena Kivel
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| |
Collapse
|
13
|
Malik AO, Amin A, Kennedy K, Qintar M, Shafiq A, Mehran R, Spertus JA. Patient-centered contrast thresholds to reduce acute kidney injury in high-risk patients undergoing percutaneous coronary intervention. Am Heart J 2021; 234:51-59. [PMID: 33359778 DOI: 10.1016/j.ahj.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contrast volume used during percutaneous coronary intervention has a direct relationship with contrast-associated acute kidney injury. While several models estimate the risk of contrast-associated acute kidney injury, only the strategy of limiting contrast volume to 3 × estimated glomerular filtration rate (eGFR) gives actionable estimates of safe contrast volume doses. However, this method does not consider other patient characteristics associated with risk, such as age, diabetes or heart failure. METHODS Using the National Cardiovascular Data Registry acute kidney injury risk model, we developed a novel strategy to define safe contrast limits by entering a contrast term into the model and using it to meet specific (eg, 10%) relative risk reductions. We then estimated acute kidney injury rates when our patient-centered model-derived thresholds were and were not exceeded using data from CathPCI version 5 between April 2018 and June 2019. We repeated the same analysis in a sub-set of patients who received ≤3 × eGFR contrast. RESULTS After excluding patients on hemodialysis, below average risk (<7%), missing data and multiple percutaneous coronary interventions, our final analytical cohort included 141,133 patients at high risk for acute kidney injury. The rate of acute kidney injury was 10.0% when the contrast thresholds derived from our patient-centered model were met and 18.2% when they were exceeded (P < .001). In patients who received contrast ≤3 × eGFR (n = 82,318), contrast-associated acute kidney injury rate was 9.8% when the contrast thresholds derived from our patient centered model were met and 14.5% when they were exceeded (P < .001). CONCLUSIONS A novel strategy for developing personalized contrast volume thresholds, provides actionable information for providers that could decrease rates of contrast-associated acute kidney injury. This strategy needs further prospective testing to assess efficacy in improving patient outcomes.
Collapse
Affiliation(s)
- Ali O Malik
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke's Mid America Heart Institute, Kansas City, MO.
| | - Amit Amin
- Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, MO
| | - Kevin Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Mohammed Qintar
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke's Mid America Heart Institute, Kansas City, MO
| | | | | | - John A Spertus
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke's Mid America Heart Institute, Kansas City, MO
| |
Collapse
|
14
|
Nicorandil for CIN Prevention — A Hope or Hype? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1128-1130. [DOI: 10.1016/j.carrev.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022]
|
15
|
Abstract
Chronic kidney disease is a major risk factor for developing coronary artery disease, serving as an independent risk factor while overlapping with other risk factors. Percutaneous coronary intervention is a cornerstone of therapy for coronary artery disease and requires contrast media, which can contribute to renal injury. Identifying patients at risk for contrast-induced nephropathy is critical for preventing renal injury, which is associated with short- and long-term mortality. Determination of the potential risk for contrast-induced nephropathy and a new need for dialysis using validated risk prediction tools is a method of identifying patients at high risk for this complication.
Collapse
Affiliation(s)
- Rachel G Kroll
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109, USA
| | - Prasanthi Yelavarthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109, USA
| | - Daniel S Menees
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109, USA
| | - Nadia R Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, MI 48109, USA.
| |
Collapse
|
16
|
Azzalini L, Kalra S. Contrast-Induced Acute Kidney Injury-Definitions, Epidemiology, and Implications. Interv Cardiol Clin 2020; 9:299-309. [PMID: 32471671 DOI: 10.1016/j.iccl.2020.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is the acute onset of renal injury following exposure to iodinated contrast media. Several definitions have been used, which complicates the estimation of the epidemiological relevance of this condition and comparisons in outcome research. The incidence of CI-AKI increases as a function of patient and procedure complexity in coronary, endovascular, and structural interventions. CI-AKI is associated with a high burden of short- and long-term adverse events, and leads to increased healthcare costs. This review will provide an overview of the definitions, epidemiology, and implications of CI-AKI in patients undergoing coronary, endovascular, and structural catheter-based procedures.
Collapse
Affiliation(s)
- Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Klingenstein Clinical Center, 7th Floor North, 1450 Madison Avenue, New York, NY 10029, USA.
| | - Sanjog Kalra
- Einstein Heart and Vascular Institute, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA 19085, USA
| |
Collapse
|
17
|
Armaly Z, Artol S, Jabbour AR, Saffouri A, Habashi N, Abd Elkadir A, Ghattas N, Farah R, Kinaneh S, Nseir W. Impact of pretreatment with carnitine and tadalafil on contrast-induced nephropathy in CKD patients. Ren Fail 2020; 41:976-986. [PMID: 31797710 PMCID: PMC6913644 DOI: 10.1080/0886022x.2019.1669459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: The present study assesses whether phosphodiesterase type 5 (PDE-5) inhibitor or carnitine exert nephroprotective effects against clinical contrast-induced nephropathy (CIN). Materials and Methods: The present study consisted of three groups of CKD patients. The first group was control group, who were treated with N-acetyl-L-cysteine 1 day before and on the day of radiocontrast administration. The second one was carnitine group, where the patients were infused with carnitine over 10 min 2 h prior to the radiocontrast administration and 24 h post CT. The third one was PDE-5 inhibitor group, where patients were given tadalafil 2 h prior to the administration of the radiocontrast and in the subsequent day. Urine and blood samples were collected before and at the following time sequence: 2, 6, 12, 24, 48, and 120 h after the contrast administration, for creatinine and NGAL determination. Results: Pretreated with N-acetyl-L-cysteine prior to administration of contrast media (CM) to CKD patients caused a significant increase in urinary but not of plasma neutrophil gelatinase-associated lipocalin (NGAL) and serum creatinine (SCr). In contrast, pretreatment with carnitine prevented the increase in urinary NGAL and reduced SCr below basal levels. Similarly, tadalafil administration diminished the elevation of CM-induced urinary NGAL. Conclusions: These results indicate that carnitine and PDE-5 inhibitors may comprise potential therapeutic maneuvers for CIN.
Collapse
Affiliation(s)
- Zaher Armaly
- Department of Nephrology, E.M.M.S. Hospital, and Azrieli Faculty of Medicine in Galilee, Bar- Ilan University, Zafed, Israel
| | - Suheil Artol
- Department of Radiology, E.M.M.S. Hospital, Nazareth, Israel
| | - Adel R Jabbour
- Laboratory of Medicine, E.M.M.S. Hospital, Nazareth, Israel
| | - Amer Saffouri
- Department of Internal Medicine, E.M.M.S. Hospital, Nazareth, Israel
| | - Nayef Habashi
- Department of Nephrology, HaEmeq Hospital Afula, Afula, Israel
| | - Amir Abd Elkadir
- Department of Nephrology, E.M.M.S. Hospital, and Azrieli Faculty of Medicine in Galilee, Bar- Ilan University, Zafed, Israel
| | - Naser Ghattas
- Department of Internal Medicine, The Western Galilee Hospital, Nahariya, Israel
| | - Raymond Farah
- Department of Internal Medicine "B", Ziv Medical Center, and Azrieli Faculty of Medicine in Galilee, Bar- Ilan University, Zafed, Israel
| | - Safa Kinaneh
- Department of Nephrology, E.M.M.S. Hospital, and Azrieli Faculty of Medicine in Galilee, Bar- Ilan University, Zafed, Israel
| | - William Nseir
- Department of Internal Medicine, E.M.M.S. Hospital, Nazareth, Israel
| |
Collapse
|
18
|
Alliu S, Ugwu J, Babalola O, Obiagwu C, Moskovits N, Ayzenberg S, Hollander G, Frankel R, Shani J. Outcomes of percutaneous coronary intervention (PCI) among patients with connective tissue disease: Propensity match analysis. Int J Cardiol 2020; 304:29-34. [PMID: 31982165 DOI: 10.1016/j.ijcard.2019.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/04/2019] [Accepted: 12/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inflammation is the hallmark of coronary artery disease (CAD) and CTD. There are reports of increased prevalence of CAD among patients with CTD such as Rheumatoid Arthritis. However, there is a paucity of data regarding the outcomes of PCI among patients with CTD. METHODS Using the National Inpatient Database, patients that underwent PCI between 2007 and 2015 were identified using ICD-9-CM codes. Propensity match analysis with 1: 3 matching of patients with and without CTD was performed. Outcomes were acute kidney injury (AKI), access site complication (ASC), ventricular fibrillation (VF), cardiogenic shock (CS), Stroke, In-hospital mortality and hospital length of stay (LOS) compared between both groups. RESULT We identified 17,422 patients with CTD and matched with 52, 266 patients without CTD. Patients were predominantly female (63.1%) and white (77.2%), with a mean age of 63 ± 12.1 years. AKI (8.3% vs. 6.6%, p < 0.001), ASC (3.2% vs. 2.7%, p = 0.01) and hospital stay (4.2 ± 4.8 vs. 3.8 ± 5.2, p < 0.001) were higher among patients with CTD. There was no statistically significant difference in rates of VF, CS, stroke, and In-hospital mortality among the two groups. However, in subgroup analysis, rates of VF were lower among patients with Systemic Lupus Erythematosus (SLE) (1.5% vs. 2.2%, p = 0.006). CONCLUSIONS Patients with CTD undergoing PCI have a higher rate of AKI, Access site complications, and prolonged hospital stay.
Collapse
Affiliation(s)
- Samson Alliu
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Justin Ugwu
- Department of Cardiology, University of Texas Medical Center, Galveston, TX, USA
| | - Omotooke Babalola
- Department of Internal Medicine, St. Elizabeth Hospital, Youngstown, OH, USA
| | - Chukwudi Obiagwu
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA
| | - Norbert Moskovits
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sergey Ayzenberg
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA
| | - Gerald Hollander
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA
| | - Robert Frankel
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jacob Shani
- Heart and Vascular Institute, Maimonides Medical Center, Brooklyn, NY, USA
| |
Collapse
|
19
|
Oloko A, Talreja H, Davis A, McCormick B, Clark E, Akbari A, Kong J, Hiremath S. Does Iodinated Contrast Affect Residual Renal Function in Dialysis Patients? A Systematic Review and Meta-Analysis. Nephron Clin Pract 2020; 144:176-184. [DOI: 10.1159/000505576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
|
20
|
Gupta A, Dosekun AK, Kumar V. Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy. World J Cardiol 2020; 12:76-90. [PMID: 32184976 PMCID: PMC7061263 DOI: 10.4330/wjc.v12.i2.76] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with peripheral arterial disease (PAD) and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow. Patients with PAD often have several comorbidities, including chronic kidney disease, diabetes mellitus, and hypertension. Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy (CIN). The use of carbon dioxide (CO2) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN. However, CO2 angiography has been underutilized due to concerns regarding safety and image quality. Modern CO2 delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN. Awareness of the need for optimal imaging conditions, contraindications, and potential complications have improved the safety of CO2 angiography. This review aims to highlight current technological advances in the delivery of CO2 in vascular angiography for patients with PAD and critical limb ischemia, which result in limb preservation while preventing kidney damage.
Collapse
Affiliation(s)
- Amol Gupta
- Department of Cardiology, Heart, Vascular and Leg Center, Bakersfield, CA 93309, United States
| | | | - Vinod Kumar
- Department of Cardiology, Heart, Vascular and Leg Center, Bakersfield, CA 93309, United States
| |
Collapse
|
21
|
Garcia S, Bhatt DL, Gallagher M, Jneid H, Kaufman J, Palevsky PM, Wu H, Weisbord SD. Strategies to Reduce Acute Kidney Injury and Improve Clinical Outcomes Following Percutaneous Coronary Intervention: A Subgroup Analysis of the PRESERVE Trial. JACC Cardiovasc Interv 2019; 11:2254-2261. [PMID: 30466822 DOI: 10.1016/j.jcin.2018.07.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to compare intravenous (IV) sodium bicarbonate with IV sodium chloride and oral acetylcysteine with placebo for the prevention of contrast-associated acute kidney injury (CAAKI) and intermediate-term adverse outcomes. BACKGROUND Data are conflicting on the optimal strategy to reduce CAAKI and related complications after percutaneous coronary intervention (PCI). METHODS The PRESERVE (Prevention of Serious Adverse Events Following Angiography) trial used a 2 × 2 factorial design to randomize 5,177 patients with stage III or IV chronic kidney disease undergoing angiography to IV 1.26% sodium bicarbonate or IV 0.9% sodium chloride and 5 days of oral acetylcysteine or placebo. A subgroup analysis was conducted of the efficacy of these interventions in patients who underwent PCI during the study angiographic examination. The primary endpoint was a composite of death, need for dialysis, or persistent kidney impairment at 90 days; CAAKI was a secondary endpoint. RESULTS A total of 1,161 PRESERVE patients (mean age 69 ± 8 years) underwent PCI. The median estimated glomerular filtration rate was 50.7 ml/min/1.73 m2 (interquartile range: 41.7 to 60.1 ml/min/1.73 m2), and 952 patients (82%) had diabetes mellitus. The primary endpoint occurred in 15 of 568 patients (2.6%) in the IV sodium bicarbonate group and 24 of 593 patients (4.0%) in the IV sodium chloride group (odds ratio: 0.64; 95% confidence interval: 0.33 to 1.24; p for interaction = 0.41) and in 23 of 598 patients (3.8%) in the acetylcysteine group and 16 of 563 patients (2.8%) in the placebo group (odds ratio: 1.37; 95% confidence interval: 0.71 to 2.62; p for interaction = 0.29). There were no significant between-group differences in the rates of CAAKI. CONCLUSIONS Among patients with CKD undergoing PCI, there was no benefit of IV sodium bicarbonate over IV sodium chloride or of acetylcysteine over placebo for the prevention of CAAKI or intermediate-term adverse outcomes.
Collapse
Affiliation(s)
- Santiago Garcia
- Minneapolis VA Healthcare System, University of Minnesota, Minneapolis Heart Institute, Minneapolis, Minnesota.
| | - Deepak L Bhatt
- VA Boston Healthcare System and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | | | - Hani Jneid
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
| | - James Kaufman
- VA Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Paul M Palevsky
- VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hongsheng Wu
- VA Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Steven D Weisbord
- VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | |
Collapse
|
22
|
Nemoto T, Minami Y, Sato T, Muramatsu Y, Kakizaki R, Hashimoto T, Oikawa J, Fujiyoshi K, Meguro K, Shimohama T, Tojo T, Ako J. Contrast Volume and Decline in Kidney Function in Optical Coherence Tomography-Guided Percutaneous Coronary Intervention. Int Heart J 2019; 60:1022-1029. [PMID: 31484858 DOI: 10.1536/ihj.18-565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may increase contrast volume. However, the impact of OCT-guided PCI on the decline in kidney function (DKF) in actual clinical practice remains unclear.Among 1,003 consecutive patients who underwent either OCT-guided or intravascular ultrasound (IVUS)-guided PCI in our institute, we identified 202 propensity score-matched pairs adjusted by baseline factors. The incidence of DKF was compared between the OCT-guided PCI group and the IVUS-guided PCI group. DKF was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or a relative increase of ≥ 25% over baseline within 48 hours (acute DKF) or 1 month (sustained DKF) after PCI.Baseline characteristics, including the prevalence of chronic kidney disease (54% versus 46%, P = 0.09), were comparable between the OCT- and IVUS-guided PCI groups except for the age. The contrast volume was comparable between the two groups (153 ± 56 versus 144 ± 60 mL, P = 0.09), although it was significantly greater in the OCT-guided PCI group in patients with acute coronary syndrome (ACS; 175 ± 55 versus 159 ± 43 mL, P = 0.04). The incidence of acute DKF (0.5% versus 2.5%, P = 0.22) and sustained DKF (5.0% versus 10.4%, P = 0.31) was comparable between the two groups. Multivariate analysis demonstrated that ACS (odds ratio 4.74, 95% confidence interval 2.72-8.25, P < 0.001) was a predictor of sustained DKF.Compared with IVUS-guided PCI, OCT-guided PCI did not increase the incidence of DKF in actual clinical practice, although the increased contrast volume was observed in ACS cases.
Collapse
Affiliation(s)
- Teruyoshi Nemoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Toshimitsu Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yusuke Muramatsu
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ryota Kakizaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kazuhiro Fujiyoshi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| |
Collapse
|
23
|
Hou C, Zheng B, Wang XG, Zhang B, Shi QP, Chen M. Renal impact of high-loading-dose statin pre-cardiac catheterization in patients with chronic kidney disease and long-term statin use. Exp Ther Med 2019; 18:1609-1618. [PMID: 31410116 PMCID: PMC6676095 DOI: 10.3892/etm.2019.7766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/23/2019] [Indexed: 01/01/2023] Open
Abstract
Previous studies have reported that short-term statin loading effectively protects statin-naive patients with mild renal insufficiency from contrast-induced acute kidney injury (CI-AKI). The aim of the present study was to determine whether patients with more advanced chronic kidney disease (CKD) and long-term statin therapy also benefit from high-loading statin pretreatment. A total of 256 consecutive patients with moderate-to-severe CKD receiving long-term statin therapy and undergoing percutaneous coronary intervention (PCI) or coronary artery angiography (CAG) were divided into the statin-loading group (n=34) and the no statin-loading group (n=222), depending on whether the respective patient received high-dose statin within 24 h prior to the intervention. The primary endpoint was the percent change in serum creatinine (SCr) levels. Additional endpoints included absolute change in SCr levels, estimated glomerular filtration rate (eGFR) at 48–72 h after contrast exposure, incidence rate of CI-AKI and composite in-hospital adverse events. The mean SCr decreased from baseline in either of the two groups, and the differences in the percent (P=0.930) and absolute change (P=0.990) in SCr levels were not significant between the two groups. Furthermore, no significant difference in the post-procedural eGFR was observed between the two groups. The incidence rates of CI-AKI (2.9 vs. 4.1%, P>0.999) and in-hospital adverse events (0.0 vs. 3.6%, P=0.602) were also similar between the two groups. Stratified analyses were then performed, which yielded results consistent with the above. Multiple linear regression indicated that the baseline eGFR value and current smoking status were independent factors affecting the post-procedural eGFR value, while high-dose statin loading was not. Therefore, statin reloading prior to intervention may not provide any further renal protection or decrease the occurrence of in-hospital adverse events in patients with moderate-to-severe CKD receiving long-term statin therapy, which warrants validation in prospective trials.
Collapse
Affiliation(s)
- Chang Hou
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Xin-Gang Wang
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Qiu-Ping Shi
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing 100034, P.R. China
| |
Collapse
|
24
|
Adenosine antagonists for prevention of contrast-induced nephropathy: A meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med 2019; 18:85-98. [PMID: 31258641 PMCID: PMC6566091 DOI: 10.3892/etm.2019.7566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/01/2019] [Indexed: 11/05/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is caused by intravascular administration of contrast agent. The efficacy of adenosine antagonists (AAs) in preventing CIN remains controversial, and its elucidation was the objective of the present meta-analysis. A trial sequential analysis (TSA) to assess the reliability of the pooled results was also performed. The Medline, Embase, Web of Science and Cochrane databases were searched to retrieve all published randomized controlled trials (RCTs) comparing AAs with controls in preventing CIN. Heterogeneity, publication bias and quality of studies were assessed. Sensitivity, cumulative and subgroup analyses were also performed. The risk of random errors was evaluated by TSA. A total of 17 trials with 1,483 subjects were included. Pooled results indicated that AAs significantly reduced the incidence of CIN [risk ratio, 0.53; 95% confidence interval (CI), 0.29-0.95; P=0.034] and the serum creatinine (SCr) level after contrast media (CM) administration (standardized mean difference, -0.24; 95% CI, -0.44 to -0.04; P=0.019). Meta-regression did not identify any significant source of heterogeneity. In the subgroup analyses, AAs tended to exhibit a greater prevention efficacy in trials with sample sizes of ≥70, baseline SCr of <1.5 mg/dl and low study quality. TSA on the incidence of CIN indicated that the required information size determined as n=1,778 was not reached, and that the cumulative Z-curve did not cross the TSA boundary. In conclusion, the present meta-analysis of data from current RCTs suggested that AAs reduce the incidence of CIN and the SCr levels after CM administration. However, TSA showed that the risk of having a false-positive result was greater than 5% in the meta-analysis of the incidence of CIN, indicating that more evidence is required to ensure the benefit of AAs in preventing CIN.
Collapse
|
25
|
Adegbala O, Inampudi C, Adejumo A, Otuonye G, Akintoye E, Elsayed R, Williams K, Alvarez P, Afonso L, Briasoulis A. Characteristics and Outcomes of Patients With Cardiogenic Shock Utilizing Hemodialysis for Acute Kidney Injury. Am J Cardiol 2019; 123:1816-1821. [PMID: 30967283 DOI: 10.1016/j.amjcard.2019.02.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
In the setting of cardiogenic shock (CS), impaired biventricular function can cause acute decrease in renal function via reduced renal perfusion and increased renal venous pressure. We sought to analyze the characteristics and outcomes of patients hospitalized with CS who utilized renal replacement therapy (hemodialysis) for acute kidney injury (AKI-HD). We utilized data from the National Inpatient Sample to calculate national rates of in-hospital mortality, use of temporary mechanical support, vascular injury requiring surgery, length of stay (LOS) and hospitalization cost from 2010 to September 2015. We compared the in-hospital outcomes between CS with AKI-HD and a propensity score-matched group without AKI-HD. We identified 6,076 hospitalizations (weighted n = 24,272) with CS and AKI-HD and 76,878 (weighted n = 378,553) with CS not AKI-HD. Among these cases 48.1% (n = 39,403, weighted n = 193,746) had ST elevation myocardial infarction as the cause of CS. Patients with CS and AKI-HD had higher comorbidity burden and they were also more likely to receive mechanical circulatory support device (absolute standardized difference >10% for all comparisons) compared with CS patients without AKI-HD. After matching 4,457 cases for patient-level and hospital-level characteristics, CS with AKI-HD was associated with significantly higher in-hospital mortality (75.74% vs 51.58%, p <0.001), use of temporary mechanical support (24.0% vs 19.3%, p <0.001), LOS (21.4 vs14.4 days, p <0.001) and cost ($80,406 vs $52,833, p <0.0001). AKI-HD occurred in approximately 6% of patients with CS in years 2010 to 2015 and was associated with significantly increased in-hospital morbidity and mortality, LOS, and cost.
Collapse
|
26
|
Arokiaraj MC. Angioplasty with Stenting in Acute Coronary Syndromes with Very Low Contrast Volume Using 6F Diagnostic Catheters and Bench Testing of Catheters. Open Access Maced J Med Sci 2019; 7:1004-1012. [PMID: 30976350 PMCID: PMC6454170 DOI: 10.3889/oamjms.2019.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/05/2022] Open
Abstract
AIM To safely perform angioplasties in acute coronary syndromes with low contrast volume using Cordis 6F diagnostic catheters and to perform mechanical bench tests on the diagnostic and guide catheters in a radial path model. METHODS In 191 patients (242 lesions/268 stents) with acute coronary syndromes angioplasty were performed with cordis 6F diagnostic catheters. RESULTS The lesions were present at left anterior descending (121), Left main (5), left circumflex (51), ramus (5) and right coronary artery (60). In 72% of cases, Iodixanol was used. All contrast injections were given by hand. Regular follow-up of the patients was performed at 30 days. The procedures were performed in the femoral route only. Pre-dilatation was performed in 43 cases. Successful revascularization of the target lesion was achieved in all cases. The mean contrast volume used per patient was 28 ml (± 8 ml). Mild reversible contrast-induced nephropathy (CIN) was observed in two patients. Cardiogenic shock was seen in 7 cases, and one death was observed. Pushability and trackability tests showed good force transmission and hysteresis in diagnostic catheters compared to guide catheters. CONCLUSIONS Angioplasty with stenting could be performed safely in patients using cordis 6F diagnostic catheters using a low volume of contrast in acute coronary syndromes. Low contrast volume usage would result in a lower incidence of contrast-induced nephropathy and cardiac failures.
Collapse
|
27
|
Murray J, Balmuri A, Saurav A, Smer A, Alla VM. Impact of Chronic Kidney Disease on Utilization of Coronary Angiography and Percutaneous Coronary Intervention, and Their Outcomes in Patients With Non-ST Elevation Myocardial Infarction. Am J Cardiol 2018; 122:1830-1836. [PMID: 30336930 DOI: 10.1016/j.amjcard.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) are frequently performed in patients presenting with a non-ST elevation myocardial infarction (NSTEMI). Utilizing the National Inpatient Sample database, we assessed the trends in utilization of CAG, PCI, and coronary artery bypass grafting in 3,654,586 admissions with NSTEMI from 2001 to 2012. The rates of CAG were 54%, 36.1%, and 45.9%, respectively, in patients with normal renal function, patients with CKD not on renal replacement therapy (RRT), and patients with CKD requiring RRT. The in-hospital mortality for patients with NSTEMI was significantly higher in patients with CKD-3.9% in patients without CKD, 6.9% in CKD patients not on RRT, and 8.6% in CKD patients needing RRT. In a propensity-matched cohort of 126,740 NSTEMI admissions, CKD was associated with increased in-hospital mortality (7.9% vs 5.3%, p <0.001), acute kidney injury (34.3 % vs 10.6%, p <0.001), lower use of CAG (37.8% vs 46.4%, p <0.001), and PCI (16.2% vs 20.8, p <0.001), higher hospital costs ($17,333 vs $15,583, p <0.001), and a longer length of stay (6.8 days vs 5.5 days, p <0.001). PCI was associated with decreased mortality (odds ratio of 0.31 ± 0.01, p <0.001) in all the 3 groups. In conclusion, CKD is a marker of adverse outcomes in patients with NSTEMI. Although CAG and PCI were associated improved outcomes, they remain underutilized in these patients.
Collapse
Affiliation(s)
- Jeff Murray
- Division of Cardiology, Creighton University, Omaha, Nebraska
| | - Abilash Balmuri
- Division of Cardiology, Creighton University, Omaha, Nebraska.
| | - Alok Saurav
- Division of Cardiology, Creighton University, Omaha, Nebraska
| | - Aiman Smer
- Division of Cardiology, Creighton University, Omaha, Nebraska
| | | |
Collapse
|
28
|
Lima FV, Singh S, Parikh PB, Gruberg L. Left ventricular end diastolic pressure and contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:16-20. [PMID: 29929842 DOI: 10.1016/j.carrev.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Left ventricular end-diastolic pressure (LVEDP) reflects ventricular performance and volume status. We sought to analyze the relationship between LVEDP and the incidence of contrast-induced acute kidney injury (AKI) in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). METHODS Between January 2006 and December 2008, a total of 254 patients presenting with an acute coronary syndrome had the LVEDP assessed prior to the intervention. Contrast-induced AKI was defined as an increase in serum creatinine ≥25% from baseline or an absolute increase of >0.5 mg/dL from baseline. Patients were divided into three groups according to baseline LVEDP (<12 mmHg, 12-20 mmHg and > 20 mmHg). Baseline clinical, angiographic and procedural characteristics, as well as serum creatinine and estimated glomerular filtration rate (eGFR) at baseline and at 24, 48 and 72 h were retrospectively collected. RESULTS Baseline clinical characteristics were similar in all three groups with the exception of lower left ventricular ejection fraction in patients with elevated LVEDP (p = 0.02). Among the 17 patients with an LVEDP < 12 mmHg, only one (5.9%) developed AKI; among the 82 patients with an LVEDP = 12-20 mmHg, 15 (18.3%) developed AKI; and among the 155 patients with an LVEDP > 20 mmHg, only 22 developed AKI (13.6%). There was no correlation between LVEDP and the change in GFR at 24 h and at 48 h. Further comparison between the group of patients that developed contrast induced AKI versus those that did not, showed a that there was a significantly lower baseline left ventricular ejection fraction (LVEF) among patients that developed contrast induced AKI compared to those that did not (41.4% vs. 48.3%, p = 0.045, respectively). CONCLUSIONS In patients with acute coronary syndrome undergoing PCI, baseline LVEDP was not associated with contrast-induced AKI. However patients with reduced ejection fraction seemed to be at a higher risk of developing AKI. More studies are needed to assess the relationship between LVEDP, LVEF and the risk of developing contrast induced AKI.
Collapse
Affiliation(s)
- Fabio V Lima
- Department of Medicine, Rhode Island Hospital - Brown University, Providence, RI, United States of America
| | - Suraj Singh
- Division of Cardiovascular Diseases, Stony Brook Hospital, Stony Brook, NY, United States of America
| | - Puja B Parikh
- Division of Cardiovascular Diseases, Stony Brook Hospital, Stony Brook, NY, United States of America
| | - Luis Gruberg
- Division of Cardiology, Southside Hospital, Northwell Health, Bay Shore, NY, United States of America.
| |
Collapse
|
29
|
RenalGuard system to prevent contrast-induced acute kidney injury in Japanese patients with renal dysfunction; RESPECT KIDNEY study. Cardiovasc Interv Ther 2018; 34:105-112. [PMID: 29730853 DOI: 10.1007/s12928-018-0527-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
Increasing the urine flow rate (UFR) reduces the toxic effect of contrast media. Use of the RenalGuard system enables the achievement of a high UFR by maintaining intravascular volume and prevents the development of contrast-induced acute kidney injury (CI-AKI). However, the efficacy and safety of RenalGuard system have not yet been evaluated in Japan. This multicenter prospective study evaluated the efficacy and safety of the RenalGuard therapy in preventing CI-AKI development in 60 Japanese patients with renal dysfunction [estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2] undergoing catheter procedures. Baseline eGFR and Mehran's CIN (contrast-induced nephropathy) risk score were 35.1 ± 8.5 mL/min/1.73 m2 and 11.7 ± 4.3, respectively. Regardless of this high-risk profile, the incidence of CI-AKI was 8.6% (5/58) compared with the 26.1% incidence estimated by the CIN risk score. Moreover, two-sided 95% (Fisher's) exact confidence interval was 2.9-19.0 and its upper limit (i.e., 19.0) was less than the prespecified threshold incidence of 25.0. Univariate logistic regression analysis demonstrated that the UFR during catheter procedure was one of the most important factor associated with CI-AKI (odds ratio 0.99, confidence interval 0.98-1.00, p = 0.03). In conclusion, RenalGuard therapy may prevent CI-AKI development in Japanese patients with renal dysfunction. Further large-scale prospective multicenter studies are necessary to confirm our findings.
Collapse
|
30
|
Arokiaraj MC, Menesson E, Feltin N. Magnetic iodixanol - a novel contrast agent and its early characterization. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:10-19. [PMID: 29425536 DOI: 10.1016/j.jdmv.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
AIMS Contrast-induced nephropathy is a commonly encountered problem in clinical practice. The purpose of the study was to design and develop a novel contrast agent, which could be used to prevent contrast-induced nephropathy in the future. METHODS In total, 20-220nm magnetic nanoparticles were conjugated with iodixanol, and their radio-opacity and magnetic properties were assessed thereafter. Scanning electron microscopy pictures were acquired. Thereafter, the nanoparticles conjugate was tested in cell culture (HUVEC cells), and Quantibody® assay was studied after cell treatment in 1:5 dilutions for 48h, compared with control. RESULTS The conjugate preparation had an adequate radio-opacity. A 4mm magnetic bubble was attached to a bar magnet and the properties were studied. The magnetic bubble maintained its structural integrity in all angles including antigravity position. Scanning electron microscopy showed magnetic nanoparticles in all pictures and the particles are of 100-400nm agglomerates with primary particle sizes of roughly 20nm. 1:5 diluted particles had no effect on secretion of IL-1a, IL-1b, IL-4, IL-10, IL-13 and TNFa. Particles increased secretion of IL-8 from 24h and 48h. Secretion of IFNg was also increased when particles were added to the cells as early as 1h. Likewise, IL-6 was strongly secreted by HUVEC treated with particles from 24h incubation time. In contrast, the secretion of MCP-1 was slightly reduced on HUVEC treated with particles. CONCLUSION There is potential for a novel iodixanol-magnetic nanoparticle conjugate to be used in cineradiography. Further investigations need to be performed to study its performance in vitro and in vivo.
Collapse
Affiliation(s)
- M C Arokiaraj
- Cardiology, Pondicherry Institute of Medical Sciences, 605001 Pondicherry, India.
| | - E Menesson
- Tebu-Bio France, 39, rue de Houdan, 78610 Le Perray-en-Yvelines, France
| | - N Feltin
- Laboratoire national de métrologie et d'essais, 78197 Trappes cedex, France
| |
Collapse
|
31
|
Singh M, Karakala N, Shah SV. Long-term Adverse Events Associated With Acute Kidney Injury. J Ren Nutr 2017; 27:462-464. [DOI: 10.1053/j.jrn.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/02/2017] [Indexed: 11/11/2022] Open
|
32
|
Lima FV, Gruberg L. Here we go Again: Trying to prevent contrast-induced nephropathy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:313-314. [DOI: 10.1016/j.carrev.2017.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/26/2017] [Indexed: 11/17/2022]
|
33
|
Pre-procedural peripheral endothelial function is associated with increased serum creatinine following percutaneous coronary procedure in stable patients with a preserved estimated glomerular filtration rate. J Cardiol 2017; 70:461-469. [PMID: 28408073 DOI: 10.1016/j.jjcc.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Worsening renal function, indicated by increased serum creatinine (SCr), is a common complication of percutaneous coronary procedures. Risk factors for increased SCr overlap with coronary risk factors involved in endothelial dysfunction. We hypothesized that endothelial dysfunction, measured using the reactive hyperemia peripheral arterial tonometry index (RHI), can predict periprocedure-increased SCr. METHODS RHI was assessed before elective coronary procedures in 316 consecutive stable patients with a preserved estimated glomerular filtration rate (eGFR, >60mL/min/1.73m2). SCr was measured before and 2 days after procedures. RESULTS There was no significant correlation between natural logarithmic transformations of RHI (Ln-RHI) and basal Ln-eGFR. Periprocedure increase in SCr was observed in 148 (47%) patients. The increased SCr group had significantly lower Ln-RHI [0.48 (0.36, 0.62) vs. 0.59 (0.49, 0.76), p<0.001]. Multivariate linear regression analysis identified body mass index (BMI) (β=0.148, p=0.005) and Ln-RHI (β=-0.365, p<0.001) as significant determinants of percent changes in SCr. Multivariate logistic regression analysis identified Ln-RHI (per 0.1) [odds ratio (OR) 0.672, 95% confidence interval (95% CI) 0.586-0.722; p<0.001], Ln-B-type natriuretic peptide (OR: 1.484, 95% CI: 1.130-1.974; p=0.004), current smoking (OR: 2.563, 95% CI: 1.379-4.763, p=0.003), BMI (OR: 1.113, 95% CI: 1.031-1.203; p=0.007), coronary intervention (OR: 1.736, 95% CI: 1.036-2.909; p=0.036), and Ln-hemoglobin A1c (OR: 6.728, 95% CI: 1.093-41.392, p=0.040) as independent determinants of increased SCr. Receiver-operating characteristics curve analysis showed that Ln-RHI correlated significantly with increased SCr (area under the curve, 0.684, 95% CI: 0.626-0.742, p<0.001). The optimum cut-off point of Ln-RHI for the periprocedure increased SCr was 0.545. CONCLUSIONS Pre-procedure measurement of endothelial function by RHI is an effective strategy to assess the patient's risk conditions for worsening renal function after percutaneous coronary procedures.
Collapse
|
34
|
Grossman PM, Ali SS, Aronow HD, Boros M, Nypaver TJ, Schreiber TL, Park YJ, Henke PK, Gurm HS. Contrast-induced nephropathy in patients undergoing endovascular peripheral vascular intervention: Incidence, risk factors, and outcomes as observed in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. J Interv Cardiol 2017; 30:274-280. [DOI: 10.1111/joic.12379] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/19/2017] [Accepted: 02/22/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- P. Michael Grossman
- Division of Cardiovascular Medicine; University of Michigan School of Medicine; Ann Arbor Michigan
| | - Syed S. Ali
- Division of Cardiovascular Medicine; University of Michigan School of Medicine; Ann Arbor Michigan
| | | | | | - Timothy J. Nypaver
- Division of Vascular Surgery; Henry Ford Health System; Detroit Michigan
| | | | | | - Peter K. Henke
- Section of Vascular Surgery; University of Michigan School of Medicine; Ann Arbor Michigan
| | - Hitinder S. Gurm
- Division of Cardiovascular Medicine; University of Michigan School of Medicine; Ann Arbor Michigan
| |
Collapse
|
35
|
|
36
|
Abstract
Contrast-induced acute kidney injury (CI-AKI) is defined as an abrupt deterioration in renal function associated with the administration of iodinated contrast media. This type of acute kidney injury is frequently encountered as a complication of percutaneous coronary intervention (PCI) and is associated with adverse short- and long-term outcomes including mainly mortality, cardiovascular morbidity and prolongation of hospitalization. The incidence of CI-AKI after PCI ranges from 2 to 20 % according to baseline kidney function. It may also range according to the clinical setting, being higher after emergency PCI. The primary manifestation is a small decline in kidney function, occurring 1 to 3 days after the procedure. Kidney function usually returns to preexisting levels within 7 days. Incidence of acute renal failure requiring dialysis following PCI is rare (<1 %). The present article aims to review up-to-date published data concerning diagnosis, definition, epidemiology and prognosis of this novel in-hospital epidemic.
Collapse
Affiliation(s)
- George Chalikias
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece
| | - Ioannis Drosos
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece
| | - Dimitrios N Tziakas
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece.
| |
Collapse
|
37
|
Shen W, Aguilar R, Montero AR, Fernandez SJ, Taylor AJ, Wilcox CS, Lipkowitz MS, Umans JG. Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study. Am J Nephrol 2017; 45:217-225. [PMID: 28135709 DOI: 10.1159/000455906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. METHODS We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. RESULTS The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. CONCLUSIONS Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.
Collapse
Affiliation(s)
- Wen Shen
- Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Maximum Arterial Contrast Concentrations With Computed Tomography and Left Ventriculography. J Comput Assist Tomogr 2017; 41:976-982. [DOI: 10.1097/rct.0000000000000624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
39
|
Donahue M, Briguori C. Renal Insufficiency and the Impact of Contrast Agents. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael Donahue
- Laboratory of Interventional Cardiology and Department of Cardiology; Clinica Mediterranea; Naples Italy
| | - Carlo Briguori
- Laboratory of Interventional Cardiology and Department of Cardiology; Clinica Mediterranea; Naples Italy
| |
Collapse
|
40
|
Aubry P, Brillet G, Catella L, Schmidt A, Bénard S. Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures. BMC Nephrol 2016; 17:167. [PMID: 27821094 PMCID: PMC5100322 DOI: 10.1186/s12882-016-0385-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/30/2016] [Indexed: 01/22/2023] Open
Abstract
Background Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare. Methods A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012–2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available. Results During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively). Conclusions This is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year.
Collapse
Affiliation(s)
| | | | - Laura Catella
- st[è]ve consultant, 30 rue Narcisse Bertholey, 69600, Oullins, France.
| | - Aurélie Schmidt
- st[è]ve consultant, 30 rue Narcisse Bertholey, 69600, Oullins, France
| | - Stève Bénard
- st[è]ve consultant, 30 rue Narcisse Bertholey, 69600, Oullins, France
| |
Collapse
|
41
|
Araujo GN, Wainstein MV, McCabe JM, Huang PH, Govindarajulu US, Resnic FS. Comparison of Two Risk Models in Predicting the Incidence of Contrast-Induced Nephropathy after Percutaneous Coronary Intervention. J Interv Cardiol 2016; 29:447-453. [DOI: 10.1111/joic.12315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Gustavo N. Araujo
- Hospital de Clinicas de Porto Alegre and Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Marco V. Wainstein
- Hospital de Clinicas de Porto Alegre and Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | | | | | | | - Frederic S. Resnic
- Lahey Clinic Medical Center and Tufts University School of Medicine; Burlington Massachusetts
| |
Collapse
|
42
|
Nough H, Daryachahei R, Hadiani L, Najarzadegan MR, Mirzaee M, Hemayati R, Meidani M, Mousazadeh R, Namayandeh S. Ascorbic acid effect on CIN incidence in diabetic patient after coronary angiography. Adv Biomed Res 2016; 5:69. [PMID: 27169100 PMCID: PMC4854027 DOI: 10.4103/2277-9175.180638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/27/2014] [Indexed: 11/14/2022] Open
Abstract
Background: This study aims to investigate the antioxidant effect of vitamin C in preventing contrast-induced nephropathy (CIN) in diabetic patients after catheterization. Materials and Methods: In a double blinded, randomized controlled trial, 90 diabetic patients who were referred for cardiac catheterization were randomly allocated into two arms of vitamin C (A) and placebo (B). The treatment arm (A) received 2 g of vitamin C orally 2 h before catheterization and the control group (B) received 2 g of oral placebo. Six hours before catheterization, patients received fluid resuscitation with normal saline (CIN was considered as a 25% rise in creatinine (Cr) level or an increase of 0.5 mg/dL in earlier creatinine). CIN was compared between groups. Before andthree days after catheterization. Serum Bun – Cr was measured and GFR were calculated. The results were compared between the two groups. Six hours before catheterization, patients received fluid resuscitation with normal saline CIN was compare between arms. Results: Mean GFR in group (A) before procedure was respectively 69.82±19.26 and after the treatment was 81.51±27.40 (P=0.001). But in group (B) it was 74.18±24.41 and 75.20±29.65 (P=0.747). Contrast-induced nephropathy was observed in 10 patients (12.3%) including 3 patients (7.7%) in group (A) and (16.7%, 7 patients) in group (B) (P=0.315). Conclusion: Ascorbic acid intake in diabetic patients prior to use of contrast agents can be effective in maintaining GFR, but the incidence of contrast-induced nephropathy is not associated with the consumption of ascorbic acid.
Collapse
Affiliation(s)
- Hossein Nough
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Roya Daryachahei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Leila Hadiani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Masoud Mirzaee
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Roya Hemayati
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdy Meidani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Roya Mousazadeh
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | |
Collapse
|
43
|
Contrast Induced Nephropathy with Intravenous Iodinated Contrast Media in Routine Diagnostic Imaging: An Initial Experience in a Tertiary Care Hospital. Radiol Res Pract 2016; 2016:8792984. [PMID: 27069686 PMCID: PMC4812473 DOI: 10.1155/2016/8792984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/23/2016] [Accepted: 02/02/2016] [Indexed: 12/25/2022] Open
Abstract
Background. Contrast induced nephropathy (CIN) is common cause of hospital acquired renal failure, defined as iatrogenic deterioration of renal function following intravascular contrast administration in the absence of another nephrotoxic event. Objectives. Objectives were to calculate incidence of CIN with routine IV contrast usage and to identify its risk factors. Materials and Methods. Study was conducted on 250 patients (having eGFR ≥ 45 mL/min/1.73 m2) receiving intravenous contrast. Various clinical risk factors and details of contrast media were recorded. Patients showing 25% increase in postprocedural serum creatinine value or an absolute increase of 0.5 mg/dL (44.2 mmol/L) were diagnosed as having CIN. Results and Conclusions. Postprocedural serum creatinine showed significant increase from baseline levels. 25 patients (10%) developed CIN. CIN was transient in 21 (84%) patients developing CIN. One patient (4%) developed renal failure and another died due to unknown cause. Dehydration, preexisting renal disease, cardiac failure, previous contrast administration, and volume of contrast had significant correlation with development of CIN (p < 0.05); whereas demographic variables, baseline serum creatinine/eGFR, previous renal surgery, diabetes mellitus, hypertension, nephrotoxic drug intake, abnormal routine hematology, and contrast characteristics had no correlation with CIN. CIN is a matter of concern even in routine imaging requiring intravenous contrast media, in our set-up.
Collapse
|
44
|
Ali ZA, Karimi Galougahi K, Nazif T, Maehara A, Hardy MA, Cohen DJ, Ratner LE, Collins MB, Moses JW, Kirtane AJ, Stone GW, Karmpaliotis D, Leon MB. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study. Eur Heart J 2016; 37:3090-3095. [PMID: 26957421 DOI: 10.1093/eurheartj/ehw078] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/03/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS The feasibility, safety, and clinical utility of percutaneous coronary intervention (PCI) without radio-contrast medium in patients with advanced chronic kidney disease (CKD) are unknown. In this series, we investigated a specific strategy for 'zero contrast' PCI with the aims of preserving renal function and preventing the need for renal replacement therapy (RRT) in patients with advanced CKD. METHODS AND RESULTS A total of 31 patients with advanced CKD [creatinine = 4.2 mg/dL, inter-quartile range (IQR) 3.1-4.8, estimated glomerular filtration rate = 16 ± 8 mL/min/1.73 m2] who had clinical indication for PCI based on a prior minimal contrast coronary angiogram were included. Zero contrast PCI was performed at least 1 week after diagnostic angiography using real-time intravascular ultrasound (IVUS) guidance, with pre- and post-PCI measurements of fractional flow reserve and coronary flow reserve to confirm physiological improvement. This approach resulted in successful PCI, no major adverse cardiovascular events and preservation of renal function without the need for RRT within a follow-up time of 79 days (IQR 33-207) in all patients. CONCLUSION In patients with advanced CKD who require revascularization, PCI may safely be performed without contrast using IVUS and physiological guidance with high procedural success and without complications.
Collapse
Affiliation(s)
- Ziad A Ali
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA .,Cardiovascular Research Foundation, New York, NY, USA
| | - Keyvan Karimi Galougahi
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Tamim Nazif
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Mark A Hardy
- Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - David J Cohen
- Division of Nephrology, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Lloyd E Ratner
- Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Michael B Collins
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Jeffrey W Moses
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Ajay J Kirtane
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Dimitri Karmpaliotis
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Martin B Leon
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| |
Collapse
|
45
|
Preventive effect of oral nicorandil on contrast-induced nephropathy in patients with renal insufficiency undergoing elective cardiac catheterization. Heart Vessels 2016; 31:1776-1782. [PMID: 26874946 DOI: 10.1007/s00380-016-0809-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/29/2016] [Indexed: 12/16/2022]
Abstract
This study aims to investigate the preventive effect of oral nicorandil on contrast-induced nephropathy (CIN) in patients with renal insufficiency undergoing elective cardiac catheterization. A total of 240 patients with an estimated glomerular filtration rate (eGFR) of 60 mL/min or less, who were undergoing elective cardiac catheterization, were randomly assigned to nicorandil group (n = 120, 10 mg nicorandil, three times daily from 2 days before to 3 days after procedure) or control group (n = 120, matching placebo as the same method). The primary endpoint was the incidence of CIN defined as 25 % increase in serum creatinine (SCr) from baseline or 44 μmol/L (0.5 mg/dL) increase in absolute value within 72 h after exposure to contrast medium. The secondary endpoints were: (1) the changes of SCr, Cystatin-C (Cys-C) and eGFR within 72 h; (2) major adverse events (MACE) occurring within 30 days. Baseline characteristics of the patients in the two groups were similar. The incidence of CIN was significantly lower in nicorandil group compared with control group (6.67 vs. 17.5 %, P = 0.017). Compared with the control group, nicorandil group tended to have a lower SCr and Cys-C levels as well as a higher eGFR at 48 h after the procedure (all P < 0.05). There was no difference about the incidence of MACE within 30 days between nicorandil group and control group (4.16 vs. 5.83 %, P = 0.767). Multivariate logistic analysis showed that nicorandil was an independent protective factor against CIN (OR = 0.260, 95 % CI = 0.1-0.676, P = 0.006). Therefore, we concluded that oral nicorandil was associated with a decline in the incidence of CIN in patients with renal insufficiency undergoing elective cardiac catheterization.
Collapse
|
46
|
Brown JR, MacKenzie TA, Maddox TM, Fly J, Tsai TT, Plomondon ME, Nielson CD, Siew ED, Resnic FS, Baker CR, Rumsfeld JS, Matheny ME. Acute Kidney Injury Risk Prediction in Patients Undergoing Coronary Angiography in a National Veterans Health Administration Cohort With External Validation. J Am Heart Assoc 2015; 4:e002136. [PMID: 26656858 PMCID: PMC4845295 DOI: 10.1161/jaha.115.002136] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/21/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) occurs frequently after cardiac catheterization and percutaneous coronary intervention. Although a clinical risk model exists for percutaneous coronary intervention, no models exist for both procedures, nor do existing models account for risk factors prior to the index admission. We aimed to develop such a model for use in prospective automated surveillance programs in the Veterans Health Administration. METHODS AND RESULTS We collected data on all patients undergoing cardiac catheterization or percutaneous coronary intervention in the Veterans Health Administration from January 01, 2009 to September 30, 2013, excluding patients with chronic dialysis, end-stage renal disease, renal transplant, and missing pre- and postprocedural creatinine measurement. We used 4 AKI definitions in model development and included risk factors from up to 1 year prior to the procedure and at presentation. We developed our prediction models for postprocedural AKI using the least absolute shrinkage and selection operator (LASSO) and internally validated using bootstrapping. We developed models using 115 633 angiogram procedures and externally validated using 27 905 procedures from a New England cohort. Models had cross-validated C-statistics of 0.74 (95% CI: 0.74-0.75) for AKI, 0.83 (95% CI: 0.82-0.84) for AKIN2, 0.74 (95% CI: 0.74-0.75) for contrast-induced nephropathy, and 0.89 (95% CI: 0.87-0.90) for dialysis. CONCLUSIONS We developed a robust, externally validated clinical prediction model for AKI following cardiac catheterization or percutaneous coronary intervention to automatically identify high-risk patients before and immediately after a procedure in the Veterans Health Administration. Work is ongoing to incorporate these models into routine clinical practice.
Collapse
Affiliation(s)
- Jeremiah R. Brown
- White River Junction VA, Research & Development ServiceWhite River JunctionVT
- The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of MedicineLebanonNH
- Department of MedicineDartmouth‐Hitchcock Medical CenterLebanonNH
- Department of Community and Family MedicineGeisel School of MedicineLebanonNH
| | - Todd A. MacKenzie
- White River Junction VA, Research & Development ServiceWhite River JunctionVT
- The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of MedicineLebanonNH
- Department of Community and Family MedicineGeisel School of MedicineLebanonNH
| | - Thomas M. Maddox
- Medical ServiceVA Eastern Colorado Health Care SystemDenverCO
- Division of CardiologyUniversity of Colorado School of MedicineDenverCO
- Clinical Assessment Reporting and Tracking ProgramVA Central OfficeDenverCO
| | - James Fly
- Geriatrics Research Education & Clinical Center (GRECC)Tennessee Valley Healthcare System (TVHS)Veteran's Health AdministrationNashvilleTN
- Division of General Internal MedicineDepartment of MedicineVanderbilt University School of MedicineNashvilleTN
| | - Thomas T. Tsai
- Medical ServiceVA Eastern Colorado Health Care SystemDenverCO
- Kaiser Permanente of ColoradoDenverCO
| | - Mary E. Plomondon
- Clinical Assessment Reporting and Tracking ProgramVA Central OfficeDenverCO
- Division of Health Systems, Management, and PolicyUniversity of Colorado School of Public HealthDenverCO
| | - Christopher D. Nielson
- Office of Analytics and Business IntelligenceVA Central OfficeVeterans Health AdministrationSeattleWA
- Division of Pulmonary Medicine and Critical CareUniversity of NevadaRenoNV
| | - Edward D. Siew
- Geriatrics Research Education & Clinical Center (GRECC)Tennessee Valley Healthcare System (TVHS)Veteran's Health AdministrationNashvilleTN
- Division of NephrologyDepartment of MedicineVanderbilt University School of MedicineNashvilleTN
| | | | - Clifton R. Baker
- Office of Analytics and Business IntelligenceVA Central OfficeVeterans Health AdministrationSeattleWA
| | - John S. Rumsfeld
- Division of CardiologyUniversity of Colorado School of MedicineDenverCO
- Clinical Assessment Reporting and Tracking ProgramVA Central OfficeDenverCO
| | - Michael E. Matheny
- Geriatrics Research Education & Clinical Center (GRECC)Tennessee Valley Healthcare System (TVHS)Veteran's Health AdministrationNashvilleTN
- Division of General Internal MedicineDepartment of MedicineVanderbilt University School of MedicineNashvilleTN
- Department of Biomedical InformaticsVanderbilt University School of MedicineNashvilleTN
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTN
| |
Collapse
|
47
|
Shams-Eddin Taher H, Hassan AK, Dimitry SR, Mahfouz AK. Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
48
|
Zhang J, Li Y, Tao GZ, Chen YD, Hu TH, Cao XB, Jing QM, Wang XZ, Ma YY, Wang G, Liu HW, Wang B, Xu K, Li J, Deng J, Han YL. Short-term rosuvastatin treatment for the prevention of contrast-induced acute kidney injury in patients receiving moderate or high volumes of contrast media: a sub-analysis of the TRACK-D study. Chin Med J (Engl) 2015; 128:784-9. [PMID: 25758273 PMCID: PMC4833983 DOI: 10.4103/0366-6999.152620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Current randomized trials have demonstrated the effects of short-term rosuvastatin therapy in preventing contrast-induced acute kidney injury (CIAKI). However, the consistency of these effects on patients administered different volumes of contrast media is unknown. METHODS In the TRACK-D trial, 2998 patients with type 2 diabetes and concomitant chronic kidney disease (CKD) who underwent coronary/peripheral arterial angiography with or without percutaneous intervention were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard-of-care. This prespecified analysis compared the effects of rosuvastatin versus standard therapy in patients exposed to (moderate contrast volume [MCV], 200-300 ml, n = 712) or (high contrast volume [HCV], ≥ 300 ml, n = 220). The primary outcome was the incidence of CIAKI. The secondary outcome was a composite of death, dialysis/hemofiltration or worsened heart failure at 30 days. RESULTS Rosuvastatin treatment was associated with a significant reduction in CIAKI compared with the controls (2.1% vs. 4.4%, P = 0.050) in the overall cohort and in patients with MCV (1.7% vs. 4.5%, P = 0.029), whereas no benefit was observed in patients with HCV (3.4% vs. 3.9%, P = 0.834). The incidence of secondary outcomes was significantly lower in the rosuvastatin group compared with control group (2.7% vs. 5.3%, P = 0.049) in the overall cohort, but it was similar between the patients with MCV (2.0% vs. 4.2%, P = 0.081) or HCV (5.1% vs. 8.8%, P = 0.273). CONCLUSIONS Periprocedural short-term rosuvastatin treatment is effective in reducing CIAKI and adverse clinical events for patients with diabetes and CKD after their exposure to a moderate volume of contrast medium.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, China
| |
Collapse
|
49
|
Petek BJ, Bravo PE, Kim F, de Boer IH, Kudenchuk PJ, Shuman WP, Gunn ML, Carlbom DJ, Gill EA, Maynard C, Branch KR. Incidence and Risk Factors for Postcontrast Acute Kidney Injury in Survivors of Sudden Cardiac Arrest. Ann Emerg Med 2015; 67:469-476.e1. [PMID: 26363571 DOI: 10.1016/j.annemergmed.2015.07.516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/13/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE Survivors of sudden cardiac arrest may be exposed to iodinated contrast from invasive coronary angiography or contrast-enhanced computed tomography, although the effects on incident acute kidney injury are unknown. The study objective was to determine whether contrast administration within the first 24 hours was associated with acute kidney injury in survivors of sudden cardiac arrest. METHODS This cohort study, derived from a prospective clinical trial, included patients with sudden cardiac arrest who survived for 48 hours, had no history of end-stage renal disease, and had at least 2 serum creatinine measurements during hospitalization. The contrast group included patients with exposure to iodinated contrast within 24 hours of sudden cardiac arrest. Incident acute kidney injury and first-time dialysis were compared between contrast and no contrast groups and then controlled for known acute kidney injury risk factors. RESULTS Of the 199 survivors of sudden cardiac arrest, 94 received iodinated contrast. Mean baseline serum creatinine level was 1.3 mg/dL (95% confidence interval [CI] 1.4 to 1.5 mg/dL) for the contrast group and 1.6 mg/dL (95% CI 1.4 to 1.7 mg/dL) for the no contrast group. Incident acute kidney injury was lower in the contrast group (12.8%) than the no contrast group (17.1%; difference 4.4%; 95% CI -9.2% to 17.5%). Contrast administration was not associated with significant increases in incident acute kidney injury within quartiles of baseline serum creatinine level or after controlling for age, sex, race, congestive heart failure, diabetes, and admission serum creatinine level by regression analysis. Older age was independently associated with acute kidney injury. CONCLUSION Despite elevated baseline serum creatinine level in most survivors of sudden cardiac arrest, iodinated contrast administration was not associated with incident acute kidney injury even when other acute kidney injury risk factors were controlled for. Thus, although acute kidney injury is not uncommon among survivors of sudden cardiac arrest, early (<24 hours) contrast administration from imaging procedures did not confer an increased risk for acute kidney injury.
Collapse
Affiliation(s)
| | - Paco E Bravo
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Francis Kim
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Ian H de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | - Peter J Kudenchuk
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - William P Shuman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Martin L Gunn
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - David J Carlbom
- Division of Pulmonary Critical Care Medicine, University of Washington School of Medicine, Seattle, WA
| | - Edward A Gill
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Charles Maynard
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Kelley R Branch
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA.
| |
Collapse
|
50
|
Rose TA, Choi JW. Intravenous Imaging Contrast Media Complications: The Basics That Every Clinician Needs to Know. Am J Med 2015; 128:943-9. [PMID: 25820169 DOI: 10.1016/j.amjmed.2015.02.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
Intravenous contrast is commonly used in noninvasive imaging procedures such as magnetic resonance imaging and computed tomography and can evaluate blood vessels and better characterize soft-tissue lesions. Although the incidence of adverse events after administration of contrast is low, it is important that clinicians and radiologists minimize risks and respond quickly and effectively when reactions occur. We will discuss a range of adverse events to iodinated and gadolinium-based contrast agents, including allergic-like reactions, nephrotoxicity, extravasation, and nephrogenic systemic fibrosis. We will review risk stratification for patients, as well as premedication and treatment of adverse events.
Collapse
|