Contrast-induced acute kidney injury

Efficacy of melatonin on drug- or contrast-induced acute kidney injury: a systematic review and GRADE-assessed meta-analysis of experimental and clinical studies

OBJECTIVE

The objective of this systematic review and meta-analysis was to assess the efficacy of melatonin in drug- or contrast-induced AKI in preclinical and clinical studies.

METHODS

PubMed, Embase, Scopus, Web of Science (WOS), the Cochrane Database of Systematic Reviews (CDSR), and clinical trials.GOV from the beginning until August 1, 2024. On the basis of the inclusion and exclusion criteria, the articles were included by two independent researchers. Data regarding study design, patient characteristics, the number of patients with and without AKI, and the means and SDs of the serum creatinine and BUN levels were extracted from relevant studies. STATA version 17.0 was used to compute pooled measures of standardized mean differences, standardized mean differences, risk ratios and risk differences. I2 and chi-square tests were used to assess heterogeneity between studies. Funnel plots, Egger tests and the trim-and-fill method were used to evaluate small study effects (publication bias). The risk of bias of the included clinical and preclinical studies was assessed via the Cochrane ROB tool and SYRCLE tool, respectively. The credibility of the results was evaluated via GRADE. Sensitivity analysis was performed via the one-out removal method.

RESULTS

We identified 1,696 nonduplicate records, of which the full texts of 159 articles were examined. Twenty-nine animal experimental studies and 5 clinical trials met the inclusion criteria and were included in the review. The results of the meta-analysis confirmed that melatonin was significantly effective at reducing the serum creatinine level (standardized mean difference: - 3.04; 95% CI - 3.904 to - 2.183, with 95% prediction interval: - 7.201 to 1.163) and the BUN level (standardized mean difference: - 3.464; 95% CI - 4.378 to - 2.549, with 95% prediction interval: - 7.839 to 0.911) in drug-induced AKI animal studies. Melatonin did not have a significant effect on the serum creatinine level (standardized mean difference: - 2.67; 95% CI - 9.69 to - 4.35, with 95% prediction interval: - 42.618 to 37.278) or the BUN level (standardized mean difference: - 1.77; 95% CI - 5.533 to - 1.994, with 95% prediction interval: -22.943 to 19.404) in contrast-induced AKI animal studies. Furthermore, in clinical studies, melatonin had no significant effect on reducing the serum creatinine level (standardized mean difference: 0.183; 95% CI - 1.309 to 1.675, with 95% prediction interval: - 7.975 to 8.340), BUN level (standardized mean difference: 0.206; 95% CI - 0.0871 to 1.283, with 95% prediction interval: - 5.115 to 5.528) or risk of AKI incidence (risk ratio: 0.877; 95% CI 0.46 to 1.64, with 95% prediction interval: - 0.238 to 3.174; risk difference: - 0.06 mg/dl; 95% CI - 0.259 to 0.40 mg/dl, with 95% prediction interval: - 0.467 to 0.348). There were no significant publication biases, and after sensitivity analysis, no considerable changes were observed, indicating the robustness of the results.

CONCLUSION

This meta-analysis indicates that melatonin may protect against drug-induced AKI in animal models but is not effective in clinical studies and that melatonin has no significant effect on contrast-induced AKI. Owing to the inconclusive results in clinical trials and very low certainty of evidence, further research with higher methodological quality is needed to reach a more certain conclusion.

Intravascular Ultrasound Guidance During Peripheral Vascular Interventions: Long-term Clinical Outcomes and Costs From the Japanese Perspective

PURPOSE

The value of intravascular ultrasound (IVUS) guidance during peripheral vascular revascularization procedures is incompletely understood. Moreover, data on long-term clinical outcomes and costs are limited. The objective of this study was to compare outcomes and costs between IVUS and contrast angiography alone in patients undergoing peripheral revascularization procedures in Japan.

MATERIALS AND METHODS

This retrospective comparative analysis was performed using the Japanese Medical Data Vision insurance claims database. All patients undergoing revascularization for peripheral artery disease (PAD) between April 2009 and July 2019 were included. Patients were followed until July 2020, death, or a subsequent revascularization procedure for PAD. Two patient groups were compared: one undergoing IVUS imaging or the other contrast angiography alone. The primary end point was major adverse cardiac and limb events, including all-cause-mortality, endovascular thrombolysis, subsequent revascularization procedures for PAD, stroke, acute myocardial infarction, and major amputations. Total health care costs were documented over the follow-up and compared between groups, using a bootstrap method.

RESULTS

The study included 3956 patients in the IVUS group and 5889 in the angiography alone group. Intravascular ultrasound was significantly associated with reduced risk of a subsequent revascularization procedure (adjusted hazard ratio: 0.25 [0.22-0.28]) and major adverse cardiac and limb events (0.69 [0.65-0.73]). The total costs were significantly lower in the IVUS group, with a mean cost saving over follow-up of $18 173 [$7 695-$28 595] per patient.

CONCLUSION

The use of IVUS during peripheral revascularization provides superior long-term clinical outcomes at lower costs compared with contrast angiography alone, warranting wider adoption and fewer barriers to IVUS reimbursement for patients with PAD undergoing routine revascularization.Clinical ImpactIntravascular ultrasound (IVUS) guidance during peripheral vascular revascularization has been introduced to improve the precision of the procedure. However, questions over the benefit of IVUS in terms of long-term clinical outcome and over cost have limited its use in everyday clinical practice. This study, performed in a Japanese health insurance claims database, demonstrates that use of IVUS provides a superior clinical outcome over the long term at a lower cost compared to angiography alone. These findings should encourage clinicians to use IVUS in routine peripheral vascular revascularization procedures and encourage providers to reduce barriers to use.

Deep learning reconstruction combined with contrast-enhancement boost in dual-low dose CT pulmonary angiography: a two-center prospective trial

PURPOSE

To investigate whether the deep learning reconstruction (DLR) combined with contrast-enhancement-boost (CE-boost) technique can improve the diagnostic quality of CT pulmonary angiography (CTPA) at low radiation and contrast doses, compared with routine CTPA using hybrid iterative reconstruction (HIR).

MATERIALS AND METHODS

This prospective two-center study included 130 patients who underwent CTPA for suspected pulmonary embolism. Patients were randomly divided into two groups: the routine CTPA group, reconstructed using HIR; and the dual-low dose CTPA group, reconstructed using HIR and DLR, additionally combined with the CE-boost to generate HIR-boost and DLR-boost images. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of pulmonary arteries were quantitatively assessed. Two experienced radiologists independently ordered CT images (5, best; 1, worst) based on overall image noise and vascular contrast. Diagnostic performance for PE detection was calculated for each dataset.

RESULTS

Patient demographics were similar between groups. Compared to HIR images of the routine group, DLR-boost images of the dual-low dose group were significantly better at qualitative scores (p < 0.001). The CT values of pulmonary arteries between the DLR-boost and the HIR images were comparable (p > 0.05), whereas the SNRs and CNRs of pulmonary arteries in the DLR-boost images were the highest among all five datasets (p < 0.001). The AUCs of DLR, HIR-boost, and DLR-boost were 0.933, 0.924, and 0.986, respectively (all p > 0.05).

CONCLUSION

DLR combined with CE-boost technique can significantly improve the image quality of CTPA with reduced radiation and contrast doses, facilitating a more accurate diagnosis of pulmonary embolism.

KEY POINTS

Question The dual-low dose protocol is essential for detecting pulmonary emboli (PE) in follow-up CT pulmonary angiography (PA), yet effective solutions are still lacking. Findings Deep learning reconstruction (DLR)-boost with reduced radiation and contrast doses demonstrated higher quantitative and qualitative image quality than hybrid-iterative reconstruction in the routine CTPA. Clinical relevance DLR-boost based low-radiation and low-contrast-dose CTPA protocol offers a novel strategy to further enhance the image quality and diagnosis accuracy for pulmonary embolism patients.

Prognostic value of glycemic gap in ST-segment elevation myocardial infarction-associated acute kidney injury

BACKGROUND

Stress-induced hyperglycemia (SIH) is a common phenomenon in acute myocardial infarction and is associated with poor prognosis. The relationship between glycemic gap (GG), a marker of SIH, and ST-segment elevation myocardial infarction (STEMI)-associated acute kidney injury (STAAKI) remains unclear. This study aims to explore the predictive value of GG for the risk of STAAKI after percutaneous coronary intervention (PCI) in STEMI patients.

METHODS

This study retrospectively selected patients diagnosed with STEMI who underwent primary PCI. Logistic regression analysis was used to identify the risk factors associated with STAAKI. To examine the dose-response relationship between GG and STAAKI, restricted cubic splines (RCS) were employed. The predictive accuracy of the models was assessed using Delong test, net reclassification index (NRI) and integrated discrimination improvement (IDI).

RESULTS

This study included 595 patients, the incidence of STAAKI was 9.2%. Multivariate logistic regression showed LVEF (OR per 1% increase = 0.931, 95% CI: 0.895 ~ 0.969), NT-proBNP (OR per 1 pg/mL increase = 1.579, 95% CI: 1.212 ~ 2.057), and GG (OR per 1 mmol/L increase = 1.379, 95% CI: 1.223 ~ 1.554) as independent predictors of STAAKI. RCS analysis indicated a linear dose-response relationship between GG and STAAKI. After integrating GG, the new model could significantly improve the risk model for STAAKI (Z = 2.77, NRI = 0.780, and IDI = 0.095; All P < 0.05).

CONCLUSION

GG is an independent risk factor for the occurrence of STAAKI after PCI in STEMI patients, and integrating GG can significantly improve risk modeling regarding STAAKI.

CLINICAL TRIAL NUMBER

Not applicable.

Association between acute-to-chronic glucose ratio and acute kidney injury after emergency PCI in patients with acute myocardial infarction

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with acute myocardial infarction undergoing Percutaneous coronary intervention (PCI) treatment and is associated with poor prognosis. there is a lack of effective predictive biomarkers and functions.

OBJECTIVE

To explore the correlation between the acute-to-chronic blood glucose ratio (ARC) and CI-AKI in patients with emergency PCI.

METHODS

This study enrolled AMI patients undergoing emergency PCI from November 2018 to May 2024. Demographic characteristics, medical history, and perioperative laboratory parameters were systematically collected. Potential predictors were identified through least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression. Restricted cubic splines (RCS) were employed to examine nonlinear relationships, with subsequent subgroup analyses and nomogram construction.

RESULTS

A total of 502 patients were included, with 84 developing postoperative CI-AKI and 418 remaining non-CI-AKI. ARC was found to be an independent risk factor for CI-AKI (OR = 1.06, 95 % CI 1.04-1.08). RCS analysis revealed a non-linear relationship between ARC and CI-AKI. In various adjusted models, ARC as a continuous variable showed a correlation with CI-AKI occurrence. In the third and fourth quantiles, ARC was independently associated with CI-AKI risk (OR = 2.95, 95 % CI 1.16-7.47 and OR = 7.17, 95 % CI 2.99-17.24, respectively). The nomogram model, based on LASSO regression, demonstrated good predictive accuracy for CI-AKI (AUC = 0.831, 95 % CI 0.778-0.884).

CONCLUSION

There is a non-linear positive correlation between ARC and the risk of acute kidney injury after emergency PCI in patients with AMI.

Unpacking KDIGO Guidelines: Prioritizing and Applying Exposures and Susceptibilities for AKI in Clinical Practice

Background/Objectives: Acute kidney injury (AKI) is a significant global health issue with a high morbidity and mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines identify various exposures and susceptibilities as risk factors for AKI. However, the predictive significance of these factors in heterogeneous emergency department (ED) populations remains unclear. We hypothesized that assessing KDIGO-listed exposures and susceptibilities for AKI, alone and in combination, would provide an insight into their predictive value for AKI. Furthermore, we investigated whether adding biomarkers, plasma neutrophil gelatinase-associated lipocalin (pNGAL) and C-reactive protein (CRP), could enhance AKI risk prediction. Methods: Data were analyzed from the prospective longitudinal "NGAL study" conducted at North Zealand University Hospital in Denmark. A total of 344 ED patients were included, with AKI diagnosed using KDIGO's creatinine-based criteria. Patient data, including medical history, exposures, and susceptibilities, were extracted and analyzed. Predictive performance was evaluated using a receiver operating characteristic (ROC) analysis on individual and combined risk factors. Additional models incorporated pNGAL and CRP to assess their impact on prediction accuracy. Results: Individual exposures and susceptibilities showed a poor predictive performance, with nephrotoxic drugs and advanced age demonstrating the highest sensitivity but a low positive predictive value (PPV). Combining multiple risk factors improved AKI prediction, with models clustering into those optimizing sensitivity or PPV. The inclusion of pNGAL significantly enhanced predictive performance, achieving the highest combined sensitivity and PPV. Although less than pNGAL, CRP also improved prediction, while requiring fewer variables than pNGAL-inclusive models. Conclusions: No individual KDIGO-listed exposure or susceptibility could reliably predict AKI in the ED setting. Combining multiple exposures and susceptibilities improved the predictive accuracy, but the models excelled either at screening or confirmation, not both. The addition of pNGAL and CRP significantly enhanced AKI prediction, emphasizing the need for biomarker integration in risk stratification models. These findings highlight the limitations of clinical parameters alone and underscore the importance of a multifaceted approach to AKI risk assessment.

Wide pulse pressure as a novel predictor of contrast-induced acute kidney injury in diabetic patients undergoing primary percutaneous coronary intervention

BACKGROUND

Primary percutaneous coronary intervention (p-PCI) is pivotal in managing ST-segment elevation myocardial infarction (STEMI); however, it introduces potential risks, such as contrast-induced acute kidney injury (CI-AKI). This study aimed to investigate the relationship between pulse pressure (PP) and CI-AKI incidence in diabetic patients.

METHODS

In this retrospective study conducted between 2021 and 2022, 590 diabetic STEMI patients undergoing p-PCI were categorized based on the presence of wide PP. Individuals with PP ≥ 65 mmHg were classified as the 'wide PP (+) group', while those with PP < 65 mmHg were classified as the 'wide PP (-) group'. To determine independent predictors of CI-AKI, multivariable logistic regression models were applied. After establishing the base model, blood pressure indices, including PP, SBP, DBP, mean arterial pressure, and pulsatility were added to the model using the stepwise selection method.

RESULTS

Among the patients, 18.3% ( n  = 108) were in the wide PP (+) group, while 81.7% ( n  = 482) were in the wide PP (-) group. The incidence of hypertension, SBP, PP, and the risk of CI-AKI were higher in the wide PP (+) group. Multivariable analysis recognized PP, wide PP, and pulsatility as independent CI-AKI predictors [odds ratio (OR): 1.024, 95% confidence interval (CI): 1.003-1.045, P  = 0.025; OR: 1.684, 95% CI: 1.025-2.769, P  = 0.040; OR: 13.816, 95% CI: 2.069-92.245, P  = 0.007, respectively].

CONCLUSION

Increased PP emerges as an independent predictor for CI-AKI in diabetic patients undergoing p-PCI.

Effects of Artificial Intelligence Clinical Decision Support Tools on Complications Following Percutaneous Coronary Intervention

Background

Artificial intelligence (AI) models have been created that incorporate unique patient characteristics to risk stratify patients undergoing cardiac catheterization with percutaneous coronary intervention (PCI). The most frequent complications following PCI are contrast-induced acute kidney injury (CI-AKI) and postprocedural bleeding, resulting in increased adverse outcomes, length of stay (LOS), and health care costs. Our study investigates the impact of AI clinical decision support tools on these events.

Methods

A retrospective review of patients undergoing PCI at our institution from April 2023 to March 2024 was performed. All patients had an ePRISM (Terumo Health Outcomes AI clinical decision support tool) generated risk assessment and maximum contrast volume recommendation reported during procedure time-out. Statistical analysis was performed to determine the incidence of post-PCI CI-AKI, bleeding events, and LOS.

Results

A total of 642 patients were analyzed. The incidence of CI-AKI significantly declined from a baseline of 10% to an average of 2.18% (P < .0001). Of the remaining CI-AKI, 92.9% occurred in hospitalized patients. The incidence of bleeding complications declined from a baseline incidence of 2.15 per month to an average of 1.54 per month. Our institution's average LOS declined from a baseline of 3.44 to 1.79 days.

Conclusions

AI clinical decision support tools can be effectively incorporated into clinical practice. ePRISM successfully risk-stratified patients undergoing PCI for CI-AKI and bleeding events and gave meaningful recommendations which resulted in a significant reduction in adverse events and LOS.

Dahuang chuanxiong decoction against contrast-induced nephropathy: Multi-omics, crosstalk between BNIP3-mediated mitophagy and IL-17 pathway

BACKGROUND

Contrast-induced nephropathy (CIN), also known as contrast-induced acute kidney injury (CI-AKI), represents a prevalent form of hospital-acquired renal injury. However, the mechanisms underlying its pathogenesis remain unclear. Based on our previous research findings, the Dahuang Chuanxiong decoction (DCH), composed of Radix et Rhizoma Rhei (DH) and Rhizoma Chuanxiong (CX), has demonstrated efficacy for inhibiting CI-AKI by attenuating oxidative stress and apoptosis in renal tubular epithelial cells. Despite these findings, the detailed mechanisms underlying the renoprotective actions have not been thoroughly clarified.

PURPOSE

The objective of this study was to screen potential targets and signaling pathways involved in inhibition of CI-AKI by DCH using multi-omics analysis and to verify whether the renoprotective mechanism of DCH is related to these identified targets or pathways through in vivo and in vitro experiments.

METHODS

Initially, we identified the components of DCH using UPLC-Q-TOF-MS. Transcriptomics and proteomics, combined with experimental validation, were used to further elucidate the molecular mechanisms of the herbal pair in CI-AKI treatment. A CI-AKI rat model was established, and the expression levels of proteins related to mitophagy and the IL-17 signaling pathway were detected in renal tissues using immunofluorescence, immunohistochemistry, and western blotting analysis to elucidate the nephroprotective effects of DCH. Additionally, siRNA was used in the HK-2 cell model to investigate the crosstalk between the mitophagy and IL-17 signaling pathways and the impact on apoptosis when these pathways were inhibited.

RESULTS

Multi-omics results revealed that the crucial signaling pathways involved were mitophagy, the MAPK signaling pathway, and the IL-17 signaling pathway. In vivo experiments indicated that contrast media (CM) led to an increase in AKI biomarkers, with upregulated expression of Parkin, BNIP3, IL-17, and p-NF-κB. Notably, pretreatment with DCH markedly reversed the expression of these proteins. Furthermore, we confirmed the importance of IL-17-mediated inflammation in the pathogenesis of CIN in vitro. We stimulated HK-2 cells with human IL-17 recombinant protein and observed an increase in the expression of p-NF-κB. Conversely, knockdown of IL-17 receptor A (IL-17RA) on the cell membrane reduced the expression of p-NF-κB and BNIP-3 under IL-17 stimulation. Additionally, the results revealed that BNIP3 knockdown reduced p-NF-κB production and alleviated the inflammation triggered by CM. The crosstalk between the two signaling pathways was initially explored.

CONCLUSION

In conclusion, these findings suggested that DCH may exert ameliorative effects on CI-AKI through a multifaceted approach, including inhibition of BNIP3-mediated mitophagy and IL-17-mediated inflammation. This study elucidated the renoprotective mechanism of DCH through transcriptomics, proteomics, and experimental validation, providing evidence for the therapeutic potential of this agent in the clinical treatment of CI-AKI.

Lymphocyte to c-reactive protein ratio predicts the risk of contrast-induced acute kidney injury in STEMI patients undergoing percutaneous coronary intervention

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is a common complication of percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients. Our aim was to assess the lymphocyte to C-reactive protein ratio (LCR) to predict CI-AKI in patients with acute STEMI.

METHODS

A total of 777 patients with STEMI undergoing primary PCI were continuously included in this study. The occurrence of CI-AKI was monitored during the follow-up period for all patients. Logistic regression analysis was employed to assess the relationship between LCR and CI-AKI. Furthermore, ROC analysis was conducted to establish the optimal LCR cut-off value for the prediction of CI-AKI.

RESULTS

The incidence of CI-AKI after PCI was 12.2% (95/777). Univariate and multivariate analysis showed that LCR was an independent factor for CI-AKI after PCI. ROC curve analysis of LCR showed the optimal cut-off value of LCR identified for predicting CI-AKI was 7875.94, yielding the area under the curve of 0.626 (95% CI: 0.572-0.679; P < 0.001). The integration of the LCR could significantly improve the ability of the model to identify CI-AKI (IDI = 0.016[P < 0.001], and NRI = 0.137[P = 0.006]).

CONCLUSION

LCR is an independent risk factor for CI-AKI in STEMI patients undergoing primary PCI. Integration of LCR can significantly improve the risk model for CI-AKI.

Safety of transarterial chemoembolization on renal function in combined hepatocellular carcinoma and chronic kidney disease patients

This study was to investigate the safety of transarterial chemoembolization (TACE) which required injection of contrast medium on renal function in combined hepatocellular carcinoma and chronic kidney disease (CKD) patients. A total of 265 patients admitted for the first session of TACE were included for analysis. CKD was defined as Cockcroft-Gault glomerular filtration rate (CG-GFR) < 60 mL/min/1.73 m2. The odds ratio (OR) and 95% confident interval (CI) were calculated to show the influence of factors on renal function. Overall, 24.07% patients with CKD and 31.21% patients without CKD showed exacerbated renal function at discharge. However, 73.15% patients with CKD and 63.69% patients without CKD showed significantly improved renal function (all p = 0.00001). No significant difference in influence of TACE on renal function between patients with and without CKD (p = 0.20509). Factors to exacerbate the serum creatinine level at the third day after TACE included proteinuria ≥1+ (OR 2.2469, 95% CI = 1.1559-4.3675) and glycated hemoglobin ≥7% (OR 2.0796, 95% CI = 1.0497-4.1200). These factors could be obliterated by admission for more than 3 days after TACE. Serum albumin level <3 g/dL at admission was the only factor to exacerbate renal function at discharge (OR 4.4179, 95% CI = 1.3964-13.9776). In conclusion, TACE exerted same influence on renal function between patients with and without CKD. Most patients showed improved renal function at discharge. Low serum albumin level, proteinuria and poor diabetes mellitus control were factors to exacerbate renal function after TACE.

Baicalin: a potential therapeutic agent for acute kidney injury and renal fibrosis

Acute kidney injury (AKI) is a common critical clinical disease that is linked to significant morbidity, recurrence, and mortality. It is characterized by a fast and prolonged loss in renal function arising from numerous etiologies and pathogenic pathways. Renal fibrosis, defined as the excessive accumulation of collagen and proliferation of fibroblasts within renal tissues, contributes to the structural damage and functional decline of the kidneys, playing a pivotal role in the advancement of Chronic Kidney Disease (CKD). Until now, while continuous renal replacement therapy (CRRT) has been utilized in the management of severe AKI, there remains a dearth of effective targeted therapies for AKI stemming from diverse etiologies. Similarly, the identification of specific biomarkers and pharmacological targets for the treatment of renal fibrosis remains a challenge. Baicalin, a naturally occurring compound classified within the flavonoid group and commonly found in the Chinese herb Scutellaria baicalensis, has shown a range of pharmacological characteristics, such as antioxidant, anti-inflammatory, antifibrotic, antitumor and antiviral effects, as evidenced by research studies. Research shows that Baicalin has potential in treating kidney diseases like AKI and renal fibrosis. This review aims to summarize Baicalin's progress in these areas, including its molecular mechanism, application in treatment, and absorption, distribution, metabolism, and excretion. Baicalin's therapeutic effects are achieved through various pathways, including antioxidant, anti-inflammatory, antifibrosis, and regulation of apoptosis and cell proliferation. Besides, we also hope this review may give some enlightenment for treating AKI and renal fibrosis in clinical practice.

Prediction of post-contrast acute kidney injury by bedside ultrasonography

BACKGROUND

The incidence of contrast-induced acute kidney injury (CI-AKI) in the general population ranges from 0.6 to 2.3%, whereas for specific high-risk patients, the incidence can reach more than 30-40%. Ultrasound measurements of the development of CI-AKI after contrast-enhanced imaging for diagnosis in the emergency department (ED) have yet to be adequately studied. Accordingly, we aimed to evaluate the usefulness of Doppler ultrasound measurements for predicting CI-AKI in patients with normal renal function.

METHODS

This prospective, observational, single-center study was conducted in the ED of a tertiary teaching and research hospital between 1 January and 1 July 2024. All patients who presented to the tertiary training and research hospital ED, who were admitted to the hospital with a decision to undergo contrast-enhanced tomography for diagnosis, and who did not meet any exclusion criteria were included in the study. Patients included in the study were evaluated by ultrasonographic measurements (interlobar renal artery peak systolic velocity (PSV), interlobar renal artery end-diastolic velocity (EDV), inferior vena cava (IVC) collapsibility index, and renal resistive index (RRI)).

RESULTS

The postcontrast RRI cutoff values were calculated to predict CI-AKI. The area under the curve (AUC) for the postcontrast RRI was 0.914, and the cutoff value for the postcontrast RRI was 0.70 (≥), exhibiting 72.7% sensitivity and 95.6% specificity.

CONCLUSION

Postcontrast RRI ultrasound measurements performed after diagnostic contrast imaging in the ED show high specificity in predicting CI-AKI development. Postcontrast ultrasound measurements may predict CI-AKI development, allowing further measures to be taken. Further studies are needed to confirm these findings.

TRIAL REGISTRATION

Clinical trial number: not applicable.

Risk Score for Predicting Acute Kidney Injury from Contrast-Enhanced Computed Tomography (Pre-Computed Tomography Acute Kidney Injury Score): Training and Validation from Retrospective Cohort

Key Points

There is a well-established score for predicting contrast-associated AKI (CA-AKI) after coronary angiography, but there remains a paucity of data regarding its prediction after contrast-enhanced computed tomography (CT). CA-AKI after contrast-enhanced CT risk factors are male sex, admission setting, hemoglobin <10 g/dl, and eGFR. Pre-CT AKI score, using these factors, predicts CA-AKI risk with an area under the receiver operating characteristic curve of 0.715 and 0.706 for external validation.

Background

The lack of a recognized risk evaluation for contrast-associated AKI (CA-AKI) after contrast-enhanced computed tomography (CECT) makes it challenging to counsel patients before the procedure. This study aims to identify the incidence of CA-AKI after CECT, assess the associated risk factors, and develop and validate a predictive score.

Methods

All adult patients who underwent CECT in 2018–2022 were included in the training cohort, whereas those in 2023 formed the external validation cohort. Exclusions applied to patients with CKD stage 5, recent dialysis, or incomplete data. Multiple logistic regression was used to identify risk factors. The area under the receiver operating characteristic curve was used to evaluate both internal and external validation.

Results

From 21,878 enrolled patients, 6042 and 2463 met the inclusion criteria for the training and validation cohorts with a mean eGFR of 86.0 (26.4) and 81.4 (27.6) ml/min per 1.73 m2, respectively. In the training cohort, 492 patients (8.1%) developed CA-AKI, and 49 (0.8%) required dialysis. Independent risk factors of CA-AKI included male sex, clinical setting, hemoglobin levels of <10 g/dl, and baseline eGFR <90 ml/min per 1.73 m2. The model, using a weighted integer score derived from these factors, exhibited an area under the receiver operating characteristic curve of 0.715 (95% confidence interval, 0.692 to 0.743) in the training cohort and 0.706 (95% confidence interval, 0.663 to 0.748) in the validation cohort.

Conclusions

CECT can lead to CA-AKI in specific populations. The pre-computed tomography AKI risk score for CA-AKI after CECT demonstrated good discriminative power and can be easily applied in clinical practice.

Combination drug therapy prevents CIAKI by suppressing ER stress-induced apoptosis

Contrast-induced acute kidney injury (CIAKI) is an important clinical complication that occurs after the application of contrast agent in percutaneous coronary intervention. The pathogenesis of CIAKI is complex. Studies have shown that cell apoptosis induced by endoplasmic reticulum stress (ERS) plays an important role in renal tubular injury in CIAKI. These findings suggest that atorvastatin, probucol and alprostadil can inhibit renal tubular cell apoptosis to prevent CIAKI. However, there is no specific research on the above effects of drug combinations. Therefore, this study aimed to establish a rat CIAKI model with meglumine diatrizoate and add drug intervention to compare the influence of combined drugs with that of atorvastatin alone on CIAKI via the inhibition of ERS-specific molecular chaperones. Fifty Wistar rats were randomly divided into 5 groups: Group A + CC (atorvastatin group, n = 10); Group PA + CC (probucol + atorvastatin group, n = 10); Group AA + CC (alprostadil + atorvastatin group, n = 10); Group PCC (contrast group, n = 10); and Group NCC (control group, n = 10). Among the five groups, Group PCC presented the significantly highest creatinine increase rate and protein and nucleic acid expression levels, with the most severe cell injury and apoptosis observed via HE and TUNEL staining. Compared with those in the atorvastatin group, the rate of increase in creatinine and protein expression in the combined treatment groups were decreased to some extent, and the histological morphology was also improved. This was especially evident in Group AA + CC. Renal cell apoptosis induced by the ERS pathway may play an important role in the pathogenesis of CIAKI induced by meglumine diatrizoate. Atorvastatin, probucol and alprostadil can prevent the occurrence of CIAKI, and the ERS-induced apoptosis pathway is involved in this mechanism. The protective effect of probucol or alprostadil combined with atorvastatin on CIAKI may be stronger than that of atorvastatin alone, with a greater effect of the combination of alprostadil and atorvastatin.

Use of multiparametric MRI to noninvasively assess iodinated contrast-induced acute kidney injury

PURPOSE

To gauge the utility of multiparametric MRI in characterizing pathologic changes after iodinated contrast-induced acute kidney injury (CI-AKI) in rats.

METHODS

We randomly grouped 24 rats injected with 8 g iodine/kg of body weight (n = 6 each) and 6 rats injected with saline as controls. All rats underwent T1, T2 mapping and diffusion kurtosis imaging (DKI) after contrast injection at 0 (control), 1, 3, 7, 13 days. T1, T2, and mean kurtosis (MK) values were performed in renal outer/inner stripes of outer medulla (OSOM and ISOM) and cortex (CO), and their diagnosis performance for CI-AKI also been evaluated. Serum creatinine (SCr), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor metalloproteinase 2 (TIMP-2), aquaporin-1 (AQP1), α-smooth muscle actin (α-SMA), and histologic indices were examined.

RESULTS

Compared with controls, urinary concentrations of both TIMP-2 and IGFBP7 were obviously elevated from Day 1 to Day 13 (all p < 0.05). T2 values were significantly higher than control group for Days 1 and 3, and T1 and MK increased were more remarkable at all time points (Days 1-13) in CI-AKI (all p < 0.05) than control group. Changes in T1 and MK strongly correlated with renal injury scores of all anatomical compartments and with expression levels of AQP1 and moderately correlated with α-SMA. Changes in T2 values correlating moderately with renal scores of CO, ISOM and OSOM and AQP1. The MK obtained the highest area under the receiver operating characteristic (ROC) curve of 0.846 with a sensitivity of 70.8 % and specificity of 88.9 %.

CONCLUSIONS

Combined use of multiparametric MRI could be a valid noninvasive method for comprehensive monitoring of CI-AKI. Among these parameters, MK may achieve the best diagnostic performance for CI-AKI.

An Evaluation of a Point-of-Care GEM Premier ChemSTAT Analyzer in an Emergency Department: Prevention of Contrast-Induced Nephropathy and Optimization of Patient Flow

Background: Having a laboratory renal profile for medical imaging examinations requiring contrast media (CM) administration is strongly advised. Creatinine helps identify patients at risk of contrast-induced nephropathy (CIN). The GEM® Premier™ ChemSTAT (Werfen) is a point-of-care (POC) analyzer with 12 emergency parameters, including a creatinine assay. This study aims to compare ChemSTAT with the central analytical solution of the University Hospital of Clermont-Ferrand and to evaluate the interest in using POC creatinine in the emergency department (ED) to optimize the flow of patients, especially when CM administration is necessary. Methods: More than 200 whole blood (WB) samples from the ED were evaluated on the ChemSTAT analyzer. As comparative methods, the plasma aliquots from the same samples were assayed on an Atellica® CH (Siemens Healthineers). The clinical concordance was assessed according to the decision cut-offs of the French Society of Radiology for the risk of CIN. The availability times of biological results between ChemSTAT and the central laboratory were studied. Results: WB results from the ChemSTAT analyzer correlated well with those from the Atellica® CH, except for tCO2 (the known bias between the Siemens and Cobas Roche methods for predicting ChemSTAT values). The results of the creatinine assay allow for identical medical decisions in comparison to the renal-risk cut-offs. The availability of the biological results was reduced by 50 min on average with ChemSTAT vs the central laboratory. Computed tomography (CT) was performed for 44.7% of patients, including the injection of the CM in 68% of cases. For these patients, the availability of creatinine results relative to imaging time is faster with the ChemSTAT by an average of 45.2 min. Conclusions: Great analytical and clinical correlations for creatinine assays allow for the safe identification of patients at risk of CIN, and improve patient flow in ED, especially for those requiring computed tomography with CM.

Sodium selenite attenuates inflammatory response and oxidative stress injury by regulating the Nrf2/ARE pathway in contrast-induced acute kidney injury in rats

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is an acute renal complication that occurs after intravascular contrast agent administration. Sodium selenite (SS) is an inorganic source of Se and has potent antioxidant properties. This study intends to examine its anti-inflammatory and antioxidant effects in CI-AKI.

METHODS

A rat CI-AKI model was established with the pretreatment of SS (0.35 mg/kg). Hematoxylin-eosin staining was employed for histopathological analysis of rat kidney specimens. Biochemical analysis was conducted for renal function detection. Tissue levels of oxidative stress-related markers were estimated. Reverse transcription-quantitative polymerase chain reaction revealed the mRNA levels of proinflammatory cytokines. Western blotting showed the Nrf2 signaling-related protein expression in the rat kidney.

RESULTS

SS administration alleviated the renal pathological changes and reduced the serum levels of serum creatinine, blood urea nitrogen, neutrophil gelatinase-associated lipocalin, cystatin C, and urinary level of kidney injury molecule-1 in CI-AKI rats. SS attenuated oxidative stress and inflammatory response in CI-AKI rat kidney tissues. SS activated the Nrf2 signaling transduction in the renal tissues of rats with CI-AKI.

CONCLUSION

SS ameliorates CI-AKI in rats by reducing oxidative stress and inflammation via the Nrf2 signaling.

CUX1 attenuates the apoptosis of renal tubular epithelial cells induced by contrast media through activating the PI3K/AKT signaling pathway

OBJECTIVE

Contrast media (CM) is a commonly applied drug in medical examination and surgery. However, contrast-induced acute kidney injury (CIAKI) poses a severe threat to human life and health. Notably, the CUT-like homeobox 1 (CUX1) gene shows protective effects in a variety of cells. Therefore, the objective of this study was to provide a new target for the treatment of CIAKI through exploring the role and possible molecular mechanism of CUX1 in CIAKI.

METHOD

Blood samples were collected from 20 patients with CIAKI and healthy volunteers. Human kidney 2 (HK-2) cells were incubated with 200 mg/mL iohexol for 6 h to establish a contrast-induced injury model of HK-2 cells. Subsequently, qRT-PCR was used to detect the relative mRNA expression of CUX1; CCK-8 and flow cytometry to assess the proliferation and apoptosis of HK-2 cells; the levels of IL(interleukin)-1β, tumor necrosis factor alpha (TNF-α) and malondialdehyde (MDA) in cells and lactate dehydrogenase (LDH) activity in cell culture supernatant were detect; and western blot to observe the expression levels of CUX1 and the PI3K/AKT signaling pathway related proteins [phosphorylated phosphoinositide 3-kinase (p-PI3K), PI3K, phosphorylated Akt (p-AKT), AKT].

RESULTS

CUX1 expression was significantly downregulated in blood samples of patients with CIAKI and contrast-induced HK-2 cells. Contrast media (CM; iohexol) treatment significantly reduced the proliferation of HK-2 cells, promoted apoptosis, stimulated inflammation and oxidative stress that caused cell damage. CUX1 overexpression alleviated cell damage by significantly improving the proliferation level of HK-2 cells induced by CM, inhibiting cell apoptosis, and reducing the level of LDH in culture supernatant and the expression of IL-1β, TNF-α and MDA in cells. CM treatment significantly inhibited the activity of PI3K/AKT signaling pathway activity. Nevertheless, up-regulating CUX1 could activate the PI3K/AKT signaling pathway activity in HK-2 cells induced by CM.

CONCLUSION

CUX1 promotes cell proliferation, inhibits apoptosis, and reduces inflammation and oxidative stress in CM-induced HK-2 cells to alleviate CM-induced damage. The mechanism of CUX1 may be correlated with activation of the PI3K/AKT signaling pathway.

Early Identification of Sepsis-Induced Acute Kidney Injury by Using Monocyte Distribution Width, Red-Blood-Cell Distribution, and Neutrophil-to-Lymphocyte Ratio

Sepsis-induced acute kidney injury (AKI) is a common complication in patients with severe illness and leads to increased risks of mortality and chronic kidney disease. We investigated the association between monocyte distribution width (MDW), red-blood-cell volume distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), sepsis-related organ-failure assessment (SOFA) score, mean arterial pressure (MAP), and other risk factors and sepsis-induced AKI in patients presenting to the emergency department (ED). This retrospective study, spanning 1 January 2020, to 30 November 2020, was conducted at a university-affiliated teaching hospital. Patients meeting the Sepsis-2 consensus criteria upon presentation to our ED were categorized into sepsis-induced AKI and non-AKI groups. Clinical parameters (i.e., initial SOFA score and MAP) and laboratory markers (i.e., MDW, RDW, and NLR) were measured upon ED admission. A logistic regression model was developed, with sepsis-induced AKI as the dependent variable and laboratory parameters as independent variables. Three multivariable logistic regression models were constructed. In Model 1, MDW, initial SOFA score, and MAP exhibited significant associations with sepsis-induced AKI (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.668-0.789). In Model 2, RDW, initial SOFA score, and MAP were significantly correlated with sepsis-induced AKI (AUC: 0.712, 95% CI: 0.651-0.774). In Model 3, NLR, initial SOFA score, and MAP were significantly correlated with sepsis-induced AKI (AUC: 0.719, 95% CI: 0.658-0.780). Our novel models, integrating MDW, RDW, and NLR with initial SOFA score and MAP, can assist with the identification of sepsis-induced AKI among patients with sepsis presenting to the ED.

Contrast-induced acute kidney injury: a review of definition, pathogenesis, risk factors, prevention and treatment

Contrast-induced acute kidney injury (CI-AKI) has become the third leading cause of hospital-acquired AKI, which seriously threatens the health of patients. To date, the precise pathogenesis of CI-AKI has remained not clear and may be related to the direct cytotoxicity, hypoxia and ischemia of medulla, and oxidative stress caused by iodine contrast medium, which have diverse physicochemical properties, including cytotoxicity, permeability and viscosity. The latest research shows that microRNAs (miRNAs) are also involved in apoptosis, pyroptosis, and autophagy which caused by iodine contrast medium (ICM), which may be implicated in the pathogenesis of CI-AKI. Unfortunately, effective therapy of CI-AKI is very limited at present. Therefore, effective prevention of CI-AKI is of great significance, and several preventive options, including hydration, antagonistic vasoconstriction, and antioxidant drugs, have been developed. Here, we review current knowledge about the features of iodine contrast medium, the definition, pathogenesis, molecular mechanism, risk factors, prevention and treatment of CI-AKI.

Feasibility of contrast-free left atrial appendage closure with WATCHMAN FLX device for patients with chronic kidney disease

Contrast media are generally necessary for transcatheter left atrial appendage closure (LAAC), however, it should be avoided in patients with chronic kidney disease (CKD). The objective of this study was to evaluate the safety and feasibility of contrast-free LAAC with WATCHMAN FLX device for patients with CKD. Among 141 patients undergoing LAAC using the WATCHMAN FLX between May 2021 and March 2023, we performed LAAC without contrast media in 10 patients. Procedural and follow-up results were evaluated. The device size was selected based on the transesophageal echocardiographic (TEE) measurements. The device shape was assessed by fluoroscopy, and the device position was adjusted by TEE images. The mean age was 78 ± 4.9 years, CHADS2 score was 3.2 ± 1.1, and the estimated glomerular filtration rate (eGFR) was 28 ± 12 mL/min/1.73m2. The procedure was completed without contrast media in ten patients. Partial recapture of the device was required in four patients, but the initially selected device was finally implanted in all patients. Mean procedure time was significantly shorter in the contrast-free LAAC than in the contrast-use LAAC (41.6 ± 14.1 min vs 30.3 ± 7.6 min, p = 0.01). Postprocedural eGFR did not change from baseline, and there were no adverse events during the hospital stay. Follow-up TEE or cardiac computed tomography performed within 3 months after the procedure revealed no device-related thrombus or peri-device leak > 3 mm, and oral antithrombotic therapy was discontinued in all patients. Our experience shows that contrast-free LAAC using the WATCHMAN FLX device was safe and feasible. Non-contrast LAAC is one of the therapeutic options for patients with severe CKD.

Significance of Kidney Disease in Cardiovascular Disease Patients

Cardiorenal syndrome is a condition where is a bidirectional and mutually detrimental relationship between the heart and kidneys. The mechanisms underlying cardiorenal syndrome are multifactorial and complex. Patients with kidney disease exhibit increased cardiovascular risk, presenting as coronary and peripheral artery disease, structural heart disease, arrhythmias, heart failure, and sudden cardiac death, largely occurring because of a systemic proinflammatory state, causing myocardial and vascular remodeling, manifesting as atherosclerotic lesions, vascular and valvular calcification, and myocardial fibrosis, particularly among those with advanced disease. This review summarizes the current understanding and clinical implications of kidney disease in patients with cardiovascular disease.

Association between elevated CHA2DS2-VASC score and contrast-induced nephropathy among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

BACKGROUND

Promising results with the CHA2DS2-VASc risk score (CVRS) have been reported for the prediction of contrast-induced nephropathy (CIN). The aim of this study is to consolidate all the data available and examine the association between elevated CVRS and the incidence of CIN in patients undergoing percutaneous coronary intervention (PCI).

METHODS

We systematically searched PubMed, Embase, and Scopus for abstracts and full-text articles from inception to May 2022. Studies were included if they evaluated the association between a high CVRS and the incidence of CIN in patients undergoing PCI. Data were integrated using the random-effects, generic inverse variance method of DerSimonian and Laird. Prospero registration: CRD42022334065.

RESULTS

Seven studies from 2016 to 2021 with a total of 7,401 patients were included. In patients undergoing PCI, a high CVRS (≥2: Odds ratio [OR]:2.98, 95% confidence interval [95% CI] 2.25-3.94, p < .01, I2 = 1%, ≥3: OR 4.46, 95% CI 2.27-8.78, p < .01, I2=56% and ≥4: OR:2.75, 95% CI 1.76-4.30, p < .01, I2 = 11%) was significantly associated with an increase incidence for CIN. Subgroup analyses were done in patients with acute coronary syndrome, and association with CIN remained statistically significant (≥2: OR 2.93, 95% CI 2.11-4.07, p < .01, I2=22%and ≥4: OR:2.24, 95% CI 1.36-3.69, p < .01, I2 = 0%,).

CONCLUSION

In patients undergoing PCI, an elevated CVRS is associated with an increased risk for CIN. More rigorous studies are needed to clarify this association and to identify strategies to reduce CIN.

Effect of iodinated contrast media on peripheral blood mononuclear cells in terms of cell viability, cell cycle and oxidative stress in an in vitro system

Iodine contrast agents are essential for diagnostic purposes in radiology and have significant medical benefits. However, they pose a risk of causing allergic reactions or adverse cellular effects. In this study, we examine the in vitro effects of iodine contrast agents (Iopamiro 370, Ultravist 370, Visipaque 320, and Optiray 350) on cellular functions of human peripheral blood mononuclear. The findings reveal that a concentration of 50 mgI/ml of iodine contrast agents causes a 50% reduction in cell viability, but lower concentrations of 2.5, 5.0, and 10.0 mgI/ml do not affect the cell cycle. Furthermore, the contrast agents decrease oxidative stress levels in cells. In conclusion, this study demonstrates that iodine contrast agents can be used safely in appropriate concentrations for diagnostic purposes without affecting the cell cycle and preventing oxidative stress on normal cells. The insights gained from this study could aid in the development of diagnostic contrast agents in the future of medicine.

Association of N-acetylcysteine use with contrast-induced nephropathy: an umbrella review of meta-analyses of randomized clinical trials

Background

The effectiveness of N-acetylcysteine (NAC) in treating contrast-induced nephropathy (CIN) has been the subject of conflicting meta-analyses, but the strength of the evidence for these correlations between NAC use and CIN has not been measured overall.

Objective

To evaluate the data from randomized clinical studies (RCTs) that examined the relationships between NAC use and CIN in meta-analyses.

Methods

Between the creation of the database and April 2023, searches were made in PubMed, Cochrane Library, EMBASE, and Web of Science. N-acetylcysteine, contrast-induced nephropathy, or contrast-induced renal disease were among the search keywords used, along with terms including systematic review and meta-analysis. The Assessment of Multiple Systematic Reviews, version 2, which assigned grades of extremely low, low, moderate, or high quality to each meta-analysis's scientific quality, was used to evaluate each meta-analysis. The confidence of the evidence in meta-analyses of RCTs was evaluated using the Grading of Recommendation, Assessment, Development and Evaluations method, with evidence being rated as very low, low, moderate, or high.

Results

In total, 493 records were screened; of those, 46 full-text articles were assessed for eligibility, and 12 articles were selected for evidence synthesis as a result of the screening process. Based on the pooled data, which was graded as moderate-quality evidence, it can be concluded that NAC can decrease CIN (OR 0.72, 95% CI 0.65-0.79, p < 0.00001) and blood levels of serum creatinine (MD -0.09, 95% CI -0.17 to -0.01, p = 0.03). In spite of this, there were no associations between NAC and dialysis requirement or mortality in these studies.

Conclusion

The results of this umbrella review supported that the renal results were enhanced by NAC. The association was supported by moderate-quality evidence.

Systematic review registration

[https://clinicaltrials.gov/], identifier [CRD42022367811].

Peripheral Interventional Strategy Assessment (PISA) for Diabetic Foot Ulcer Revascularization: Preliminary Outcomes of a Multidisciplinary Pilot Study

BACKGROUND

Digital subtraction angiography (DSA) still represents the gold standard for anatomical arterial mapping and revascularization decision-making in patients with chronic limb-threatening ischemia (CLTI), although DUS (Doppler Ultrasound) remains a primary non-invasive examination tool. The Global Vascular Guidelines established the importance of preoperative arterial mapping to guarantee an adequate in-line flow to the foot. The aim of this study was to evaluate the accuracy of DUS in guiding therapeutic vascular treatments on the basis of Global Vascular Guidelines without the need of a second-level examination.

METHODS

Between January 2022 and June 2022, all consecutive patients with CLTI to be revascularized underwent clinical examination and DUS without further diagnostic examinations. Primary outcomes assessed were technical success, and 30-day mortality. Secondary outcomes were 1-year amputation free survival, and time between evaluation and revascularization.

RESULTS

Sixty-eight patients with a mean age of 73.6 ± 8.5 years underwent lower limb revascularization. Technical success was 100%, and the 30-day mortality rate was 2.9%. Mean time between evaluation and revascularization was 29 ± 17 days. One-year amputation free survival was 97.1%.

CONCLUSIONS

DUS without further diagnostic examinations can accurately assess the status of the vascular tree and foot runoff, providing enough information about target vessels to guide revascularization strategies.

Predictive model of acute kidney injury after spontaneous intracerebral hemorrhage: A multicenter retrospective study

BACKGROUND AND OBJECTIVES

Acute kidney injury is a common comorbidity in patients with intracerebral hemorrhage. Although there are predictive models to determine risk of AKI in patients in critical care or post-surgical scenarios or in general medical floors, there are no models that specifically determine the risk of AKI in patients with ICH.

METHODS

Clinical features and laboratory tests were selected by previous studies and LASSO (least absolute shrinkage and selection operator) regression. We used multivariable logistic regression with a bidirectional stepwise method to construct ICH-AKIM (intracerebral hemorrhage-associated acute kidney injury model). The accuracy of ICH-AKIM was measured by the area under the receiver operating characteristic curve. The outcome was AKI development during hospitalization, defined as KDIGO (Kidney Disease: Improving Global Outcomes) Guidelines.

RESULTS

From four independent medical centers, a total of 9649 patients with ICH were available. Overall, five clinical features (sex, systolic blood pressure, diabetes, Glasgow coma scale, mannitol infusion) and four laboratory tests at admission (serum creatinine, albumin, uric acid, neutrophils-to-lymphocyte ratio) were predictive factors and were included in the ICH-AKIM construction. The AUC of ICH-AKIM in the derivation, internal validation, and three external validation cohorts were 0.815, 0.816, 0.776, 0.780, and 0.821, respectively. Compared to the univariate forecast and pre-existing AKI models, ICH-AKIM led to significant improvements in discrimination and reclassification for predicting the incidence of AKI in all cohorts. An online interface of ICH-AKIM is freely available for use.

CONCLUSION

ICH-AKIM exhibited good discriminative capabilities for the prediction of AKI after ICH and outperforms existing predictive models.

Different hydration methods for the prevention of contrast-induced nephropathy in patients with elective percutaneous coronary intervention: a retrospective study

BACKGROUND

Hydration is currently the main measure to prevent contrast-induced nephropathy (CIN). We aimed to compare the preventive effect of preprocedure and postprocedure hydration on CIN in patients with coronary heart disease undergoing elective percutaneous coronary intervention (PCI).

METHODS

A retrospective study included 198 cases of postprocedure hydration and 396 cases of preprocedure hydration using propensity score matching. The incidence of CIN 48 h after PCI and adverse events within 30 days after contrast media exposure were compared between the two groups. Logistic regression analysis was used to analyse the risk factors for CIN.

RESULTS

The incidence of CIN in the postprocedure hydration group was 3.54%, while that in the preprocedure hydration group was 4.8%. There was no significant difference between the two groups (p = 0.478). Multivariate logistic regression analysis showed that diabetes mellitus, baseline BNP and cystatin C levels, and contrast agent dosage were independent risk factors for CIN. There was no significant difference in the incidence of major adverse events between the two groups (3.03% vs. 2.02%, p = 0.830).

CONCLUSIONS

Postprocedure hydration is equally effective compared to preoperative hydration in the prevention of CIN in patients with coronary heart disease undergoing elective PCI.

Clinical Considerations for Patients Experiencing Acute Kidney Injury Following Percutaneous Nephrolithotomy

Acute kidney injury (AKI) is a common postoperative outcome in urology patients undergoing surgery for nephrolithiasis. The objective of this study was to determine the prevalence of postoperative AKI and its degrees of severity, identify risk factors, and understand the resultant outcomes of AKI in patients with nephrolithiasis undergoing percutaneous nephrolithotomy (PCNL). A cohort of patients admitted between 2012 and 2019 to a single tertiary-care institution who had undergone PCNL was retrospectively analyzed. Among 417 (n = 326 patients) encounters, 24.9% (n = 104) had AKI. Approximately one-quarter of AKI patients (n = 18) progressed to Stage 2 or higher AKI. Hypertension, peripheral vascular disease, chronic kidney disease, and chronic anemia were significant risk factors of post-PCNL AKI. Corticosteroids and antifungals were associated with increased odds of AKI. Cardiovascular, neurologic complications, sepsis, and prolonged intensive care unit (ICU) stay percentages were higher in AKI patients. Hospital and ICU length of stay was greater in the AKI group. Provided the limited literature regarding postoperative AKI following PCNL, and the detriment that AKI can have on clinical outcomes, it is important to continue studying this topic to better understand how to optimize patient care to address patient- and procedure-specific risk factors.

Impact of atorvastatin reload on the prevention of contrast-induced nephropathy in patients on chronic statin therapy: A prospective randomized trial

BACKGROUND

This trial aimed to assess the efficacy of Atorvastatin reloading on the prevention of Contrast-induced nephropathy (CIN) in patients pre-treated with this statin and undergoing coronary catheterization.

METHODS

This was a prospective randomized controlled study including patients on chronic atorvastatin therapy. We randomly assigned the population to the Atorvastatin Reloading group (AR group), by reloading patients with 80 mg of atorvastatin one day before and three days after the coronary procedure, and the Non-Reloading group (NR group), including patients who received their usual dose without a reloading dose. The primary endpoints were the incidence of cystatin (Cys)-based CIN and Creatinine (Scr)-based CIN. The secondary endpoints consisted of the changes in renal biomarkers (Δ biomarkers) defined as the difference between the follow-up level and the baseline level.

RESULTS

Our population was assigned to the AR group (n = 56 patients) and NR group (n = 54 patients). The baseline characteristics of the 2 groups were similar. Serum creatinine (SCr)-based CIN occurred in 11.1% in the NR group, and in 8.9% in the AR group without any significant difference. Cys-based CIN occurred in 37% in the NR group and 26.8% in the AR group without any significant difference. The subgroup analysis showed that high dose reloading had significantly reduced the CYC-based CIN risk in patients with type 2 diabetes (43.5% vs 18.8%, RR = 0.43. CI 95% [0.18-0.99])). The comparison of "Δ Cystatin" and Δ eGFR between the AR and NR groups didn't show any significant difference. However, cystatin C had significantly increased between baseline and at 24 hours in the NR group (0.96 vs 1.05, p = 0.001), but not in the AR group (0.94 vs 1.03, p = 0.206).

CONCLUSIONS

Our study did not find a benefit of systematic atorvastatin reloading in patients on chronic atorvastatin therapy in preventing CIN. However, it suggested that this strategy could reduce the risk of CyC-based CIN in diabetic type 2 patients.

Repeated Dose of Contrast Media and the Risk of Contrast-Induced Acute Kidney Injury in a Broad Population of Patients Hospitalized in Cardiology Department

Contrast-induced acute kidney injury (CI-AKI) can lead to the development of chronic kidney disease (CKD) and impaired in-hospital and long-term outcomes among cardiac patients. The aim of this study was to evaluate the impact of repeated contrast media (CM) administration during a single hospitalization on the rate of CI-AKI. The study group (n = 138) comprised patients with different diagnoses who received CM more than once during hospitalization, while the control group (n = 153) involved CAD patients subject to a single CM dose. Following propensity score matching (PSM), both groups of n = 84 were evenly matched in terms of major baseline variables. CI-AKI was defined by an absolute increase in SCr ≥ 0.3 mg/dL or >50% relative to the baseline value within 48–72 h from the last CM dose. Patients in the study group were older, had a higher prevalence of diabetes and CKD, received a higher total volume of CM, had a lower left ventricular ejection fraction, lower prevalence of multivessel coronary artery disease (MV-CAD), and a trend towards a lower prevalence of arterial hypertension and smoking. SCr did not differ between the study and control groups at 72 h after the CM use. CI-AKI occurred in 18 patients in the study (13.0%) and in 18 patients (11.8%) in the control group (p = 0.741). The rate of CI-AKI was also comparable following the PSM (13.1% vs. 13.1%, p = 1.0). Logistic regression analysis revealed that CKD, diabetes mellitus, MV-CAD, age, and non-steroidal anti-inflammatory drugs use, but not repeated CM use, were independent predictors of CI-AKI.

Melatonin Treatment in Kidney Diseases

Melatonin is a neurohormone that is mainly secreted by the pineal gland. It coordinates the work of the superior biological clock and consequently affects many processes in the human body. Disorders of the waking and sleeping period result in nervous system imbalance and generate metabolic and endocrine derangements. The purpose of this review is to provide information regarding the potential benefits of melatonin use, particularly in kidney diseases. The impact on the cardiovascular system, diabetes, and homeostasis causes melatonin to be indirectly connected to kidney function and quality of life in people with chronic kidney disease. Moreover, there are numerous reports showing that melatonin plays a role as an antioxidant, free radical scavenger, and cytoprotective agent. This means that the supplementation of melatonin can be helpful in almost every type of kidney injury because inflammation, apoptosis, and oxidative stress occur, regardless of the mechanism. The administration of melatonin has a renoprotective effect and inhibits the progression of complications connected to renal failure. It is very important that exogenous melatonin supplementation is well tolerated and that the number of side effects caused by this type of treatment is low.

A Predictive Model for Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention in Elderly Patients with ST-Segment Elevation Myocardial Infarction

Purpose

Development and validation of a nomogram model to predict the risk of Contrast-Induced Acute Kidney Injury (CI-AKI) after emergency percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI).

Patients and Methods

Retrospective analysis of 542 elderly (≥65 years) STEMI patients undergoing emergency PCI in our hospital from January 2019 to June 2022, with all patients randomized to the training cohort (70%; n=380) and the validation cohort (30%; n=162). Univariate analysis, LASSO regression, and multivariate logistic regression analysis were used to determine independent risk factors for developing CI-AKI in elderly STEMI patients. R software is used to generate a nomogram model. The predictive power of the nomogram model was compared with the Mehran score 2. The area under the ROC curve (AUC), calibration curves, and decision curve analysis (DCA) was used to evaluate the prediction model's discrimination, calibration, and clinical validity, respectively.

Results

The nomogram model consisted of five variables: diabetes mellitus (DM), left ventricular ejection fraction (LVEF), Systemic immune-inflammatory index (SII), N-terminal pro-brain natriuretic peptide (NT-proBNP), and highly sensitive C-reactive protein(hsCRP). In the training cohort, the AUC is 0.84 (95% CI: 0.790-0.890), and in the validation cohort, it is 0.844 (95% CI: 0.762-0.926). The nomogram model has better predictive ability than Mehran score 2. Based on the calibration curves, the predicted and observed values of the nomogram model were in good agreement between the training and validation cohort. Decision curve analysis (DCA) and clinical impact curve showed that the nomogram prediction model has good clinical utility.

Conclusion

The established nomogram model can intuitively and specifically screen high-risk groups with a high degree of discrimination and accuracy and has a specific predictive value for CI-AKI occurrence in elderly STEMI patients after PCI.

A novel contrast-induced acute kidney injury mouse model based on low-osmolar contrast medium

The contrast-induced acute kidney injury (CI-AKI) has been becoming the third common cause of hospital-acquired acute kidney injury. An ideal animal model is essential for understanding the pathophysiology of CI-AKI. Previous CI-AKI studies were mostly performed on rats with high-osmolar contrast medium (HOCM), which is unsuitable for transgenic researches. This study provides a novel, efficient and reproducible CI-AKI model which was developed in mouse by administrating a low-osmolar contrast medium (LOCM). First of all, we applied the frequently used pretreatments (uninephrectomy and water deprivation), which combined with HOCM on rats could induce CI-AKI, on mice with LOCM. Secondly, we attempted to find a novel pretreatment suitable for mouse and LOCM by combining two classic pretreatments(uninephrectomy, water deprivation and furosemide administration). Finally, we evaluate the kidney damage of the novel model. We found that this mouse model possessed a significant reduction in renal function, severe renal tissue damage, and increased renal tubular cells apoptosis, indicating that LOCM is a feasible inducer for CI-AKI mice model. Taken together, we found that uninephrectomy (UPHT) combined with 24 h water deprivation and furosemide administration 20 min before LOCM (iohexol, 10 ml/kg) application is a feasible pretreatment to establish a novel CI-AKI mouse model.

Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

Toxicity resulting from retained contrast media may cause adverse cardiovascular outcomes (e.g., heart failure and cardiogenic shock) for dialysis patients. However, the association between the administered contrast volume and outcomes of dialysis patients after percutaneous coronary intervention (PCI) has not been sufficiently investigated. We evaluated 953 consecutive dialysis patients (age, 67.9 ± 9.9 years; 30.1% with acute coronary syndrome) who underwent PCI between September 2008 and March 2019. Patients were divided into two groups: those with a contrast volume ≥ 200 ml and those with a contrast volume < 200 ml. The cutoff was 200 ml because 100 ml increment of contrast volume is known to raise the risk of acute kidney injury, and 200 ml is more than the average volume used at most PCI centers. The primary endpoint was a composite of in-hospital death, post-PCI cardiogenic shock and post-PCI heart failure. A multivariable logistic regression model and smooth spline curve were constructed to assess the association between contrast volume and the primary endpoint. The median contrast volume was 157 ml (interquartile range, 115-210 ml). The overall primary endpoint incidence was 6.8% (N = 65). A contrast volume ≥ 200 ml was associated with a higher risk of the primary endpoint (odds ratio 2.91; 95% confidence interval 1.42-6.05; P = 0.004). The smooth spline curve demonstrated a linear relationship between the contrast volume and primary endpoint. In conclusions, the contrast volume was associated with adverse in-hospital outcomes of dialysis patients undergoing PCI. Attention should be focused on the contrast volume used for dialysis patients undergoing PCI.

A risk score model of contrast-induced acute kidney injury in patients with emergency percutaneous coronary interventions

Background

The previously built score models of contrast-induced acute kidney injury (CI-AKI) were principally founded on selective percutaneous coronary intervention (PCI) cases. Our study was to form a risk score model of CI-AKI and make a temporal validation in a population who underwent emergency PCIs.

Methods

We included patients who underwent emergency PCIs from 2013 to 2018 and divided them into the derivation and validation cohorts. Logistic regression analysis was harnessed to create the risk model. In this research, we defined CI-AKI as an increase in serum creatinine (SCr) ≥0.5 mg/dL (44.2 μmol/L) above baseline within seven days following exposure to contrast medium.

Results

A total of 3564 patients who underwent emergency PCIs were enrolled and divided into the derivation (2376 cases) and validation cohorts (1188 cases), with CI-AKI incidence of 6.61 and 5.39%, respectively. By logistic analysis, the CI-AKI risk score model was constituted by 8 variables: female (1 point), history of transient ischemic attack (TIA)/stroke (1 point), left ventricular ejection fraction (LVEF) classification (1 point per class), big endothelin-1 (ET-1) classification (1 point per class), estimated glomerular filtration rate (eGFR) classification (1 point per class), intra-aortic balloon pump (IABP) application (1 point), left anterior descending (LAD) stented (1 point), and administration of diuretic (2 points). The patients could be further divided into three groups: low-risk, moderate-risk, and high-risk groups, in accordance with the risk scores of 3–6, 7–10, and ≥11 points, and to the CI-AKI rates of 1.4, 11.9, and 42.6%. The CI-AKI risk score model performed well in discrimination (C statistic = 0.787, 95% CI: 0.731–0.844) and calibration ability, and showed a superior clinical utility.

Conclusion

We developed a simple CI-AKI risk score model which performs well as a tool for CI-AKI prediction in patients who underwent emergency PCIs.

Exploring the effects of edaravone in rats with contrast-induced acute kidney injury

AIMS

Oxidative stress and inflammatory response play a vital role in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). This study investigated the effects of edaravone in rats with CI-AKI.

MAIN METHODS

Male Sprague Dawley rats were randomly assigned into four groups (n = 11-14/group): control, edaravone (30 mg/kg/day intraperitoneally (IP)), CI-AKI, and edaravone with CI-AKI. The induction of CI-AKI was performed by dehydration and the administration of contrast media (iohexol) and inhibitors of prostaglandin (indomethacin) and nitric oxide synthesis (L-NAME: N-nitro L-arginine methyl ester). Edaravone was administered for two weeks before the induction of CI-AKI. Serum creatinine and urea, renal oxidative stress and inflammatory biomarkers, and histopathological alterations were evaluated after 48 h of contrast exposure.

KEY FINDINGS

Rats with CI-AKI showed a significant increase in serum creatinine and urea. The levels of antioxidant biomarkers including glutathione peroxidase, superoxide dismutase and reduced glutathione were significantly decreased in CI-AKI group versus control. Pre-treatment of rats with edaravone normalized kidney function and protected the kidney from oxidative damage as demonstrated by normalization of previous biomarkers. Furthermore, edaravone partially ameliorated renal histopathological alterations relative to the CI-AKI group, notably in the nephrons. No changes were observed in inflammatory biomarkers including tumour necrosis factor-alpha and interleukin-6 among all groups.

SIGNIFICANCE

The current findings suggest that edaravone could be a potential strategy to ameliorate developing CI-AKI possibly by improving renal antioxidant capacity. Further studies are warranted to expand the current understanding of the use of edaravone in the various models of AKI.

When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention

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.

Baicalin Alleviates Contrast-Induced Acute Kidney Injury Through ROS/NLRP3/Caspase-1/GSDMD Pathway-Mediated Proptosis in vitro

Purpose

To investigate the effect of baicalin on the reactive oxygen species (ROS)/ NOD-like receptor protein 3 (NLRP3)/Caspase-1/gasdermin-D (GSDMD) inflammasome pathway and its related mechanism in regulating pyroptosis of human renal tubular epithelial cells (HK-2) induced by contrast media.

Methods

Iohexol was used to act on HK-2 cells to establish a renal tubular cell pyroptosis model; and the signal pathway genes were silenced, cytokines were detected by enzyme-linked immunosorbent assay (ELISA), and cell viability, gene expression, and protein expression were evaluated by double fluorescence staining and flow cytometry. To assess the cytotoxicity caused by the contrast agent; cells were pretreated with different concentrations of baicalin; and then the cells were exposed to iohexol again, and the relevant indicators were tested again.

Results

After HK-2 cells were exposed to iohexol, the NLRP3 inflammasome pathway markers NLRP3, interleukin (IL)-1β, and IL-18 mRNA levels as well as the protein expression levels of NLRP3, ASC, Caspase-1, and GSDMD were up-regulated. In addition, the effect also significantly increased the IL-18, IL-1β, lactate dehydrogenase (LDH), superoxide dismutase (SOD), malondialdehyde (MDA) release, and cellular ROS levels. The results of Annexin V-FITC/PI flow cytometry showed that the level of apoptosis was increased. However, after the intervention of baicalin, the changes in the above indexes caused by iohexol stimulation of HK-2 cells were inhibited.

Conclusion

Exposure to iohexol can induce pyroptosis of HK-2 cells through the ROS/NLRP3/Caspase-1/GSDMD signaling pathway. Baicalin ameliorated iohexol-induced pyroptosis in HK-2 cells by regulating the NLRP3 inflammasome pathway.

Risk factors for and characteristics of community‐ and hospital‐acquired drug‐induced acute kidney injuries

Drugs constitute one of the leading causes of acute kidney injuries (AKIs) and can appear in community (CA‐AKI) or hospital (HA‐AKI) population. The objectives of the present study of a cohort of hospitalized patients with AKI were to describe the characteristics of drug‐induced AKIs and the patients' short‐term outcomes and assess risk factors for drug‐induced AKIs overall, CA‐AKIs, and HA‐AKIs. Based on a cohort of 1557 hospitalized patients suffering from AKIs based on PMSI extraction and chart review (IRA‐PMSI), drug‐induced AKIs were identified by applying the Naranjo adverse drug reaction (ADR) probability scale. Multivariate logistic regression was used to identify factors associated with CA‐AKIs and/or HA‐AKIs. When considering the 1557 patients who experienced an AKI, 445 (28.6%) of the injuries were drug‐induced (180 CA‐AKIs (40.4%) and 265 HA‐AKIs (59.6%)). Antibiotics, diuretics, and contrast agents were significantly more likely to be involved in HA‐AKIs, whereas antineoplastic, lipid‐lowering drugs, antidiabetics, and immunosuppressive were significantly more likely to be involved in CA‐AKIs. Female sex (odds ratio [OR] [95%CI] = 1.3 [1.04–1.67]), chronic kidney disease (CKD) (OR = 1.8 [1.40–2.67]), and a history of ADRs of any type (OR = 1.3 [1.05–1.73]) were significant risk factors for drug‐induced AKIs. CKD was a risk factor for both CA‐AKI and HA‐AKI. In view of the long‐term impact of AKI on the kidneys and the differences between our CA‐AKI and HA‐AKI subgroups, our present results are interesting for optimizing treatments, limiting the occurrence of CA‐ and HA‐AKIs and (ultimately) reducing healthcare costs.

Red blood cell distribution width-to-albumin ratio: a new inflammatory biomarker to predict contrast-induced nephropathy after emergency percutaneous coronary intervention

PURPOSE

Contrast-induced nephropathy (CIN) remains a dreaded complication in the cardiac diagnostic and interventional area. We investigated the relationship between red blood cell distribution width-to-albumin ratio (RAR) and CIN in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI).

METHODS

A total of 1532 elderly patients were enrolled and divided into the CIN group and the non-CIN group. The risk factors of CIN were evaluated by univariate and multivariate regression analysis. Receiver-operating characteristic (ROC) curve analysis was used to identify the best predictive value.

RESULTS

CIN occurred in 129 (8.42%) patients. Patients in the CIN group had significantly higher RAR than those in the non-CIN group (4.69 ± 0.73 vs. 3.18 ± 0.64, P < 0.001). In multivariate regression analysis, RAR was an independent risk factor for the development of CIN (OR: 1.506, 95% CI: 1.227-2.083, P = 0.025), along with age, creatinine, eGFR, hs-CRP and contrast agent dose. The AUC of RAR was 0.755 (95% CI 0.703-0.807), and an optimal cutoff value of 3.64 or higher predicted CIN with a sensitivity of 76.2% and specificity of 65.7%.

CONCLUSION

As a combined inflammatory-related index, RAR was an independent risk factor for the development of CIN in elderly patients with STEMI undergoing emergency PCI. The RAR could be a simple but relatively reliable parameter for identifying high-risk patients.

Dapagliflozin Attenuates Contrast-induced Acute Kidney Injury by Regulating the HIF-1α/HE4/NF-κB Pathway

ABSTRACT

Contrast-induced acute kidney injury (CI-AKI) causes clinically acquired nephropathy in patients who undergo coronary interventions. Hypoxic injury to proximal tubular epithelial cells is a pathological mechanism of CI-AKI. Previous studies have shown that hypoxia activates HIF-1α/HE4/NF-κB to enhance renal fibrosis, and the SGLT-2 inhibitor luseogliflozin inhibits hypoxia-inducible factor (HIF)-1α expression to reduce the progression of diabetic nephropathy. However, the therapeutic effects and mechanisms of SGLT-2 inhibitors on CI-AKI are unclear. We explored the role of the HIF-1α/HE4/NF-κB pathway in CI-AKI and how dapagliflozin effectively treats CI-AKI by inhibiting this pathway. In vitro, cells were divided into the control, hypoxia, hypoxia + dapagliflozin, and hypoxia + pSilencer-HIF-1α groups. Cellular hypoxia, apoptosis, and related protein expression were evaluated by immunofluorescence, western blotting, and flow cytometry, respectively. Dapagliflozin significantly decreased oxygen consumption, HIF-1α, human epididymis protein 4 (HE4), NF-κB expression, and apoptotic cells compared with the control (P < 0.01). In vivo, rats were divided into the control (C), diabetes (D), diabetes + contrast media, and diabetes + contrast media + dapagliflozin groups. Rats in the latter 2 groups were treated with dapagliflozin for 2 days. CI-AKI was induced by intravenously injecting indomethacin, N-nitro-l-arginine methyl ester, and iohexol. The effects of dapagliflozin on CI-AKI rats were elucidated by assessing renal function, H&E staining, and immunohistochemistry. Serum creatinine, urea nitrogen, TUNEL-positive tubular cells, HIF-1α, HE4, NF-κB expression, and histopathological scores were increased in diabetes + contrast media rats compared with C, D, and diabetes + dapagliflozin + contrast media rats (P < 0.01). Thus, dapagliflozin may ameliorate CI-AKI through suppression of HIF-1α/HE4/NF-κB signaling in vitro and in vivo.

Predictivity of acute kidney injury risk scores for late kidney injury in patients with chronic coronary syndrome

Late rather than acute kidney injury after percutaneous coronary intervention (PCI) has been recently recognized as a predictor of future adverse events in patient with coronary artery disease. The risk-predicting models for acute kidney injury reported by Mehran et al., Bartholomew et al., and Tsai et al. were derived from a large cohort and externally validated, although the applicability of these models for predicting late kidney injury is unknown. A total of 327 patients undergoing elective PCI procedures were included. We calculated the three scores and tested their diagnostic ability for predicting late kidney injury (> 6 months after PCI), defined as an increase in creatinine levels ≥ 0.3 mg/dl or ≥ 50% from baseline. During the median follow-up period of 28 months, 27 (8.3%) patients had late kidney injury. All three scores significantly predicted late kidney injury, among which the score by Tsai et al. had a better diagnostic ability (area under the curve 0.83, best cut-off value 14, p < 0.001). With the best cut-off value, patients with Tsai score ≥ 14 had a significantly higher rate of late kidney injury than their counterpart (27.4% vs. 2.8%, p < 0.001). In conclusion, established risk scores for acute kidney injury may be useful for predicting late kidney injury after PCI in patients with chronic coronary syndrome.

The preventive effects of different doses of atorvastatin on contrast-induced acute kidney injury after CT perfusion

Background

Contrast‐induced acute kidney injury (CI‐AKI) is a severe complication among patients receiving intravascular contrast media. The purpose of this study was to investigate the preventive effects of pretreatment of atorvastatin at intensive doses on CI‐AKI after computed tomography (CT) perfusion.

Methods

The levels of serum creatinine (SCR), blood urea nitrogen (BUN), Cystatin C (CysC), estimated glomerular filtration rate (eGFR), high‐sensitivity C‐reactive protein (hs‐CRP), and interleukin‐6 (IL‐6) in patients were compared between the observation group receiving 40 mg/kg atorvastatin and the control group receiving 20 mg/kg atorvastatin before and 72 h after CT examination. In addition, the incidence of CI‐AKI was recorded.

Results

Compared with the control group, the incidence of renal injury in the observation group was significantly reduced, from 8% to 2% (χ² = 6.62, p = 0.010). In addition, there was no notable difference in the levels of Scr, BUN, CysC, hs‐CRP, and IL‐6 before CT examination between two groups (p > 0.05). The levels of SCR, BUN, CysC, hs‐CRP, and IL‐6 were increased, while the levels of eGFR were decreased in the control group at 72 h after CT examination (p < 0.05). At 72 h after CT enhancement, the levels of BUN, CysC, and hs‐CRP were prominently increased in the observation group (p < 0.05), while SCR, eGFR, and IL‐6 did not change (p > 0.05). Compared with the control group, the levels of SCR, BUN, CysC, eGFR, hs‐CRP, and IL‐6 in the observation group were significantly decreased at 72 h after CT examination (p < 0.05).

Conclusion

Intensive dose of atorvastatin pretreatment can prevent CI‐AKI undergoing CT perfusion through lowering inflammation as well as renal function indexes SCR, CysC, BUN, and eGFR.

Computed tomography venography description of the normal anatomy of the canine hindlimb venous system

This study was performed to provide a description of the normal anatomy of the canine hindlimb veins using helical CT images. The studies of 30 dogs that underwent CT venography with a 64-slice helical CT scanner were retrospectively reviewed. The dogs were positioned in a head-first prone or head-first supine body position. A topogram CT scan was performed from the pelvic limbs cranial to the iliac wings to the tips of the paws. Bolus-tracking software was used for the dual-phase angiogram, and contrast medium was administered in a cephalic vein. The venous phase was scanned after a delay time of a few seconds after the arterial phase in a caudocranial direction. Three-dimensional images were generated using maximum intensity projections and volume rendering technique. Representative images of three of the 30 dogs were selected and anatomic structures labelled.

Low-Osmolar vs. Iso-Osmolar Contrast Media on the Risk of Contrast-Induced Acute Kidney Injury: A Propensity Score Matched Study

Objective:

Among the various risk factors associated with contrast-induced acute kidney injury (CI-AKI), the importance of osmolality and viscosity is emerging among the characteristics of contrast media (CM) itself. High osmolality CM (HOCM) is deprecated and low osmotic pressure (LOCM) and iso-osmotic pressure (IOCM) are mainly used in clinical situations where the results of studies on their effect on the development of CI-AKI are contradictory. We evaluated the association between the type of CM and the risk of CI-AKI.

Materials and Methods

A retrospective observational cohort study to analyze the effect of the type of CM on the development of CI-AKI. Using propensity score (PS) matching, 2,263 LOCM and IOCM groups were paired for analysis from 5,267 patients and fulfilled the inclusion criteria among 12,742 patients who underwent CAG between 1 January 2007, and 31 December 2016. LOCM included iopromide and iopamidol, IOCM was iodixanol. CI-AKI, which was the primary endpoint, was defined based on the Kidney Disease Improving Global Outcomes criteria within 48 h after exposure to the CM. A multivariable logistic regression analysis was used in the unmatched and matched cohorts, respectively. In addition, a stratified model on clinically important variables, including a high Mehran score (≥ 6), was also used in the matched cohort.

Results

LOCM users showed an increased incidence of CI-AKI (11.7% vs. 9.3%; p = 0.006), but it lost statistical significance after PS matching (9.9% vs. 9.5%, p = 0.725). In multivariable analyses, the adjusted odds ratio for CI-AKI in the LOCM group were 1.059 [95% confidence interval (CI) = 0.875–1.282; p = 0.555] in unmatched cohort and 0.987 (95% CI = 0.803–1.214; p = 0.901) in matched cohort. These results were also consistent with the high-risk (high Mehran score) group.

Conclusions

Although the role of CM types in the development of CI-AKI has been debated, our observation shows that the selection between LOCM and IOCM during CAG has no influence on the incidence of CI-AKI.

Tolvaptan Improves Contrast-Induced Acute Kidney Injury

OBJECTIVE

Contrast-induced acute kidney injury (CI-AKI) is a serious side effect of contrast media use. The purpose of this study was to investigate the role and mechanism of tolvaptan (TOL) in CI-AKI.

METHODS

24 Wistar male rats were randomly divided into 4 groups (n = 6). And a rat model of CI-AKI was established. Then, the blood and urine of rats in each group were collected to detect relevant parameters. HE staining was utilized for the observation of the pathological changes of rat kidney tissues, TUNEL assay for the detection of tubular cell apoptosis, biochemical detection for the confirmation of oxidative stress level in kidney tissues, and western blot for the test of the expression of apoptotic proteins and the Nrf2 signaling pathway-related proteins in kidney tissues.

RESULTS

TOL could significantly reduce the serum level of urea nitrogen, creatinine, and neutrophil gelatinase-associated lipocalin and decrease serum Cys-C and urine KIM-1 in CI-AKI rats. The result above meant that TOL could improve kidney injury and reduce tubular cell apoptosis in CI-AKI rats. In addition, TOL contributed to a reduction of oxidative stress level by downregulating myeloperoxidase level and increasing the activities of superoxide dismutase and glutathione peroxidase in the kidney tissue of CI-AKI rats. After the pretreatment of TOL, the expression of proapoptotic proteins cleaved-caspase 3 and BAX, as well as mitochondrial fusion proteins DRP1 and MFN2 was downregulated, while the expression of Bcl-2 and PINK1 was upregulated in the kidney tissue of CI-AKI rats. Further, TOL could activate the Nrf2 signaling pathway, and the Nrf2 inhibitor ML385 reversed the effect of TOL on CI-AKI.

CONCLUSION

TOL can improve CI-AKI by activating the Nrf2/HO-1 signaling pathway, inhibiting oxidative stress response, and reducing tubular cell apoptosis.