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Gupta H, Singh MM, Sahani KK, Gupta A, Seth G. Evaluation of Emerging Predictors for Contrast-Induced Nephropathy in High-Risk Patients Undergoing Percutaneous Coronary Intervention. Cureus 2024; 16:e64363. [PMID: 39130830 PMCID: PMC11316681 DOI: 10.7759/cureus.64363] [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: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE The objective of this study is to investigate the occurrence and factors that influence the development of contrast-induced nephropathy (CIN) in high-risk patients undergoing angioplasty and to evaluate the effectiveness of the Mehran risk score in predicting CIN among this patient population. MATERIALS AND METHOD This prospective, observational study enrolled patients undergoing elective coronary angiography or a percutaneous coronary intervention (PCI) procedure. The patients were stratified into four risk groups based on the Mehran risk score, a validated tool for predicting the risk of CIN. Univariate and multivariate analyses were conducted to evaluate the risk factors associated with the development of CIN. A p-value of <0.05 was considered to indicate statistical significance. RESULTS During the study period, a total of 55 high-risk patients underwent PCI. The incidence of CIN was 25.5% (n=14). Univariate and multivariate analyses revealed that age >75 years and estimated glomerular filtration rate (eGFR) <60 (p<0.05) were independently associated with a significantly increased risk of developing CIN. A considerable proportion of patients (23; 41.8%) in the study were categorized as having an intermediate risk for CIN based on the Mehran risk score. CONCLUSION This study observed a high incidence of CIN and encourages the use of predictive tools like the Mehran risk score to assess the risk of CIN occurrence, with age over 70 years and eGFR less than 60 emerging as significant.
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Affiliation(s)
- Himanshu Gupta
- Cardiology, Medanta Heart Institute, Medanta Hospital, Lucknow, IND
| | | | | | - Ayushi Gupta
- Anesthesia, Hind Institute of Medical Sciences, Safedabad, IND
| | - Ganesh Seth
- Cardiology, Medanta Heart Institute, Medanta Hospital, Lucknow, IND
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Kord A, Park SJ, Rao A, Eppurath A, Lipnik A, Ray CE. Postcontrast Acute Kidney Injury After Transarterial Chemoembolization. Semin Intervent Radiol 2021; 38:139-143. [PMID: 33883811 PMCID: PMC8049752 DOI: 10.1055/s-0041-1724016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Simon J. Park
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Amith Rao
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Atul Eppurath
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Andrew Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Charles E. Ray
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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High-Dose Atorvastatin Raises Threshold of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Elective Coronary Intervention: A Randomized Controlled Study. J Interv Cardiol 2021. [DOI: 10.1155/2021/8862316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Contrast-induced nephropathy (CIN) is a significant complication of angiographic procedures resulting from injection of iodinated contrast media (CM). Patients with diabetes mellitus (DM) are at the highest risk of CIN. Statins have recently been proposed for protection against CIN due to their antioxidant and anti-inflammatory properties. Aim of Work. To investigate the potential benefit of acute pretreatment with high-dose atorvastatin (80 mg) in reduction of the incidence of CIN in diabetic patients indicated for elective coronary intervention. Patients and Methods. 200 diabetic patients with indication for coronary intervention were enrolled in the study. 100 patients will be randomly assigned to receive atorvastatin (80 mg) just before coronary intervention (statin group) and 100 patients received placebo (control group). CIN was defined as a rise of serum creatinine of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 hours of the angiography. After the procedure, Thrombolysis in Myocardial Infarction (TIMI) flow of the culprit vessel was reported, as well as the volume of used contrast media and time of X-ray exposure. Results. Our study reported a CIN incidence of 12, 18, and 6% among the whole study, placebo, and statin groups, respectively,
value of 0.001. Among the placebo group, CIN is likely to develop after a 13.5-minute X-ray exposure time with a specificity of 73.2% and sensitivity of 77.8%, area under the curve (AUC) of 0.879 (CI: 0.798–0.960), and
value of 0.001, while in the statin group, CIN is likely to develop after 14.5-minute X-ray exposure time with a specificity of 74.5% and sensitivity of 83.3%, AUC of 0.818 (CI: 0.727–0.910), and P value of 0.009. In the placebo group, CIN is likely to develop after injection of 145 ml of contrast media with a specificity of 75.6% and sensitivity of 77.8%, AUC of 0.855 (CI: 0.757–0.952), and
value of 0.001, while in the statin group, CIN is likely to develop after injection of 165 ml of contrast media with a specificity of 84% and sensitivity of 83.3%, AUC of 0.878 (CI: 0.811–0.944), and
value of 0.002. Conclusions. Acute pretreatment with high-dose atorvastatin can effectively protect against CIN and was associated with a marked decrease in the prevalence of CIN in diabetic patients undergoing coronary interventions. Moreover, pretreatment with high-dose atorvastatin raises the threshold of X-ray exposure time and the amount of contrast media beyond which CIN is likely to develop. The trial is registered with NCT04375787.
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Faucon AL, Bobrie G, Clément O. Nephrotoxicity of iodinated contrast media: From pathophysiology to prevention strategies. Eur J Radiol 2019; 116:231-241. [DOI: 10.1016/j.ejrad.2019.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
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Hirzallah H, Amro A, Kusmic D, Curtis Z, Leigh EC, Numan Y, Parsons J, Amro M, Akpanudo S, Sayyed R, Elhamdani M. Comparison of Transradial and Transfemoral Approaches for Coronary Angiography and Percutaneous Intervention in Patients with Coronary Bypass Grafts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:2-5. [PMID: 30885499 DOI: 10.1016/j.carrev.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/15/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to compare the transradial and transfemoral approaches for coronary angiography and percutaneous intervention in patients with coronary artery bypass grafts in terms of volume of radiographic contrast administered during cardiac catheterization, fluoroscopy time, and total procedure time. BACKGROUND The transradial access has been increasingly used as an alternative to transfemoral. Several studies demonstrated that such access is associated with lower rates of vascular and bleeding complications. Although coronary artery bypass graft patients comprise a significant portion of the coronary artery disease population, this subpopulation was often excluded or underrepresented in transradial access studies. METHODS Single center, retrospective cohort study. In the study period, all patients who had previously undergone coronary artery bypass graft surgery and had received cardiac catheterization at our institution were included in the study population. RESULTS A total of 2153 patients were included in the study. From these, 1937 were performed by femoral artery and 216 by transradial approach. Compared to the transfemoral approach, transradial access was associated with lower contrast use (136.3 ± 74.4 ml vs. 122.8 ± 59.1 ml, p = 0.035) and longer fluoroscopy time (13.9 ± 25.6 min vs. 15.9 ± 14.3 min, p < 0.001). CONCLUSION Diagnostic and interventional catheterization through the transradial approach in patients with previous coronary artery bypass graft surgery was associated with less contrast amount used and longer fluoroscopy time compared to the transfemoral approach. The transradial approach was also associated with lower crossover rates and less vascular complications.
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Affiliation(s)
- Hisham Hirzallah
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America.
| | - Ahmed Amro
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
| | - Damir Kusmic
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Zachary Curtis
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Emilia C Leigh
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Yazan Numan
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Julia Parsons
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | | | - Sutoidem Akpanudo
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Rameez Sayyed
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
| | - Mehiar Elhamdani
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
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Zhang J, Guo Y, Jin Q, Bian L, Lin P. Meta-analysis of rosuvastatin efficacy in prevention of contrast-induced acute kidney injury. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3685-3690. [PMID: 30464400 PMCID: PMC6216974 DOI: 10.2147/dddt.s178020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Contrast-induced nephropathy (CIN) is a complication after the intravascular administration of a contrast medium injection. Previous studies have investigated statins as therapy for CIN due to its positive results in the prevention of contrast-induced acute kidney injury (CI-AKI). Nevertheless, the beneficial effects of rosuvastatin pretreatment in preventing CIN in patients with acute coronary syndromes still remain controversial. In this study, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the beneficial impact of rosuvastatin in the prevention of CI-AKI in acute coronary syndrome patients. Methods PubMed, Embase, and Cochrane library were searched, for RCTs, updated on January 2018. The method was to evaluate rosuvastatin prior to angiography for the prevention of CI-AKI in patients undergoing coronary angiography, of which the main outcome was the incidence of CIN. Results A total of five RCTs were included in this analysis. Patients treated with rosuvastatin prior to invasive angiography had a significantly lower incidence of CI-AKI than controls (odds ratio [OR]: 0.53, 95% CI: 0.40–0.71, P<0.0001). Moreover, the subgroup analysis also showed that the benefit of rosuvastatin for patients with chronic kidney disease (OR: 0.49, 95% CI: 0.26–0.92, P=0.03) and diabetes mellitus (OR: 0.56, 95% CI: 0.38–0.83, P=0.004) which was consistent in compared with the respective control groups. Conclusion The findings of this meta-analysis suggest that the preoperative rosuvastatin treatment significantly reduces the risk of renal insufficiency of CIN in at-risk patients with chronic kidney disease or diabetes mellitus. Additional studies are needed to identify at-risk patients, provide optimum dose peri-procedural treatment, and reduce the incidence of CIN.
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Affiliation(s)
- Jing Zhang
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, People's Republic of China
| | - Ying Guo
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, People's Republic of China
| | - Qi Jin
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, People's Republic of China
| | - Li Bian
- Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, People's Republic of China,
| | - Ping Lin
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China,
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A New and Simple Risk Predictor of Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention: TIMI Risk Index. Cardiol Res Pract 2018; 2018:5908215. [PMID: 30356419 PMCID: PMC6178187 DOI: 10.1155/2018/5908215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background The thrombolysis in myocardial infarction risk index (TRI) was developed to estimate prognosis at the initial contact of the healthcare provider in coronary artery disease patients without laboratory parameters. In this study, we aimed to investigate the relationship of the baseline TRI and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI). Methods A total of 963 consecutive STEMI diagnosed patients who underwent primary percutaneous intervention were included in the study. TRI was calculated using the formula “heart rate × (age/10) 2/SBP” on admission. CIN was defined as an increase in serum creatinine concentration ≥25%, 48 hours later over the baseline. Results Of the total of 963 patients, CIN was observed in 13% (n=128). TRI was significantly higher in the CIN (+) group compared with the CIN (−) group (32.9 ± 18.8 vs 19.9 ± 9.9, P < 0.001). There was a stronger correlation between CIN and age, diastolic blood pressure, heart rate, Killip class, left ventricular ejection fraction, amount of contrast media, and diabetes mellitus. The amount of contrast media (OR 1.010, 95% CI 1.007–1.012, P < 0.001) and TRI (OR 1.047, 95% CI 1.020–1.075, P=001) were independent predictors of CIN. The best threshold TRI for predicting CIN was ≥25.8, with a 67.1% sensitivity and 80.4% specificity (area under the curve (AUC): 0.740, 95% CI: 0.711–0.768, P < 0.001). Conclusion TRI is an independent predictor of CIN, and it may be used as a simple and reliable risk assessment of CIN in STEMI patients without the need for laboratory parameters.
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Firouzi A, Kazem Moussavi A, Mohebbi A, Alemzadeh-Ansari MJ, Kiani R, Sanati HR, Mohebbi B, Shakerian F, Zahedmehr A, Ansari-Ramandi MM, Oni Heris S, Ghaleshi B, Ghorbani F. Comparison between rosuvastatin and atorvastatin for the prevention of contrast-induced nephropathy in patients with STEMI undergoing primary percutaneous coronary intervention. J Cardiovasc Thorac Res 2018; 10:149-152. [PMID: 30386535 PMCID: PMC6203872 DOI: 10.15171/jcvtr.2018.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: There is some controversy over the efficacy of statins for the prevention of contrastinduced
nephropathy (CIN). There have also been reports on varying efficacies of different
statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of
CIN was assessed.
Methods: This single-blind randomized clinical trial was performed on 495 random patients with
myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary
intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to
receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and
daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI.
Results: The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary
PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There
was no significant difference between rosuvastatin group compared with atorvastatin group,
regarding the CIN grading (P = 0.14).
Conclusion: Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the
prevention of CIN.
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Affiliation(s)
- Ata Firouzi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kazem Moussavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mohebbi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Reza Kiani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Sanati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Shakerian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zahedmehr
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Oni Heris
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahar Ghaleshi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghorbani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Liu LY, Liu Y, Wu MY, Sun YY, Ma FZ. Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018. [PMID: 29535505 PMCID: PMC5840281 DOI: 10.2147/dddt.s149106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Results of studies on the efficacy of atorvastatin pretreatment on reducing the prevalence of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) have been controversial. Objective We undertook a meta-analysis to evaluate the efficacy of atorvastatin on contrast-induced nephropathy (CIN) after CAG or PCI. Materials and methods We undertook a systematic search of electronic databases (PubMed, Embase, and the Cochrane Library) up to June 2017. A meta-analysis was carried out including randomized controlled trials (RCTs) that compared atorvastatin pretreatment with pretreatment with a low-dose statin or placebo for CIAKI prevention in patients undergoing CAG. The main endpoint was CIN prevalence. Results Nine RCTs were included in our meta-analysis. Atorvastatin pretreatment reduced the prevalence of CIN significantly (odds ratio [OR] 0.46; 95% confidence interval [95% CI] 0.27–0.79; p=0.004). The benefit of high-dose atorvastatin pretreatment was consistent when compared with the control group (OR 0.45; 95% CI 0.21–0.95; p=0.04). Conclusion At high doses, atorvastatin pretreatment was associated with a significant reduction in the prevalence of CIAKI in patients undergoing CAG. Pretreatment with high-dose atorvastatin could be employed to prevent CIAKI.
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Affiliation(s)
| | - Yang Liu
- Department of Nephrology, the First Hospital of Jilin University
| | - Mei-Yan Wu
- Department of Nephrology, the First Hospital of Jilin University
| | - Yan-Yan Sun
- Department of Nephrology, the Fourth Hospital of Jilin University, Changchun, China
| | - Fu-Zhe Ma
- Department of Nephrology, the First Hospital of Jilin University
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Mamoulakis C, Tsarouhas K, Fragkiadoulaki I, Heretis I, Wilks MF, Spandidos DA, Tsitsimpikou C, Tsatsakis A. Contrast-induced nephropathy: Basic concepts, pathophysiological implications and prevention strategies. Pharmacol Ther 2017. [PMID: 28642116 DOI: 10.1016/j.pharmthera.2017.06.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is reversible acute renal failure observed following administration of iodinated contrast media (CM) during angiographic or other medical procedures such as urography. There are various mechanisms through which CM develop their nephrotoxic effects, including oxidative stress and apoptosis. CIN is a real-life, albeit not very rare, entity. Exact pathophysiology remains obscure and no standard diagnostic criteria apply. The Acute Kidney Injury Network criteria was recently employed but its incidence/clinical significance warrants further clarification based on recent methodological advancements, because most published studies to date were contaminated by bias. The current study is a comprehensive review conducted to provide an overview of the basic concepts of CIN and summarize recent knowledge on its pathophysiology and the evidence supporting potential prevention strategies. CIN is expected to increase morbidity, hospital stay and mortality, while all patients scheduled to receive CM should undergo risk assessment for CIN and high-risk patients may be considered candidates for prevention strategies. The value of using compounds with antioxidant properties other than sodium bicarbonate, remains controversial, warranting further clinical investigation.
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Affiliation(s)
- Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
| | | | - Irini Fragkiadoulaki
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
| | - Ioannis Heretis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Martin F Wilks
- Swiss Centre for Applied Human Toxicology, University of Basel, CH-4055 Basel, Switzerland
| | - Demetrios A Spandidos
- Department of Virology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christina Tsitsimpikou
- Department of Hazardous Substances, Mixtures and Articles, General Chemical State Laboratory of Greece, Ampelokipi, Athens, Greece
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
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Zhang JZ, Kang XJ, Gao Y, Zheng YY, Wu TT, Li L, Liu F, Yang YN, Li XM, Ma YT, Xie X. Efficacy of alprostadil for preventing of contrast-induced nephropathy: A meta-analysis. Sci Rep 2017; 7:1045. [PMID: 28432310 PMCID: PMC5430773 DOI: 10.1038/s41598-017-01160-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/27/2017] [Indexed: 12/20/2022] Open
Abstract
Contrast-induced nephropathy (CIN) has become the third-leading cause of hospital-acquired acute renal injury. Although alprostadil has been proposed as an effective preventative measure, this conclusion remains inconsistent. Thus, we performed a meta-analysis of the published studies on this topic to evaluate the preventative effect of alprostadil on CIN. Databases, including PubMed, the Web of Science, Cochrane Library, Wanfang, the China Biological Medicine Database (SinoMed) and the China National Knowledge Infrastructure (CNKI) were systematically searched. Nineteen clinical trials involving 2267 individuals were identified. We utilized a random or a fixed effect model to calculate the pooled odd ratios (ORs) and the standardized mean differences (SMD), respectively. Compared to the control group, the CIN risk decreased significantly in the alprostadil group (P < 0.00001, OR = 0.29, 95% CI = 0.21-0.39). In the subgroup of coronary angiography patients, the use of alprostadil also decreased the risk of CIN (P < 0.00001, OR = 0.27, 95% CI: 0.19-0.39). In conclusion, Alprostadil might be associated with a significant reduction in postcontrast Scr, BUN and CysC level and decrease the incidence of CIN.
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Affiliation(s)
- Jing-Zhan Zhang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, P.R. China
| | - Xiao-Jing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, P.R. China
| | - Ying Gao
- Department of Cadre ward, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Long Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Fen Liu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Yi-Ning Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Xiao-Mei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R. China.
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13
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Paraskevas KI, Mikhailidis DP. Contrast-Induced Acute Kidney Injury in Patients Undergoing Carotid Artery Stenting: An Underestimated Issue. Angiology 2016; 68:752-756. [PMID: 27645233 DOI: 10.1177/0003319716668934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Carotid artery stenting (CAS) is increasingly offered to patients with carotid artery stenosis. Although CAS is a less invasive (and thus more attractive) alternative compared with carotid endarterectomy, it requires the use of contrast material. A possible side effect from the use of contrast material during CAS is the development of contrast-induced acute kidney injury (CI-AKI). This review discusses the incidence/prevalence and clinical significance of CI-AKI developing after CAS. We also discuss possible measures to reduce the incidence of CI-AKI after CAS.
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Affiliation(s)
- Kosmas I Paraskevas
- 1 Northern Vascular Center, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Dimitri P Mikhailidis
- 2 Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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14
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Li H, Wang C, Liu C, Li R, Zou M, Cheng G. Efficacy of Short-Term Statin Treatment for the Prevention of Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography/Percutaneous Coronary Intervention: A Meta-Analysis of 21 Randomized Controlled Trials. Am J Cardiovasc Drugs 2016; 16:201-19. [PMID: 26899537 DOI: 10.1007/s40256-016-0164-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The results of previous studies have been contradictory in terms of the efficacy of statin treatment in preventing contrast-induced acute kidney injury (CI-AKI) and clinical adverse events (AEs). OBJECTIVE This meta-analysis was undertaken to assess the role of short-term statin treatment in the prevention of CI-AKI and clinical AEs. METHODS We searched the Cochrane Library, EMBASE, and PubMed databases for randomized controlled trials (RCTs) with the development of CI-AKI as a primary outcome. Secondary outcomes were the post-procedural serum creatinine (SCr) level, estimated glomerular filtration rate (eGFR), and development of AEs. We also performed prespecified subgroup analyses. RESULTS A total of 21 RCTs involving 7746 patients were included. Short-term statin treatment significantly reduced the risk of CI-AKI [risk ratio (RR) 0.57; 95 % confident interval (CI) 0.47-0.69; p < 0.00001) and was associated with a lower post-procedural SCr level and a higher eGFR. High-dose statins resulted in a lower incidence of CI-AKI than the lower-dose statins. In addition, the benefit was seen across various subgroups for patients at risk of CI-AKI, statin-naïve patients, and East Asians, regardless of statin type, definition of CI-AKI, use of N-acetylcysteine (NAC) and hydration, and osmolality of contrast. However, there was no significant difference between the two groups in terms of the incidence of AEs. CONCLUSIONS The meta-analysis suggests that short-term statin treatment can effectively prevent CI-AKI, and the benefit is also observed in high-risk patients, statin-naïve patients, and an East Asian population. However, the effect of simvastatin for the prevention of CI-AKI, of statins for the prevention of AEs, and whether high-dose statins have a better effect than lower-dose statins are all still uncertain.
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Affiliation(s)
- Haixia Li
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, Liaoning, China
| | - Cailian Wang
- Department of Cardiology, General Hospital of Shenyang Military Area, Shenhe District, Shenyang, Liaoning, China
| | - Chuanzhi Liu
- Department of Nephrology, General Hospital of Shenyang Military Area, Shenhe District, Shenyang, Liaoning, China
| | - Ruifei Li
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, Liaoning, China
| | - Meijuan Zou
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, Liaoning, China
| | - Gang Cheng
- Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, Liaoning, China.
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Abstract
OBJECTIVE The effect of statins in preventing contrast-induced nephropathy (CIN) has been reported, with conflicting results. The aim of this study was to carry out an updated meta-analysis to determine whether pretreatment with statins can reduce the risk of CIN and adverse clinical events. MATERIALS AND METHODS Systematic database searches of MEDLINE (1950 to December 2013), EMBASE (1966 to December 2013), and the Cochrane Central Register of Controlled Trials (Issue 12, December 2013) were performed. All randomized controlled trials assessing the efficacy of statins on CIN were included. RESULTS Seventeen studies with 6323 patients were included. Pretreatment with statins before angiography significantly reduced the risk of CIN [relative risk 0.50; 95% confidence interval (CI) 0.35-0.71; P<0.001] and was associated with significantly lower postprocedural serum creatinine levels (weighted mean difference -0.05 mg/dl; 95% CI -0.09 to -0.02 mg/dl; P=0.005). Meanwhile, the use of statins resulted in trends of reduced risks of renal replacement therapy and all-cause death within 30 days (relative risk 0.44; 95% CI 0.18-1.08; P=0.07). Further analyses indicated that high-dose statins were more effective than low-dose statins in reducing the risk of CIN and that different types of statins showed similar effects in preventing CIN. CONCLUSION Pretreatment with statins before angiography is effective in preventing CIN and may reduce the risk of adverse clinical events. However, the optimal dose and duration for statin pretreatment are still unknown.
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Galal H, Nammas W, Samir A. Impact of high dose versus low dose atorvastatin on contrast induced nephropathy in diabetic patients with acute coronary syndrome undergoing early percutaneous coronary intervention. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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17
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Barbieri L, Verdoia M, Schaffer A, Nardin M, Marino P, De Luca G. The role of statins in the prevention of contrast induced nephropathy: a meta-analysis of 8 randomized trials. J Thromb Thrombolysis 2015; 38:493-502. [PMID: 24705677 DOI: 10.1007/s11239-014-1076-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Contrast induced nephropathy (CIN) is a common complication of coronary angiography/angioplasty. Prevention is the key to reduce the incidence of CIN and it begins with appropriate pre-procedural management. Statins have been shown to possess pleiotropic effects (anti-oxidant, anti-inflammatory and anti-thrombotic properties) and their effects on CIN were assessed in several studies with conflicting results. Aim of this meta-analysis is to evaluate the efficacy of short-term statins for the prevention of CIN in patients undergoing coronary angiography/percutaneous interventions. We performed formal searches of PubMed, EMBASE, Cochrane central register of controlled trials and major international scientific session abstracts from January 1990 to January 2014 of trials which compares short-term statins versus Placebo for the prevention of CIN in patients undergoing coronary angiography/angioplasty. Data regarding study design, statin dose, inclusion/exclusion criteria, number of patients, and clinical outcome was extracted by 2 investigators. Eight trials were included, with a total of 4734 patients. CIN occurred in 79/2,358 patients (3.3%) treated with statins versus 153/2,376 patients (6.4%) of the placebo group [OR 95% CI 0.50 (0.38-0.66), p < 0.00001; p het = 0.39]. Benefits were both observed with high-dose short-term statins [OR 95% CI 0.44 (0.30-0.65), p < 0.0001; p het = 0.16] and low-dose statins, [OR 95% CI 0.58 (0.39-0.88), p = 0.010; p het = 0.90]. By meta-regression analysis, no significant relationship was observed between benefits from statin therapy and patient's risk profile (p = 0.26), LDL cholesterol (p = 0.4), contrast volume (p = 0.94) or diabetes rate (p = 0.38). This meta-analysis showed that among patients undergoing coronary angiography/percutaneous intervention the use of short-term statins reduces the incidence of CIN, and therefore is highly recommended even in patients with low LDL-cholesterol levels.
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Affiliation(s)
- Lucia Barbieri
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Corso Mazzini, 18, 28100, Novara, Italy
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18
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Abaci O, Arat Ozkan A, Kocas C, Cetinkal G, Sukru Karaca O, Baydar O, Kaya A, Gurmen T. Impact of Rosuvastatin on contrast-induced acute kidney injury in patients at high risk for nephropathy undergoing elective angiography. Am J Cardiol 2015; 115:867-71. [PMID: 25670636 DOI: 10.1016/j.amjcard.2015.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 11/27/2022]
Abstract
Although statins have been shown to prevent contrast-induced acute kidney injury in patients with acute coronary syndromes, the benefit of statins is not known for patients at high risk for nephropathy who undergo elective coronary angiography. Two hundred twenty consecutive statin-naive patients with chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) who underwent elective coronary or peripheral angiography were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; n = 110) or no statin treatment (control group, n = 110). Contrast-induced acute kidney injury was defined by an absolute increase in serum creatinine of ≥0.5 mg/dl or a relative increase of ≥25% measured 48 or 72 hours after the procedure. Contrast-induced acute kidney injury occurred in 15 patients (7.2%), 9 (8.5%) in the control group and 6 (5.8%) in the rosuvastatin group (p = 0.44). The incidences of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) were similar between the two groups at follow-up. In conclusion, rosuvastatin did not reduce the risk for contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients who underwent coronary and peripheral vascular angiography.
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Affiliation(s)
- Okay Abaci
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey.
| | - Alev Arat Ozkan
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Cuneyt Kocas
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Gokhan Cetinkal
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Osman Sukru Karaca
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Onur Baydar
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Aysem Kaya
- Department of Biochemistry, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Tevfik Gurmen
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
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Chyou AC, Thodge A, Feldman DN, Swaminathan RV. Statins in the prevention of contrast-induced nephropathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:375. [PMID: 25778426 DOI: 10.1007/s11936-015-0375-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Coronary angiography and percutaneous coronary interventions are common procedures that utilize iodinated contrast medium to visualize the coronary arterial tree and treat stable and unstable ischemic heart syndromes. Exposure to contrast agents can cause acute and persistent worsening of renal function leading to increased morbidity and mortality. Certain patient characteristics such as age, presence of diabetes, congestive heart failure, chronic kidney disease, hemodynamic instability on presentation, and type and volume of contrast used can increase the risk of developing contrast-induced nephropathy (CIN) and its subsequent complications. Despite the lack of a universal definition, CIN is typically defined as an increase in serum creatinine ≥0.5 mg/dL or 25 % above baseline 48 to 72 h after contrast exposure. Previous research has shown the benefits of adequate intravenous hydration with iso-osmolar crystalloids and the importance of limiting the amount of low-osmolar and iso-osmolar contrast used to prevent the development of CIN. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have anti-inflammatory and anti-apoptotic properties with few side effects, making it an attractive therapeutic option for prevention of CIN. A number of trials have examined the benefit of different types of statins, high-dose versus low-dose statins, loading versus chronic dosing of statins, in various clinical presentations including acute coronary syndromes and elective procedures, and in those with associated comorbidities such as anemia and chronic kidney disease. In this review, we will summarize recent data regarding statin therapy for prevention of contrast-induced nephropathy.
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Affiliation(s)
- Anthony C Chyou
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
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20
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Jo SH, Hahn JY, Lee SY, Kim HJ, Song YB, Choi JH, Choi SH, Lee SH, Gwon HC. High-dose atorvastatin for preventing contrast-induced nephropathy in primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2015; 16:213-9. [DOI: 10.2459/jcm.0000000000000157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Deng J, Wu G, Yang C, Li Y, Jing Q, Han Y. Rosuvastatin attenuates contrast-induced nephropathy through modulation of nitric oxide, inflammatory responses, oxidative stress and apoptosis in diabetic male rats. J Transl Med 2015; 13:53. [PMID: 25880311 PMCID: PMC4329210 DOI: 10.1186/s12967-015-0416-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. We observe the effect of rosuvastatin on preventing CIN in diabetic rats in current study. Methods Diabetic rats were then divided into five groups: 1 diabetic rats (D), 2 diabetic rats + contrast media (DCM), 3 diabetic rats + rosuvastatin (DR), 4 diabetic rats + contrast media + rosuvastatin (DRCM), 5 non-diabetic rat control (NDCM). Contrast-induced nephropathy was induced by intravenous injection a single dose of indomethacin (10 mg/kg), double doses of N-nitro-L-arginine methyl ester (10 mg/kg) and a single dose of high-osmolar contrast medium meglumine amidotrizoate (6 ml/kg). DR and DRCM group rats were treated with rosuvastatin (10 mg/kg/day) by gavage for 5 days. At the end of treatment, the experimental groups were sacrificed, and their renal tissues were investigated histopathologically beside assessments of functional activities, nitric oxide metabolites, and oxidative stress and apoptic markers. Results After 6 days, serum creatinine and urine microprotein were increased, and creatinine clearance, kidney nitrite were decreased in DCM rats compared with NDCM, D, DR and DRCM groups. Histopathology scores in group DCM were increased compared with groups NDCM, D and DR, but lower in group DRCM than in group DCM (p < 0.01). Kidney thiobarbituric acid-reacting substances (TBARS), serum malondialdehyde (MDA), and serum protein carbonyl content (PCC) were increased, and serum thiol was decreased in the DCM group compared with groups NDCM, D and DR; however, these results were reversed in group DRCM compared with group DCM. Both expression of IL-6, TNF-α and the percentage of apoptotic cells were increased in group DCM than in groups NDCM, D and DR, but they were decreased in group DRCM than in group DCM. The expression of phospho-p38, cleaved capase-3, and the Bax/Bcl-2 ratio, were increased in group DCM than in groups NDCM, D and DR, but were decreased in group DRCM than in group DCM. Conclusions Our study demonstrated that rosuvastatin treatment attenuated both inflammatory processes and apoptosis and inhibited oxidative stress and the p38 MAPK pathway in a diabetic rat model in the setting of CIN.
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Affiliation(s)
- Jie Deng
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Guijun Wu
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Chen Yang
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Yi Li
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Quanmin Jing
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
| | - Yaling Han
- Department of Cardiology, the General Hospital of Shenyang Military Region, Chinese People's Liberation Army, Shenyang, Liaoing, China.
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Lee JM, Park J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Jo SH, Kim HS. Efficacy of short-term high-dose statin pretreatment in prevention of contrast-induced acute kidney injury: updated study-level meta-analysis of 13 randomized controlled trials. PLoS One 2014; 9:e111397. [PMID: 25369120 PMCID: PMC4219719 DOI: 10.1371/journal.pone.0111397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI. METHODS AND RESULTS Randomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2-5 days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35-0.57, p<0.001, I(2)= 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34-0.65, p<0.001, I(2) = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21-0.58, p<0.001, I(2)= 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥ 60 years), regardless of osmolality of contrast or administration of N-acetylcystein. CONCLUSIONS High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ki-Hyun Jeon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ji-hyun Jung
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University, Boramae Medical Center, Seoul, Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Ukaigwe A, Karmacharya P, Mahmood M, Pathak R, Aryal MR, Jalota L, Donato AA. Meta-analysis on efficacy of statins for prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography. Am J Cardiol 2014; 114:1295-302. [PMID: 25239829 DOI: 10.1016/j.amjcard.2014.07.059] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022]
Abstract
Contrast-induced acute kidney injury (CIAKI) is a leading cause of hospital-acquired acute kidney injury, and pretreatment with hydroxymethylglutaryl CoA reductase inhibitors (statins) have shown promise in prevention. A systematic review and meta-analysis was performed including randomized controlled trials of short-term high-dose statins (compared with either low-dose statin or placebo) for CIAKI prevention in patients undergoing coronary angiography. Study-specific odds ratios (ORs) were calculated, and between-study heterogeneity was assessed using the I(2) statistic. We used a random-effects model meta-analysis to pool the OR. Twelve RCTs, including 5,564 patients, were included. CIAKI occurred in 94 of 2,769 patients (3.4%) pretreated with high-dose statins and 213 of 2,795 patients (7.6%) in the low-dose or no-statin group (OR 0.43, 95% confidence interval [CI] 0.33 to 0.55, I(2) = 19%, p <0.001). Subgroup analysis showed that the occurrence of CIAKI did not differ in patients with diabetes (OR 0.60, 95% CI 0.43 to 0.85, I(2) = 0%, p = 0.004) or in patients with documented renal insufficiency (creatinine clearance <60 ml/min/m(2); OR 0.66, 95% CI 0.45 to 0.96, I(2) = 0%, p = 0.03). In conclusion, pretreatment with high-dose statins, compared with low-dose statins or placebo, in patients undergoing coronary angiography reduces the incidence of CIAKI. This benefit was seen irrespective of the presence of diabetes and chronic kidney disease. Future studies should identify optimum dosing protocols for each statin.
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Leung KCW, Pannu N, Tan Z, Ghali WA, Knudtson ML, Hemmelgarn BR, Tonelli M, James MT. Contrast-associated AKI and use of cardiovascular medications after acute coronary syndrome. Clin J Am Soc Nephrol 2014; 9:1840-8. [PMID: 25318754 DOI: 10.2215/cjn.03460414] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria. RESULTS In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI. CONCLUSIONS Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.
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Affiliation(s)
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Zhi Tan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and
| | - William A Ghali
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and
| | | | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and
| | | | - Matthew T James
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and
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Statins and contrast-induced acute kidney injury with coronary angiography. Am J Med 2014; 127:987-1000. [PMID: 24852935 DOI: 10.1016/j.amjmed.2014.05.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Contrast-induced acute kidney injury is an adverse outcome resulting from radiocontrast medium exposure during coronary angiography and percutaneous coronary intervention. METHODS A systematic search was conducted to retrieve studies that investigated the impact of statin exposure before coronary angiography or percutaneous coronary intervention on the development of contrast-induced acute kidney injury. The primary outcome was the development of contrast-induced acute kidney injury. We separately analyzed statin/placebo comparisons and high-/low-dose statin comparisons. RESULTS Fifteen randomized controlled trials met inclusion criteria: 11 studies with statin-naïve subjects, 2 studies with chronic statin users, and 2 studies with unspecified prior statin exposure. Statin exposure reduced the risk of contrast-induced acute kidney injury relative to placebo (relative risk [RR] 0.63, P = .01) with a nonsignificant reduction in the need for hemodialysis (RR 0.25, P = .08). This benefit was also observed in high-dose versus low-dose statin trials (RR 0.46, P = .004), in statin-naïve patients (RR 0.53, P <.0001), and with all studied statins. Higher statin exposure reduced contrast-induced acute kidney injury in patients with acute coronary syndromes compared with placebo or low-dose statins (RR 0.49, P <.00001), with no significant benefit among patients undergoing elective procedures (RR 0.86, P = .50). Subgroup analyses confirmed the benefit of statins in patients with diabetes, chronic kidney disease, congestive heart failure, and those receiving >140 mL of contrast dye. CONCLUSION Statin therapy is effective at reducing the risk of contrast-induced acute kidney injury. It should thus be considered, at least on a short-term basis, for patients at increased risk of this complication.
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Yun KH, Lim JH, Hwang KB, Woo SH, Jeong JW, Kim YC, Joe DY, Ko JS, Rhee SJ, Lee EM, Oh SK. Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy. Korean Circ J 2014; 44:301-6. [PMID: 25278982 PMCID: PMC4180606 DOI: 10.4070/kcj.2014.44.5.301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/30/2014] [Accepted: 07/18/2014] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS). Subjects and Methods A total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after PCI. Results The incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84±22.59% vs. 2.43±24.49%, p=0.038; -11.44±14.00 vs. -9.51±13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026). Conclusion High-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.
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Affiliation(s)
- Kyeong Ho Yun
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jae Hong Lim
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kyo Bum Hwang
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Sun Ho Woo
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jin Woo Jeong
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Yong Cheol Kim
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Dai-Yeol Joe
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jum Suk Ko
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Sang Jae Rhee
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Eun Mi Lee
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Seok Kyu Oh
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
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Ball T, McCullough PA. Statins for the Prevention of Contrast-Induced Acute Kidney Injury. ACTA ACUST UNITED AC 2014; 127:165-71. [DOI: 10.1159/000363202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Liu YH, Liu Y, Duan CY, Tan N, Chen JY, Zhou YL, Li LW, He PC. Statins for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography/Percutaneous Interventions: A Meta-analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol Ther 2014; 20:181-92. [PMID: 25193735 DOI: 10.1177/1074248414549462] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Statins have been demonstrated to prevent the development of contrast-induced nephropathy (CIN). Nevertheless, clinical research has indicated conflicting results. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the protective effects of statins on CIN and the requirement of renal replacement therapy (RRT) in patients undergoing coronary angiography/percutaneous interventions. METHODS PubMed, MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central RCTs were searched for RCTs from inception to February 2014 to compare statins with placebo treatment for preventing CIN in patients undergoing coronary angiography/percutaneous interventions. RESULTS Nine RCTs were identified and analyzed in a total of 5143 patients involving 2560 patients with statin pretreatment and 2583 patients as control. Patients who received statin therapy had a 53% lower risk of CIN with different definitions (within 48 or 72 hours) compared to the control group based on a fixed effect model (risk ratio = 0.47, 95% confidence interval = 0.37-0.60, P < .0001) and were less likely to require RRT based on Peto fixed effect. Subgroup analysis showed that statin pretreatment could decrease the incidence of CIN in patients with preexisting renal dysfunction or diabetes mellitus. In addition, patients on rosuvastatin had a similar reduced incidence of CIN compared to patients on atorvastatin. CONCLUSION This updated meta-analysis demonstrated that preprocedural statin treatment could reduce the risk of CIN and the need for RRT in patients undergoing coronary angiography/percutaneous interventions. Moreover, statin therapy would be helpful in reducing the incidence of CIN in high-risk patients with preexisting renal dysfunction or diabetes mellitus. Additionally, rosuvastatin and atorvastatin had similar efficacies in preventing CIN development.
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Affiliation(s)
- Yuan-hui Liu
- Department of Graduate School, Southern Medical University, Guangzhou, Guangdong, China Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China These authors (Yuan-hui Liu, Yong Liu, Chong-yang Duan) contributed equally to this work
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China These authors (Yuan-hui Liu, Yong Liu, Chong-yang Duan) contributed equally to this work
| | - Chong-yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, Chin These authors (Yuan-hui Liu, Yong Liu, Chong-yang Duan) contributed equally to this work
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Li-wen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Peng-cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Singh N, Lee JZ, Huang JJ, Low SW, Howe C, Pandit A, Suryanarayana P, Lee KS. Benefit of statin pretreatment in prevention of contrast-induced nephropathy in different adult patient population: systematic review and meta-analysis. Open Heart 2014; 1:e000127. [PMID: 25332824 PMCID: PMC4189228 DOI: 10.1136/openhrt-2014-000127] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/03/2014] [Accepted: 07/15/2014] [Indexed: 12/29/2022] Open
Abstract
Objective Previous studies have suggested that statin pretreatment prevents contrast-induced nephropathy (CIN). However, single randomised trials are limited in their number of patients. This meta-analysis aims to assess the role of statin use in CIN prevention, as well as to determine patient subgroups that will benefit from statin pre-treatment. Methodology We searched PubMed, EMBASE, Web of science and the Cochrane Central Register of Controlled Trials databases for randomised controlled trials (RCT) comparing statin pretreatment versus placebo for preventing CIN. Our main outcome was the risk of CIN within 1–5 days after contrast administration. Results Data analysed from nine randomised studies with a total of 5143 patients, where 2559 received statins and 2584 received placebo, showed that statin pretreatment was associated with significant reduction in risk of CIN (MH-RR=0.47, 95% CI 0.34 to 0.64, Z=4.49, p<0.00001). This beneficial effect of statin was also seen in patients with baseline renal impairment (MH-RR=0.46, 95% CI 0.29 to 0.72, p=0.0008) and also those who were cotreated with NAC (MH-RR=0.46, 95% CI 0.25 to 0.83, p=0.01). Conclusions Statin pretreatment leads to significant reduction in CIN, and should be strongly considered in all patients who are planned for diagnostic and interventional procedures involving contrast-media administration.
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Affiliation(s)
- Nirmal Singh
- Department of Cardiovascular Diseases , University of Arizona , Tucson, Arizona , USA
| | - Justin Z Lee
- Department of Internal Medicine , University of Arizona , Tucson, Arizona , USA
| | - Jennifer J Huang
- Department of Internal Medicine , University of Arizona , Tucson, Arizona , USA
| | - See Wei Low
- Department of Cardiovascular Diseases , University of Arizona , Tucson, Arizona , USA
| | - Carol Howe
- Arizona Health Sciences Library , University of Arizona , Tucson, Arizona , USA
| | - Anil Pandit
- Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA
| | - Prakash Suryanarayana
- Department of Cardiovascular Diseases , University of Arizona , Tucson, Arizona , USA
| | - Kwan S Lee
- Department of Cardiovascular Diseases , University of Arizona , Tucson, Arizona , USA
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Toso A, Leoncini M, Maioli M, Tropeano F, Bellandi F. Pharmacologic Prophylaxis for Contrast-Induced Acute Kidney Injury. Interv Cardiol Clin 2014; 3:405-419. [PMID: 28582225 DOI: 10.1016/j.iccl.2014.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the effort to prevent contrast-induced acute kidney injury (CI-AKI), several pharmacologic agents have been tested for their single or combined nephroprotective properties. To date, however, no drug has been officially approved for this aim. This article focuses on the three agents that have been most extensively studied: statins, N-acetylcysteine, and ascorbic acid. Particular attention is paid to the impact of these drugs on the CI-AKI prevention and improved prognosis.
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Affiliation(s)
- Anna Toso
- Cardiology Division, Prato Hospital, Prato, Italy.
| | | | - Mauro Maioli
- Cardiology Division, Prato Hospital, Prato, Italy
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Gomez SI, Mihos CG, Pineda AM, Santana O. The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in renal disease. Int J Nephrol Renovasc Dis 2014; 7:123-30. [PMID: 24729724 PMCID: PMC3974687 DOI: 10.2147/ijnrd.s55102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
It is well known that statins exert their main effect by inhibiting cholesterol synthesis through the inhibition of the 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme. The pleiotropic effects of statins, which are independent of their inhibition of cholesterol synthesis, have explained many of the beneficial effects of these drugs in a variety of disorders such as malignancies, infection, and sepsis, as well as in cardiovascular and rheumatologic disorders. However, the role of these drugs in renal disorders remains controversial. In the present review, we examine the most recent findings involving statins and renal disease among different clinical scenarios, including chronic kidney disease, contrast-induced nephropathy, renal injury after coronary artery bypass surgery, and renal transplant patients.
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Affiliation(s)
- Sabas I Gomez
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G Mihos
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Andres M Pineda
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
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Han Y, Zhu G, Han L, Hou F, Huang W, Liu H, Gan J, Jiang T, Li X, Wang W, Ding S, Jia S, Shen W, Wang D, Sun L, Qiu J, Wang X, Li Y, Deng J, Li J, Xu K, Xu B, Mehran R, Huo Y. Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol 2013; 63:62-70. [PMID: 24076297 DOI: 10.1016/j.jacc.2013.09.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 09/03/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and efficacy of rosuvastatin in preventing contrast-induced acute kidney injury (CI-AKI) in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). BACKGROUND CI-AKI is an important complication after contrast medium injection. While small studies have shown positive results with statin therapy, the role of statin therapy in prevention of CI-AKI remains unknown. METHODS We randomized 2,998 patients with type 2 DM and concomitant CKD who were undergoing coronary/peripheral arterial angiography with or without percutaneous intervention to receive rosuvastatin, 10 mg/day (n = 1,498), for 5 days (2 days before, and 3 days after procedure) or standard-of-care (n = 1,500). Patients' renal function was assessed at baseline, 48 h, and 72 h after exposure to contrast medium. The primary endpoint of the study was the development of CI-AKI, which was defined as an increase in serum creatinine concentration ≥0.5 mg/dl (44.2 μmol/l) or 0.25% above baseline at 72 h after exposure to contrast medium. RESULTS Patients randomized to the rosuvastatin group had a significantly lower incidence of CI-AKI than controls (2.3% vs. 3.9%, respectively; p = 0.01). During 30 days' follow-up, the rate of worsening heart failure was significantly lower in the patients treated with rosuvastatin than that in the control group (2.6% vs. 4.3%, respectively; p = 0.02). CONCLUSIONS Rosuvastatin significantly reduced the risk of CI-AKI in patients with DM and CKD undergoing arterial contrast medium injection. (Rosuvastatin Prevent Contrast Induced Acute Kidney Injury in Patients With Diabetes [TRACK-D]; NCT00786136).
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Affiliation(s)
- Yaling Han
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China.
| | - Guoying Zhu
- Department of Cardiology, WuHan Asia Heart Hospital, Wuhan, China
| | - Lixian Han
- Department of Cardiology, CangZhou Central Hospital, CangZhou, China
| | - Fengxia Hou
- Department of Cardiology, Changchun Central Hospital, Changchun, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Huiliang Liu
- Department of Cardiology, General Hospital of Armed Police Forces, Beijing, China
| | - Jihong Gan
- Department of Cardiology, Lanzhou Military WuluMuqi PLA Hospital, Wulumuqi, China
| | - Tiemin Jiang
- Department of Cardiology, Affiliated Hospital of Medical College of Armed Police Forces, Tianjin, China
| | - Xiaoyan Li
- Department of Cardiology, Jinan Military General Hospital, Jinan, China
| | - Wei Wang
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shifang Ding
- Department of Cardiology, Wuhan General Hospital of Guangzhou Military, Wuhan, China
| | - Shaobin Jia
- Department of Cardiology, Affiliated Hospital of Ningxia Medical College, Yinchuan, China
| | - Weifeng Shen
- Department of Cardiology, Ruijin Hospital Affiliated to the Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Dongmei Wang
- Department of Cardiology, Shijiazhuang International Peace Hospital, Shijiazhuang, China
| | - Ling Sun
- Department of Cardiology, Fushun Central Hospital, Fushun, China
| | - Jian Qiu
- Department of Cardiology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| | - Xiaozeng Wang
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Yi Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jie Deng
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jing Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Kai Xu
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Bo Xu
- Cardiac Catheterization Laboratory, Fuwai Hospital, Beijing, China
| | - Roxana Mehran
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yong Huo
- Department of Cardiology, First Hospital of Beijing University, Beijing, China
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Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome: Results from the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome). J Am Coll Cardiol 2013; 63:71-9. [PMID: 24076283 DOI: 10.1016/j.jacc.2013.04.105] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/19/2013] [Accepted: 04/30/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study sought to determine if in addition to standard preventive measures on-admission, high-dose rosuvastatin exerts a protective effect against contrast-induced acute kidney injury (CI-AKI). BACKGROUND Patients with acute coronary syndrome (ACS) are at high risk for CI-AKI, and the role of statin pre-treatment in preventing renal damage remains uncertain. METHODS Consecutive statin-naïve non-ST elevation ACS patients scheduled to undergo early invasive strategy were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; statin group n = 252) or no statin treatment (control group n = 252). CI-AKI was defined as an increase in creatinine concentration of ≥0.5 mg/dl or ≥25% above baseline within 72 h after contrast administration. RESULTS The incidence of CI-AKI was significantly lower in the statin group than in controls (6.7% vs. 15.1%; adjusted odds ratio: 0.38; 95% confidence interval [CI]: 0.20 to 0.71; p = 0.003). The benefits against CI-AKI were consistent, even applying different CI-AKI definition criteria and in all the pre-specified risk categories. The 30-day incidence of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) was significantly lower in the statin group (3.6% vs. 7.9%, respectively; p = 0.036). Moreover, statin treatment given on admission was associated with a lower rate of death or nonfatal myocardial infarction at 6 month follow-up (3.6% vs. 7.2%, respectively; p = 0.07). CONCLUSIONS High-dose rosuvastatin given on admission to statin-naïve patients with ACS who are scheduled for an early invasive procedure can prevent CI-AKI and improve short-term clinical outcome. (Statin Contrast Induced Nephropathy Prevention [PRATO-ACS]; NCT01185938).
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Alpert MA. Do statins reduce the risk of contrast-induced acute kidney injury in patients undergoing coronary angiography or percutaneous coronary interventions? J Am Coll Cardiol 2013; 63:80-2. [PMID: 24076280 DOI: 10.1016/j.jacc.2013.07.097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Martin A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri.
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Leoncini M, Toso A, Maioli M, Tropeano F, Bellandi F. Statin treatment before percutaneous cononary intervention. J Thorac Dis 2013; 5:335-42. [PMID: 23825770 DOI: 10.3978/j.issn.2072-1439.2013.05.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 05/13/2013] [Indexed: 12/31/2022]
Abstract
Treatment with 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) improves short-and-long term prognosis in high-risk patients with stable coronary artery disease and in those with acute coronary syndrome and their use is strongly recommended for secondary prevention. Moreover, recent data suggest that statin pre-treatment is associated with a better short- and long-term outcome in patients undergoing percutaneous coronary intervention. Current guidelines for coronary revascularization recommend the use of high-dose of statins before percutaneous coronary intervention to reduce the risk of periprocedural myocardial infarction in statin naïve patients (class IIa A) and in those on chronic statin therapy (class IIa B). However, the beneficial clinical effects elicited by statins in patients undergoing coronary angioplasty may arise not only from a cardiac protection against periprocedural myocardial injury but also from a renal protection against acute kidney injury caused by iodinated contrast media. Actually, statins exert multiple non-lipid lowering (pleiotropic) effects, including improved endothelial function, reduced inflammatory and immuno-modulatory processes, oxidative stress and platelet adhesion, that may contribute to both cardio- and nephro-protection even in the short-term.
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Kaya A, Kaya Y, Topçu S, Günaydin ZY, Kurt M, Tanboğa IH, Kalkan K, Aksakal E. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology 2013; 65:51-6. [PMID: 23620308 DOI: 10.1177/0003319713484789] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the relationship between baseline neutrophil-to-lymphocyte ratio (NLR) and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI). Consecutive patients diagnosed with STEMI (n = 691) who underwent primary percutaneous coronary intervention (p-PCI) were included in the study. The CIN was defined as an increase in serum creatinine concentration ≥25% over baseline at 48 hours. Both NLR and C-reactive protein levels were significantly higher in the CIN group. There was a stronger correlation in patients with a known history of chronic kidney disease and in patients with a history of diabetes mellitus (DM). Advanced age, DM, low baseline glomerular filtration rate, reduced postprocedural ST resolution, high amount of contrast media, high NLR, and low left ventricular ejection fraction were independent predictors of CIN. The NLR may be used as a simple and reliable indicator of CIN in patients with STEMI who underwent p-PCI.
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Affiliation(s)
- Ahmet Kaya
- 1Department of Cardiology, Ordu University Medical School, Ordu, Turkey
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Abstract
PURPOSE OF REVIEW To discuss the beneficial effects of statin treatment in patients with peripheral arterial disease (PAD), abdominal aortic aneurysms (AAAs), atherosclerotic renal artery stenosis (ARAS) and carotid artery disease. RECENT FINDINGS Evidence suggests that statins may reduce the progression (or even reverse the development) of carotid artery stenosis and AAAs. Statins also improve several indices (e.g. serum creatinine) and preserve renal function in ARAS. In patients with PAD, statins are associated with improved claudication distance and time, reduced cardiovascular events, and improved graft patency rates should these patients undergo surgery. Finally, statins are associated with improved perioperative and long-term morbidity and mortality rates in all vascular patients whether they undergo surgery or endovascular procedures. SUMMARY Routine statin treatment should be implemented for all vascular patients to ensure a reduced progression of their disease, as well as a reduction in cardiovascular events.
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Argalious MY, Dalton JE, Cywinski JB, Seif J, Abdelmalak M, Sessler DI. Association between preoperative statin therapy and postoperative change in glomerular filtration rate in endovascular aortic surgery. Br J Anaesth 2012; 109:161-7. [PMID: 22628391 DOI: 10.1093/bja/aes143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Acute kidney injury during endovascular aortic repair can result in a reduction in the postoperative glomerular filtration rate (GFR). The 'pleiotropic' effects of statins offer a potential mechanism of reducing the postoperative decline in the GFR. We therefore tested the hypothesis that in patients undergoing endovascular aortic repair, the GFR decreases less in patients taking preoperative statins than in those who do not. METHODS A cohort investigation of 501 consecutive patients who underwent endovascular aortic repair between June 2005 and March 2007 in an academic tertiary care centre. Multivariable linear regression was used to assess the association between the statin use and the postoperative GFR, after adjusting for the baseline GFR and other confounding covariables selected using a stepwise criterion. RESULTS The statin use was not associated with a change in the postoperative GFR (P=0.94); the difference (95% confidence interval) in the mean postoperative GFR (statins minus no statins) was estimated at 0.1 (-3.1, +3.4) ml min(-1) 1.73 m(-2). A decrease in the GFR of ≥ 25% (the threshold to diagnose contrast-induced nephropathy) developed in 26 of 192 patients given statins before operation (13.5%) compared with 36 of 296 patients who were not taking statins (12.2%). CONCLUSIONS Statin therapy is not associated with a statistically significant change in the mean postoperative GFR in patients undergoing endovascular aortic surgery, nor a reduction in the risk of a GFR decline of >25%.
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Affiliation(s)
- M Y Argalious
- Department of General Anaesthesiology, Cleveland Clinic, 9500 Euclid Ave, G3-214, Cleveland, OH 44195, USA.
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Li Y, Liu Y, Fu L, Mei C, Dai B. Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials. PLoS One 2012; 7:e34450. [PMID: 22511942 PMCID: PMC3325242 DOI: 10.1371/journal.pone.0034450] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/28/2012] [Indexed: 12/29/2022] Open
Abstract
Background A few studies focused on statin therapy as specific prophylactic measures of contrast-induced nephropathy have been published with conflicting results. In this meta-analysis of randomized controlled trials, we aimed to assess the effectiveness of shor-term high-dose statin treatment for the prevention of CIN and clinical outcomes and re-evaluate of the potential benefits of statin therapy. Methods We searched PubMed, OVID, EMBASE, Web of science and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing short-term high-dose statin treatment versus low-dose statin treatment or placebo for preventing CIN. Our outcome measures were the risk of CIN within 2–5 days after contrast administration and need for dialysis. Results Seven randomized controlled trials with a total of 1,399 patients were identified and analyzed. The overall results based on fixed-effect model showed that the use of short-term high-dose statin treatment was associated with a significant reduction in risk of CIN (RR = 0.51, 95% CI 0.34–0.76, p = 0.001; I2 = 0%). The incidence of acute renal failure requiring dialysis was not significant different after the use of statin (RR = 0.33, 95% CI 0.05–2.10, p = 0.24; I2 = 0%). The use of statin was not associated with a significant decrease in the plasma C-reactive protein level (SMD −0.64, 95% CI: −1.57 to 0.29, P = 0.18, I2 = 97%). Conclusions Although this meta-analysis supports the use of statin to reduce the incidence of CIN, it must be considered in the context of variable patient demographics. Only a limited recommendation can be made in favour of the use of statin based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of CIN is required to more adequately assess the role for statin in CIN prevention.
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Affiliation(s)
- Yongchuan Li
- Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yawei Liu
- Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lili Fu
- Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- * E-mail: (BD) (CM); (CM) (BD)
| | - Bing Dai
- Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- * E-mail: (BD) (CM); (CM) (BD)
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Okumura K, Sone T. Risk assessment and prevention of contrast-induced nephropathy in patients undergoing coronary angiography. Intern Med 2012; 51:519-21. [PMID: 22449656 DOI: 10.2169/internalmedicine.51.6875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pappy R, Abu-Fadel MS. Additional data supporting the use of statins to prevent contrast induced nephropathy. Int J Cardiol 2011; 152:265-6. [DOI: 10.1016/j.ijcard.2011.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/27/2022]
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. Statins and contrast-induced nephropathy: Issues requiring further investigation. Int J Cardiol 2011; 151:364. [DOI: 10.1016/j.ijcard.2011.06.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 11/25/2022]
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