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Guo W, Liu J, He Y, Lei L, Guo Z, Song F, Zhou Z, Liu W, Zhong X, Chen S, Rao L, Liu Y. The Impact of Contrast-Associated Acute Kidney Injury on All-Cause Mortality in Older Patients After Coronary Angiography:A 7.5-year Follow-Up. Angiology 2024; 75:434-440. [PMID: 36748250 DOI: 10.1177/00033197231155610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Older patients (≥75 years) after coronary angiography constitute an increasing proportion, but only limited data are available regarding the prognosis of geriatric contrast-associated acute kidney injury (CA-AKI). Patients (≥75 years) undergoing coronary angiography between December 2010 and September 2013 were consecutively enrolled. CA-AKI was defined as an increase in serum creatinine of 25% or .5 mg/dL from the baseline within 48-72 h of contrast exposure. All-cause mortality was assessed during median 7.5 years (interquartile range [IQR] 6.7-8.7 years) follow-up period. In total, 571 patients aged >75 years undergoing coronary angiography were enrolled in a single center study; 82 (14.4%) patients had CA-AKI. The all-cause mortality during the median 7.5 years follow-up period was 22.0% in patients with CA-AKI and 13.1% in patients without CA-AKI (P = .015). After adjusting for potential confounding factors, the multivariable analysis indicated that CA-AKI was related to an increased risk of all-cause mortality during the median 7.5-year follow-up (hazard ratio [HR]: 2.46; 95% CI: 1.29-4.7; P = .006). CA-AKI is a significant and independent predictor of long-term mortality for patients aged over 75 years who underwent coronary angiography.
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Affiliation(s)
- Wei Guo
- Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China
| | - Li Lei
- Department of Cardiology, Southern Medical University Nanfang Hospital, China
| | - Zhaodong Guo
- Department of Cardiology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China
| | - Ziyou Zhou
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China
- School of Medicine South China University of Technology, Guangzhou
| | - Wenhai Liu
- College of Pharmacy, Guangdong Medical University, China
| | - Xian Zhong
- College of Pharmacy, Guangdong Medical University, China
| | - Shiqun Chen
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, China
| | - Lifen Rao
- Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China
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Cherbi M, Bonnefoy E, Puymirat E, Lamblin N, Gerbaud E, Bonello L, Levy B, Lim P, Muller L, Merdji H, Range G, Ferrari E, Elbaz M, Khachab H, Bourenne J, Seronde MF, Florens N, Schurtz G, Labbé V, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Faguer S, Roubille F, Delmas C. Cardiogenic shock and chronic kidney disease: Dangerous liaisons. Arch Cardiovasc Dis 2024; 117:255-265. [PMID: 38594150 DOI: 10.1016/j.acvd.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs - the so-called "cardiorenal syndrome". Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce. METHODS FRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors. RESULTS CKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01-1.9; P=0.04) and 1year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09-1.77; P<0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1month and 1year regardless of baseline CKD status. CONCLUSIONS Cardiogenic shock and CKD are frequent "cross-talking" conditions with limited therapeutic options, resulting in higher rates of death at 1month and 1year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Department of Cardiology, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 5, avenue de Magellan, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, avenue du Haut-Lévêque, 33600 Pessac, France
| | - Laurent Bonello
- Aix-Marseille Université, 13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Assistance publique-Hôpitaux de Marseille, Hôpital Nord, 13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, 54500 Vandœuvre-Lès-Nancy, France
| | - Pascal Lim
- Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, 94010 Créteil, France
| | - Laura Muller
- Réanimation, Centre Hospitalier Broussais, 35400 Saint-Malo, France
| | - Hamid Merdji
- Medical Intensive Care Unit, Nouvel Hôpital Civil, CHU de Strasbourg, 67091 Strasbourg, France
| | - Grégoire Range
- Cardiology Department, Centre Hospitalier Louis-Pasteur, 28630 Chartres, France
| | - Emile Ferrari
- Cardiology Department, CHU de Nice, 06003 Nice, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix-en-Provence, avenue des Tamaris, 13616 Aix-en-Provence cedex 1, France
| | - Jeremy Bourenne
- Aix-Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, 13005 Marseille, France
| | | | - Nans Florens
- Nephrology Department, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | - Vincent Labbé
- Medical Intensive Care Unit, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, Inserm U1044, INSA-15, 69229 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU de Clermont-Ferrand, CNRS, Université Clermont-Auvergne, 63003 Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médicochirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, CHU de Rennes, Inserm, LTSI, UMR 1099, Université Rennes 1, 35000 Rennes, France
| | - Stanislas Faguer
- Department of Nephrology and Transplantation, French Intensive Care Renal Network, Inserm U1297 (Institute of Metabolic and Cardiovascular Diseases), University Hospital of Toulouse, 31059 Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, Inserm, CNRS, Cardiology Department, CHU de Montpellier, 34295 Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France.
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DE Rubeis G, Zilahi DE Gyurgyokai S, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Biondi-Zoccai G, Versaci F, Saba L, Pampana E. Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression. Minerva Med 2024; 115:151-161. [PMID: 38563606 DOI: 10.23736/s0026-4806.23.09093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI). METHODS A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates. RESULTS A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03). CONCLUSIONS Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.
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Affiliation(s)
- Gianluca DE Rubeis
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy -
| | | | - Sebastiano Fabiano
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca R Pezzella
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Sabrina Anticoli
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Versaci
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Monserrato, Cagliari, Italy
| | - Enrico Pampana
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
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Kurtul A, Gok M. Preinterventional pan-immune-inflammation value as a tool to predict postcontrast acute kidney injury among acute coronary syndrome patients implanted drug-eluting stents: a retrospective observational study. Scand J Clin Lab Invest 2024; 84:97-103. [PMID: 38506475 DOI: 10.1080/00365513.2024.2330904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
We evaluated the value of pan-immune-inflammation value (PIV) in predicting the risk for postcontrast acute kidney injury (PCAKI), an important complication following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients. Medical records of 839 ACS patients underwent PCI between June 2019 and December 2022 were retrospectively analyzed. Patients were divided into two groups: PCAKI (-) and PCAKI (+). PCAKI was defined as a ≥ 0.5 mg/dL and/or a ≥ 25% increase in serum creatinine within 72 h after PCI. The PIV was computed as [neutrophils × platelets × monocytes]÷lymphocytes. The mean age was 60.7 ± 12.9 years. PCAKI was detected in 105 (12.51%) patients. PIV was higher in the PCAKI (+) group compared to PCAKI (-) group (median 1150, interquartile range [IQR] 663-2021 vs median 366, IQR 238-527, p < 0.001). Receiver operating characteristic curve analysis showed that the best cutoff of PIV for predicting PCAKI was 576 with 81% sensitivity and 80% specificity. PIV was superior to neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for the prediction of PCAKI (area under curve:0.894, 0.849 and 0.817, respectively, p < 0.001 for all). A high PIV was independently correlated with PCAKI (≤576 vs. >576, odds ratio [OR] 12.484, 95%confidence interval [CI] 4.853-32.118, p < 0.001) together with older age (OR 1.058, p = 0.009), female gender (OR 4.374, p = 0.005), active smoking (OR 0.193, p = 0.012), left ventricular ejection fraction (OR 0.954, p = 0.021), creatinine (OR 10.120, p < 0.001), hemoglobin (OR 0.759, p = 0.019) and c-reactive protein (OR 1.121, p = 0.002). In conclusion, a high PIV seems to be an easily assessable tool that can be used in clinical practice for predicting the risk of PCAKI in ACS patients implanted drug-eluting stents.
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Affiliation(s)
- Alparslan Kurtul
- Faculty of Medicine, Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Murat Gok
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
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Feng W, Zhou J, Lun Z, Zhou D, Li P, Ye J. A Comparison Between Two Different Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Patients with Chronic Kidney Disease Undergoing Coronary Angiography. Clin Interv Aging 2024; 19:303-311. [PMID: 38404478 PMCID: PMC10887939 DOI: 10.2147/cia.s452882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is a prevalent complication following coronary angiography (CAG). However, there is ongoing controversy surrounding its precise definition. Although previous studies have demonstrated the successful application of appropriate definitions in managing high-risk CA-AKI patients, there remains limited research on the association between different definitions and prognosis specifically in patients with chronic kidney disease (CKD). Methods A total of 4197 CKD patients undergoing coronary angiography (CAG) were included in this study. Two definitions of contrast-associated acute kidney injury (CA-AKI) were used: CA-AKIA, which was defined as an increase of ≥0.5 mg/dL or >25% in serum creatinine (SCr) from baseline within 72 hours after CAG, and CA-AKIB, which was defined as an increase of ≥0.3 mg/dL or >50% in SCr from baseline within 48 hours after CAG. Cox regression analysis was employed to assess the association between these two definitions and long-term mortality. Additionally, population attributable risks (PARs) were calculated to evaluate the impact of CA-AKI definitions on long-term prognosis. Results During the median follow-up period of 4.70 (2.50-7.78) years, the overall long-term mortality was 23.6%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 33.5% and 33.8%, respectively. We found that CA-AKIA (HR: 1.45, 95% CI: 1.23-1.70, p<0.001) and CA-AKIB (HR: 1.44, 95% CI: 1.23-1.69, p<0.001) were associated with long-term mortality. The PARs were the highest for CA-AKIA (5.87%), followed by CA-AKIB (5.70%). Conclusion Contrast-associated acute kidney injury (CA-AKI) is a frequently observed complication in CKD patients undergoing coronary angiography (CAG), and both definitions of CA-AKI are significantly correlated with a poor long-term prognosis. Consequently, in the clinical management of CKD patients, it is crucial to prioritize CA-AKI, irrespective of the specific CA-AKI definition used.
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Affiliation(s)
- Wenwei Feng
- Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, People’s Republic of China
| | - Jiancong Zhou
- Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, People’s Republic of China
| | - Zhubin Lun
- Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, People’s Republic of China
| | - Dianhua Zhou
- Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, People’s Republic of China
| | - Peiwen Li
- Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, People’s Republic of China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, Guangdong, People’s Republic of China
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Murugan R, Boudreaux-Kelly MY, Kellum JA, Palevsky PM, Weisbord S. Contrast-associated acute kidney injury and cardiovascular events: a secondary analysis of the PRESERVE cohort. Clin Kidney J 2023; 16:2626-2638. [PMID: 38046040 PMCID: PMC10689134 DOI: 10.1093/ckj/sfad214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) has been associated with a higher risk of cardiovascular (CV) events. We studied the risk of CV events in chronic kidney disease (CKD) patients undergoing angiography and whether biomarkers can predict such events. We also explored whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate (eGFR) on CV events. Methods We analysed participants from the Prevention of Serious Adverse Events following the Angiography (PRESERVE) trial. Urinary tissue inhibitor of matrix metalloproteinase [TIMP]-2 and insulin growth factor binding protein [IGFBP]-7, plasma brain-type natriuretic peptide (BNP), high sensitivity C-reactive protein (hs-CRP), and serum cardiac troponin-I (Tn-I) were assayed before and after angiography. We assessed the composite risk of CV events by day 90. Results Of the 922 participants, 119 (12.9%) developed CV events, and 73 (7.9%) developed CA-AKI. Most cases of CA-AKI (90%) were stage 1. There were no differences in urinary [TIMP-2]•[IGFBP7] concentrations or the proportion of patients with CA-AKI among those with and without CV events. Higher BNP, Tn-I, and hs-CRP were associated with CV events, but their discriminatory capacity was modest (AUROC <0.7). CA-AKI did not mediate the association of the pre-angiography eGFR on CV events. Conclusions Most episodes of CA-AKI are stage 1 AKI and are not associated with CV events. Less severe CA-AKI episodes also did not mediate the risk of pre-angiography eGFR on CV events. Our findings suggest that most CV events after contrast procedures are due to underlying CKD and CV risk factors rather than less severe CA-AKI episodes and should help enhance the utilization of clinically indicated contrast procedures among high-risk patients with CKD. Further research is required to examine whether moderate-to-severe CA-AKI episodes are associated with CV events.
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Affiliation(s)
- Raghavan Murugan
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Monique Y Boudreaux-Kelly
- Office of Research and Development, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - John A Kellum
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul M Palevsky
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Steven Weisbord
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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7
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Ji B, Yao T, Tong J, Ye Z, Ping F, Chen F, Liu XB. Impact of percutaneous coronary intervention on renal function in patients with coronary heart disease. Monaldi Arch Chest Dis 2023. [PMID: 37930658 DOI: 10.4081/monaldi.2023.2766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023] Open
Abstract
The relationship between cardiac and renal function is complicated. The impact of percutaneous coronary intervention (PCI) on renal function in patients with coronary artery disease is still unclear. The current study sought to assess renal function change, including the time course of renal function, after elective PCI in patients with improved renal function and to identify renal function predictors of major adverse cardiovascular events. We examined data from 1572 CHD patients who had coronary angiography (CAG) or PCI in this retrospective cohort study. Patients receiving elective PCI (n=1240) and CAG (n=332) between January 2013 and December 2018 were included. Pre-PCI and procedural variables associated with post-PCI eGFR, change in renal function after post-PCI follow-up, and post-PCI eGFR association with major adverse cardiovascular events were investigated. Following the procedure, 88.7 percent of PCI group patients had unchanged or improved renal function. The treatment of PCI was found to independently correlate with IRF following coronary angiography in an analysis of patients undergoing PCI [OR 4.561 (95% CI:2 .556-8.139); p<0.001]. The area under the receiver operating characteristic (ROC) curve is 0.763 (model with the treatment of PCI). Improved renal function (IRF) and stable renal function were both associated with a lower risk of a major cardiovascular event.
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Affiliation(s)
- Bing Ji
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
| | - Tongqing Yao
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
| | - Jing Tong
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
| | - Zi Ye
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
| | - Fan Ping
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
| | - Fei Chen
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
| | - Xue-Bo Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai.
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8
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Kaneda K, Shiomi H, Abe M, Morimoto T, Yamamoto K, Obayashi Y, Nishikawa R, Tamura A, Kadota K, Domei T, Nakatsuma K, Yokomatsu T, Imai M, Taniguchi T, Nawada R, Toyofuku M, Tamura T, Inada T, Matsuda M, Sato Y, Furukawa Y, Ando K, Nakagawa Y, Kimura T. Post-contrast Acute Kidney Injury After Emergent and Elective Percutaneous Coronary Intervention (from the CREDO-Kyoto PCI/CABG Registry Cohort 3). Am J Cardiol 2023; 202:58-66. [PMID: 37421731 DOI: 10.1016/j.amjcard.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
Post-contrast acute kidney injury (PC-AKI) is a common complication after percutaneous coronary intervention (PCI). However, it is unclear whether or not the effects of PC-AKI on long-term clinical outcomes were different between emergent and elective procedures. Among patients enrolled in the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) registry cohort 3, we identified 10,822 patients treated using PCI (emergent PCI stratum: n = 5,022 [46%] and elective PCI stratum: n = 5,860 [54%]). PC-AKI was defined as ≥0.3 mg/100 ml absolute or 1.5-fold relative increase of serum creatinine within 72 hours after PCI. The incidence of PC-AKI was significantly higher after emergent PCI than after elective PCI (10.5% vs 3.7%, p <0.001). In the multivariable logistic regression model, emergent PCI was the strongest independent risk factor for PC-AKI in the entire study population. The excess adjusted risk of patients with PC-AKI relative to those without remained significant for all-cause death in both the emergent and elective PCI strata (hazard ratio 1.87, 95% confidence interval 1.59 to 2.21, p <0.001 and hazard ratio 1.31, 95% confidence interval 1.03 to 1.68, p = 0.03, respectively). There was a significant interaction between the PCI setting (emergent and elective) and the effect of PC-AKI on all-cause death, with a greater magnitude of effect in the emergent PCI stratum than in the elective PCI stratum (p for interaction = 0.01). In conclusion, the incidence of PC-AKI was 2.8 times higher after emergent PCI than after elective PCI. The excess mortality risk of PC-AKI relative to no PC-AKI was greater after emergent PCI than after elective PCI.
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Affiliation(s)
- Kazuhisa Kaneda
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Obayashi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akinori Tamura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Masao Imai
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryuzo Nawada
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Mitsuo Matsuda
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kosai Hospital, Hirakata, Japan
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9
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Murugan R, Boudreaux-Kelly MY, Kellum JA, Palevsky PM, Weisbord S. Kidney Cell Cycle Arrest and Cardiac Biomarkers and Acute Kidney Injury Following Angiography: The Prevention of Serious Adverse Events Following Angiography (PRESERVE) Study. Kidney Med 2023; 5:100592. [PMID: 36874509 PMCID: PMC9976574 DOI: 10.1016/j.xkme.2022.100592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale & Objective Recent studies in patients with chronic kidney disease (CKD) indicate that most cases of contrast-associated acute kidney injury (CA-AKI) are mild and are not associated with elevation in kidney injury biomarkers. We used highly sensitive kidney cell cycle arrest and cardiac biomarkers to assess the risk of CA-AKI and major adverse kidney events in patients with CKD undergoing angiography. Study Design A retrospective study. Setting & Participants A subset of 922 participants from the Prevention of Serious Adverse Events following Angiography trial. Predictors Pre- and postangiography urinary tissue inhibitor of matrix metalloproteinase [TIMP]-2 and insulin growth factor binding protein [IGFBP]-7 were measured in 742 subjects, and plasma β natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP), and serum troponin (Tn) in 854 participants using samples obtained 1-2 hours before and 2-4 hours after angiography. Outcomes CA-AKI and major adverse kidney events. Analytical Approach We fitted logistic regression to examine association and area under the receiver operating characteristic curves for risk prediction. Results There were no differences in postangiography urinary [TIMP-2]•[IGFBP7], plasma BNP, serum Tn, and hs-CRP concentrations among patients with and without CA-AKI and major adverse kidney events. However, higher pre- and postangiography median plasma BNP (pre: 200.0 vs 71.5, pg/mL, P = 0.05; post: 165.0 vs 81 pg/mL, P = 0.02); serum Tn (pre: 0.03 vs 0.01, ng/mL, P < 0.001; post, 0.04 vs 0.02, ng/mL, P = 0.01); and hs-CRP (pre: 9.55 vs 3.40 mg/L, P = 0.01; post: 9.90 vs 3.20 mg/L, P = 0.002) concentrations were associated with major adverse kidney events, although their discriminatory capacity was only modest (area under the receiver operating characteristic curves <0.7). Limitations Most participants were men. Conclusions Most mild CA-AKI cases are not associated with urinary cell cycle arrest biomarker elevation. Significant elevation in preangiography cardiac biomarkers may reflect patients with more significant cardiovascular disease that may predispose to poor long-term outcomes independent of CA-AKI status.
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Affiliation(s)
- Raghavan Murugan
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - John A. Kellum
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Paul M. Palevsky
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Steven Weisbord
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Biomarker Effectiveness Analysis in Contrast Nephropathy (BEACON) Study Investigators
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Office of Research and Development, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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10
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Yuan Y, Qiu H, Hu X, Zhang J, Wu Y, Qiao S, Yang Y, Gao R. A risk score model of contrast-induced acute kidney injury in patients with emergency percutaneous coronary interventions. Front Cardiovasc Med 2022; 9:989243. [PMID: 36312242 PMCID: PMC9606750 DOI: 10.3389/fcvm.2022.989243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background The previously built score models of contrast-induced acute kidney injury (CI-AKI) were principally founded on selective percutaneous coronary intervention (PCI) cases. Our study was to form a risk score model of CI-AKI and make a temporal validation in a population who underwent emergency PCIs. Methods We included patients who underwent emergency PCIs from 2013 to 2018 and divided them into the derivation and validation cohorts. Logistic regression analysis was harnessed to create the risk model. In this research, we defined CI-AKI as an increase in serum creatinine (SCr) ≥0.5 mg/dL (44.2 μmol/L) above baseline within seven days following exposure to contrast medium. Results A total of 3564 patients who underwent emergency PCIs were enrolled and divided into the derivation (2376 cases) and validation cohorts (1188 cases), with CI-AKI incidence of 6.61 and 5.39%, respectively. By logistic analysis, the CI-AKI risk score model was constituted by 8 variables: female (1 point), history of transient ischemic attack (TIA)/stroke (1 point), left ventricular ejection fraction (LVEF) classification (1 point per class), big endothelin-1 (ET-1) classification (1 point per class), estimated glomerular filtration rate (eGFR) classification (1 point per class), intra-aortic balloon pump (IABP) application (1 point), left anterior descending (LAD) stented (1 point), and administration of diuretic (2 points). The patients could be further divided into three groups: low-risk, moderate-risk, and high-risk groups, in accordance with the risk scores of 3–6, 7–10, and ≥11 points, and to the CI-AKI rates of 1.4, 11.9, and 42.6%. The CI-AKI risk score model performed well in discrimination (C statistic = 0.787, 95% CI: 0.731–0.844) and calibration ability, and showed a superior clinical utility. Conclusion We developed a simple CI-AKI risk score model which performs well as a tool for CI-AKI prediction in patients who underwent emergency PCIs.
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Affiliation(s)
- Ying Yuan
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong Qiu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,*Correspondence: Hong Qiu
| | - Xiaoying Hu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuan Wu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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11
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Xie W, Zhou Y, Liao Z, Lin B. Effect of Oral Hydration on Contrast-Induced Acute Kidney Injury among Patients after Primary Percutaneous Coronary Intervention. Cardiorenal Med 2021; 11:243-251. [PMID: 34823253 DOI: 10.1159/000520088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the protective effect of oral hydration volume to weight ratio (OHV/W) on contrast-induced acute kidney injury (CI-AKI) among patients with ST-elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI). METHODS A total of 754 patients with STEMI undergoing PCI were selected. Each patient was encouraged to drink as much water as possible 24 h after PCI. Total volume intake was recorded for all patients. The ratio of OHV/W was calculated. The occurrence of CI-AKI was defined as ≥0.5 mg/dL absolute or ≥25% relative increase in serum creatinine within 48-72 h following PCI. Logistic regression analysis and generalized additive model were performed to evaluate the relationship between OHV/W and CI-AKI. RESULTS There was a nonlinear relationship between OHV/W and CI-AKI with an inflection point of 15.69 mL/kg. On the right side of the inflection point (OHV/W ≥15.69 mL/kg), a negative relationship was detected between OHV/W and CI-AKI (HR = 0.90, 95% CI: 0.82∼0.98, p = 0.0126). However, no relationship was observed between OHV/W and CI-AKI on the left of inflection point (HR = 1.19, 95% CI: 0.95∼1.49, p = 0.1302). Subgroup analysis showed that significant interactions were observed only for gender difference (p for interaction = 0.0155), male patients had a significantly lower risk of CI-AKI (HR = 0.84, 95% CI: 0.75∼0.93, p = 0.0012). CONCLUSION OHV/W ≥15.6 mL/kg for 24 h post-procedure may be an effective preventive strategy of CI-AKI. In addition, male patients may particularly benefit from OHV to prevent CI-AKI.
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Affiliation(s)
- Weining Xie
- Department of Scientific Research, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China,
| | - Yuge Zhou
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Foshan, China
| | - Zhishan Liao
- Department of Cardiology, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
| | - Biying Lin
- Department of Nephrology, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
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12
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Ahmed M, Ibrahim GH, Adel M, Ismail A, Almaghraby A, Abdelnabi M. Midkine as an Early Biomarker of Contrast-induced Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Single-center Prospective Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Contrast-induced acute kidney injury (CI-AKI), is an important complication of percutaneous coronary intervention (PCI). We aimed to study the role of serum midkine (MK) as an early biomarker of CI-AKI.
Methods: We conducted a prospective observational cohort study. It includes 100 chronic kidney disease (CKD) patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2. All patients were undergoing PCI for ACS. We measured serum midkine before, 2 and 24 hours after PCI.
Results: The mean age of the patients was 70.32±3.62 years, 74% males. Twenty-seven patients developed CI-AKI. The CI-AKI group has a history of diabetes mellitus (DM) and/or dyslipidemia, history of diuretics, metformin and/or angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARBs) use. The CI-AKI patients have low left ventricular ejection fraction (LVEF) (EF < 45%) and low Creatinine Clearance (CrCl) before PCI. The CI-AKI received more contrast volume, had a longer duration of PCI and had high Mehran risk score after PCI. Comparison between the two studied groups regarding serum MK showed that there was a statistically significant difference regarding serum MK 2 hours after PCI. Receiver operating characteristic (ROC) curve analysis for serum MK showed that serum MK measured 2 hours after PCI was statistically significant to predict CI-AKI.
Conclusion: An early Serum MK after PCI can be used as an early predictor of CI-AKI in ACS patients.
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13
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Lun Z, Mai Z, Liu L, Chen G, Li H, Ying M, Wang B, Chen S, Yang Y, Liu J, Chen J, Ye J, Liu Y. Hypertension as a Risk Factor for Contrast-Associated Acute Kidney Injury: A Meta-Analysis Including 2,830,338 Patients. Kidney Blood Press Res 2021; 46:670-692. [PMID: 34492656 DOI: 10.1159/000517560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Previous studies have shown that the relationship between hypertension (HT) and contrast-associated acute kidney injury (CA-AKI) is not clear. We apply a systematic review and meta-analysis to assess the association between HT and CA-AKI. METHODS We searched for articles on the study of risk factors for CA-AKI in the Embase, Medline, and Cochrane Database of Systematic Reviews (by March 25, 2021). Two authors independently performed quality assessment and extracted data such as the studies' clinical setting, the definition of CA-AKI, and the number of patients. The CA-AKI was defined as a serum creatinine (SCr) increase ≥25% or ≥0.5 mg/dL from baseline within 72 h. We used fixed or random models to pool adjusted OR (aOR) by STATA. RESULTS A total of 45 studies (2,830,338 patients) were identified, and the average incidence of CA-AKI was 6.48%. There was an increased risk of CA-AKI associated with HT (aOR: 1.378, 95% CI: 1.211-1.567, I2 = 67.9%). In CA-AKI with a SCr increase ≥50% or ≥0.3 mg/dL from baseline within 72 h, an increased risk of CA-AKI was associated with HT (aOR: 1.414, 95% CI: 1.152-1.736, I2 = 0%). In CA-AKI with a Scr increase ≥50% or ≥0.3 mg/dL from baseline within 7 days, HT increases the risk of CA-AKI (aOR: 1.317, 95% CI: 1.049-1.654, I2 = 51.5%). CONCLUSION Our meta-analysis confirmed that HT is an independent risk factor for CA-AKI and can be used to identify risk stratification. Physicians should pay more attention toward prevention and treatment of patients with HT in clinical practice.
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Affiliation(s)
- Zhubin Lun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Ziling Mai
- Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | - Huanqiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Ying
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongquan Yang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jianfeng Ye
- The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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14
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Liu T, Lee SR. Poor Prognosis of Contrast-Induced Nephropathy during Long Term Follow Up. Chonnam Med J 2021; 57:197-203. [PMID: 34621640 PMCID: PMC8485089 DOI: 10.4068/cmj.2021.57.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is known to associate with poor prognosis. However, there have been few studies for long-term follow up. The purpose of this study was to know the prognosis of CIN during a 10-year follow up. We retrospectively analyzed 528 patients who underwent coronary angiography in Jeonbuk National University Hospital (South Korea, Jeonju) between Jan 2005 to Dec 2006. We excluded the patients who required regular dialysis before study enrollment. We compared adverse events in the no CIN (group I, n=485, 61.9±11.4 years, male 64.1%) and CIN (group II, n=43, 65.7±11.1 years, male 62.8%). Baseline clinical characteristics and cardiovascular risk factors were not different between the two groups except the post-procedure creatinine level (1.04 mg/dL vs 1.84 mg/dL, p=0.0001). The higher rates of all-cause death were observed in group II at 1-year (3.7% vs 13.9%, log-rank, p=0.001), 5-years (17.9% vs 34.9%, log-rank, p=0.003), and 10-years (25.3% vs 48.8%, log-rank, p=0.000). MACE was higher in group II at 1-year (3.9% vs 11.6%, log-rank, p=0.013), 5-years (6.8% vs 20.9%, log-rank, p=0.000) and 10-years (13.4% vs 27.9%, log-rank, p=0.000). In addition, CIN was an independent predictor for 10-year MACE (adjusted HR 3.432, 95% CI 1.314-8.965, p=0.012) after propensity score matching. The worse prognosis of CIN was continuously observed after the 10-year follow-up. Our data suggests that it is worthwhile to prevent the appearance of CIN in order to improve longterm results.
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Affiliation(s)
- Taili Liu
- Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
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15
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Meng Z, Zhao Y, Zheng X, He Y. The Relationship Between AKI in Patients With STEMI and Short-Term Mortality: A Propensity Score Matching Analysis. Angiology 2021; 72:733-739. [PMID: 34240623 DOI: 10.1177/0003319721998567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute myocardial infarction (AMI) in patients with acute kidney injury (AKI) is associated with poor long-term outcome. However, the short-term prognosis of AKI in patients with ST-elevation AMI (STEMI) needs to be explored further. We assessed this relationship between these patients and short-term mortality in relation to AKI and chronic kidney disease (CKD). All data were extracted from the Medical Information Mart for Intensive Care III database. The primary outcome was 28-day mortality. Kaplan-Meier curves, logistic regression models, and propensity score matching analysis were used to evaluate the associations between AKI in patients with STEMI and outcomes. A total of 1031 patients with STEMI met the inclusion criteria. For 28-day mortality, in the multivariable logistic regression models, the odds ratio (95% CI) of group 2 (AKI but no CKD) and group 3 (AKI in the presence of CKD) were 3.24 (1.46-7.18) and 4.57 (1.83-11.37), respectively, compared with group 1 (no AKI and no CKD). Comorbid AKI increased the risk of short-term mortality among patients with STEMI, especially for those with AKI in the presence of CKD.
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Affiliation(s)
- Zhongyuan Meng
- Department of Geriatric Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yaxin Zhao
- Department of Geriatric Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xifeng Zheng
- Department of Geriatric Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yan He
- Department of Geriatric Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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16
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Cardiovascular and Renal Disease in Chronic Critical Illness. J Clin Med 2021; 10:jcm10081601. [PMID: 33918938 PMCID: PMC8070314 DOI: 10.3390/jcm10081601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 12/29/2022] Open
Abstract
With advances in critical care, patients who would have succumbed in previous eras now survive through hospital discharge. Many survivors suffer from chronic organ dysfunction and induced frailty, representing an emerging chronic critical illness (CCI) phenotype. Persistent and worsening cardiovascular and renal disease are primary drivers of the CCI phenotype and have pathophysiologic synergy, potentiating one another and generating a downward spiral of worsening disease and clinical outcomes manifest as cardio-renal syndromes. In addition to pharmacologic therapies (e.g., diuretics, beta adrenergic receptor blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and blood pressure control), special consideration should be given to behavioral modifications that avoid the pitfalls of polypharmacy and suboptimal renal and hepatic dosing, to which CCI patients may be particularly vulnerable. Smoking cessation, dietary modifications (e.g., early high-protein nutrition and late low-sodium diets), and increased physical activity are advised. Select patients benefit from cardiac re-synchronization therapy or renal replacement therapy. Coordinated, patient-centered care bundles may improve compliance with standards of care and patient outcomes. Given the complex, heterogeneous nature of cardiovascular and renal disease in CCI and the dismal long-term outcomes, further research is needed to clarify pathophysiologic mechanisms of cardio-renal syndromes in CCI and develop targeted therapies.
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Valdenor C, McCullough PA, Paculdo D, Acelajado MC, Dahlen JR, Noiri E, Sugaya T, Peabody J. Measuring the Variation in the Prevention and Treatment of CI-AKI Among Interventional Cardiologists. Curr Probl Cardiol 2021; 46:100851. [PMID: 33994040 DOI: 10.1016/j.cpcardiol.2021.100851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/15/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) occurs in up to 10% of cardiac catheterizations and coronary interventions, resulting in increased morbidity, mortality, and cost. One main reason for these complications and costs is under-recognition of CI-AKI risk and under-treatment of patients with impaired renal status. 157 interventional cardiologists each cared for three simulated patients with common conditions requiring intravascular contrast media in three typical settings: pre-procedurally, during the procedure, and post-procedure. We evaluated their ability to assess the risk of developing CI-AKI, make the diagnosis, and treat CI-AKI, including proper volume expansion and withholding nephrotoxic medications. Overall, the quality-of-care scores averaged 46.0% ± 10.5, varying between 18% to 78%. The diagnostic scores for accurately assessing risk of CI-AKI were low at 57.1% ± 21.2% and the accuracy of diagnosis pre-existing chronic kidney disease was 50.2%. Poor diagnostic accuracy led to poor treatment: proper volume expansion done in only 30.7% of cases, in-hospital repeat creatinine evaluation performed in 32.1%, and avoiding nephrotoxic medications occurred in 14.2%. While volume expansion was relatively similar across the three settings (P = 0.287), the cardiologists were less likely to discontinue nephrotoxic medications in pre-procedurally (9.7%) compared to the other settings (27.0%), and to order in-hospital creatinine testing in peri-procedurally (18.8%) compared to post-procedure (57.8%) (P < 0.05 for both). The overall care of patients at risk for contrast-induced acute kidney injury varied widely and showed room for improvement. Improving care for this condition will require greater awareness by cardiologists and better diagnostic tools to guide them.
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Affiliation(s)
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Texas A & M College of Medicine, Dallas, TX
| | | | | | | | - Eisei Noiri
- National Center Biobank Network, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - John Peabody
- QURE Healthcare, San Francisco, CA; University of California, School of Medicine, San Francisco, CA; University of California, Fielding School of Public Health, Los Angeles, CA.
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18
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the use of iodinated contrast media in patients with kidney disease 2018. Clin Exp Nephrol 2020; 24:1-44. [PMID: 31709463 PMCID: PMC6949208 DOI: 10.1007/s10157-019-01750-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiromitsu Hayashi
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazutaka Aonuma
- Cardiology Department, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Fujigaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Taichi Sato
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Toei
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryusuke Murakami
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadateru Takayama
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiro Komatsu
- Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Yugo Ito
- Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Ryo Miyazawa
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Tomonari Ogawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Eri Koshi
- Department of Nephrology, Komaki City Hospital, Aichi, Japan
| | - Tomoki Kosugi
- Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
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19
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Long-term renal outcomes after elective percutaneous coronary intervention in patients with advanced renal dysfunction. Heart Vessels 2020; 36:452-460. [PMID: 33151381 DOI: 10.1007/s00380-020-01720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to evaluate the renal outcomes, including the time course of renal function, after elective PCI in patients with advanced renal dysfunction and to assess the predictors of renal dysfunction progression. This is a subanalysis of a previous observational multicenter study that investigated long-term clinical outcomes in patients with advanced renal dysfunction (eGFR < 30 mL/min/1.73 m2), focusing on 151 patients who underwent elective PCI and their long-term renal outcomes. Renal dysfunction progression was defined as a 20% relative decrease in eGFR at 1 year from baseline or the initiation of permanent dialysis within 1 year. Progression of renal dysfunction at 1 year occurred in 42 patients (34.1%). Among patients with renal dysfunction progression, the decrease of renal function from baseline was not observed at 1 month but after 6 months of the index PCI. Baseline eGFR and serum albumin level were significant predictors of renal dysfunction progression at 1 year. Among 111 patients who had not been initiated on dialysis within 1 year, those with renal dysfunction progression had a significantly higher incidence of dialysis initiation more than 1 year after the index PCI than those with preserved renal function (p < 0.001). Among patients with advanced renal dysfunction who underwent elective PCI, 34.1% showed renal dysfunction progression at 1 year. The decrease in renal function was not observed at 1 month but after 6 months of the index PCI in patients with renal dysfunction progression. Furthermore, patients with renal dysfunction progression had poorer long-term renal outcomes.
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20
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Uemura Y, Ishikawa S, Takemoto K, Negishi Y, Tanaka A, Takagi K, Yoshioka N, Tashiro H, Umemoto N, Inoue Y, Morishima I, Shimizu K, Shibata N, Asano H, Ishii H, Watarai M, Murohara T. Improved Renal Function After Percutaneous Coronary Intervention in Non-Dialysis Patients With Acute Coronary Syndrome and Advanced Renal Dysfunction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 24:26-30. [PMID: 32952075 DOI: 10.1016/j.carrev.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The deterioration of renal function is a strong prognostic predictor in patients with coronary artery disease. Although percutaneous coronary intervention (PCI) has sometimes resulted in improved renal function (IRF) in acute coronary syndrome (ACS) patients, its clinical implications have not been fully elucidated. This study aimed to investigate the prevalence and predictors of IRF after PCI and its relationship with long-term renal outcomes. METHODS In this retrospective observational cohort study, we examined data from 177 ACS patients with non-dialysis advanced renal dysfunction (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) who underwent PCI. Patients with and without IRF were compared in terms of baseline demographic, clinical, and procedural characteristics and renal outcomes. IRF was defined as a 20% increase in eGFR from baseline at 7 or 30 days after the index PCI. RESULTS IRF was observed in 66 (37.3%) patients. ST-elevation myocardial infarction and shock during PCI were independent predictors of IRF. Patients were followed up for a median of 695 days. Kaplan-Meier analyses demonstrated that patients with IRF had the lower incidence of initiation of permanent dialysis than those without IRF (Log-rank P = 0.015). CONCLUSIONS IRF was relatively common in non-dialysis patients with ACS and advanced renal dysfunction who underwent PCI. ST-elevation myocardial infarction and shock, which may be indicative of hemodynamic instability during PCI, were independent predictors of IRF. Further, IRF was associated with favorable renal outcomes. Hemodynamic stabilization may be important for improving the short-term and long-term renal outcomes of high-risk patients.
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Affiliation(s)
- Yusuke Uemura
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan.
| | - Shinji Ishikawa
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Kenji Takemoto
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Masato Watarai
- Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Protective Effects and Mechanisms of Rosuvastatin on Acute Kidney Injury Induced by Contrast Media in Rats. Int J Nephrol 2020; 2020:3490641. [PMID: 32509347 PMCID: PMC7251452 DOI: 10.1155/2020/3490641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the protective effect and mechanism of rosuvastatin on acute renal injury induced by a nonionic hypotonic contrast medium in rats. Methods Forty-eight healthy adult SD rats were randomly divided into three groups: normal control group (NC); contrast medium control group (CM); and rosuvastatin intervention group (RI). The RI group was intragastrically administered with a 10 mg/kg of rosuvastatin 12 h prior to the contrast exposure. All rats in CM and RI groups were inoculated with 10 mL/kg of chemical (IV) while the same volume of saline for the NC group. At 24 h and 72 h posttreatments, pathomorphological changes of renal tubules were documented, respectively, and several biochemical indicators were tested to assess renal injury of experimental rats. Results Compared with the CM group, rats in the RI group showed significantly reduced injury of kidneys and decreased levels of biochemical indicators such as blood Scr, blood Cys-C, urine NAG, urine α1-MG, and urine mALB. The serum Hs-CRP in the CM group increased significantly from 24 h to 72 h (p < 0.05), but this was not observed in the rats of the RI group. In addition, SOD activity in the RI group was significantly increased (p < 0.01) while SOD activity in renal tissue decreased significantly with time in the CM group (p < 0.05). Conclusion Short-term intervention with rosuvastatin can lead to reduced kidney damage associated with the contrast agent by reducing the levels of inflammatory factors and oxidative stress. Thus, rosuvastatin intervention has a protective effect on rats from contrast-induced nephropathy.
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22
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Lei L, Xue Y, Guo Z, Liu B, He Y, Liu J, Nie Z, Chen L, Chen K, Huang Z, Liang M, Chen S, Liu Y, Chen J. Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study. BMJ Open 2020; 10:e037256. [PMID: 32461299 PMCID: PMC7259871 DOI: 10.1136/bmjopen-2020-037256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To establish a nomogram for contrast-induced acute kidney injury (CI-AKI) risk assessment among patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). DESIGN Prospective observational cohort study. SETTING Southern China. INTERVENTIONS None. PARTICIPANTS 643 consecutive patients with CKD (defined as estimated glomerular filtration rate calculated by Modification of Diet in Renal Disease formula <60 mL/min/1.73 mm2) were enrolled. OUTCOME MEASURES The end point was CI-AKI defined as serum creatinine elevation ≥0.5 mg/dL or 25% from baseline within the first 48-72 hours following contrast exposure.Predictors of CI-AKI were selected by multivariable logistic regression and stepwise approach. A nomogram based on these predictors was constructed and compared with the classic Mehran Score. For validation, a bootstrap method (1000 times) was performed. RESULTS The nomogram including age, weight, heart rate, hypotension, PCI and β-blocker demonstrated a better predictive value than the classic Mehran Score (area under the curve: 0.78 vs 0.71, p=0.024), as well as a well-fitted calibration curve (χ2=12.146, p=0.145). Validation through the bootstrap method (1000 times) also indicated a good discriminative power (adjusted C-statistic: 0.76). CONCLUSIONS With fewer predictors and higher discriminative power, the present nomogram may be a simple and reliable tool to identify patients with CKD at risk of CI-AKI, whereas further external validations are needed.
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Affiliation(s)
- Li Lei
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Yan Xue
- Department of Cardiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhaodong Guo
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Bowen Liu
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yibo He
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Jin Liu
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Zhiqiang Nie
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Liling Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Zhidong Huang
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Min Liang
- Department of Respiratory Medicine, Maoming People's Hospital, Maoming, Guangdong, China
| | - Shiqun Chen
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Yong Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Jiyan Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Affaliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
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23
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A comparison between different definitions of contrast-induced acute kidney injury for long-term mortality in patients with acute myocardial infarction. IJC HEART & VASCULATURE 2020; 28:100522. [PMID: 32382653 PMCID: PMC7200302 DOI: 10.1016/j.ijcha.2020.100522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/14/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
CI-AKI is associated with prognosis in AMI patients irrespective of its definitions. CI-AKIC (Scr elevation ≥ 25% in the first 72 h) had the highest prevalence (18.77%) CI-AKIA (Scr elevation ≥ 50%/ ≥0.3 mg/dL in the first 72 h) had the highest PAR.
Background Few studies have demonstrated the association between contrast-induced acute kidney injury (CI-AKI) and long-term mortality and explored which definition of CI-AKI accounts for most long-term deaths among patients with acute myocardial infarction (AMI). Therefore, we aimed to evaluate this association and compared the population attributable risks (PARs) of three CI-AKI definitions. Methods We analyzed 1300 consecutive AMI patients undergoing angiography in Guangdong Provincial People‘s Hospital. The endpoint was all-cause mortality. CI-AKI was evaluated according to three definitions: (1) CI-AKIA, with a serum creatinine elevation ≥ 50% or ≥ 0.3 mg/dL from baseline in the first 72 h after procedure; (2) CI-AKIB, ≥ 0.5 mg/dL in 72 h; (3) CI-AKIC: ≥ 25% in 72 h; multivariable Cox analysis was conducted to evaluate the association between CI-AKI and long-term mortality. PARs of CI-AKI under different definitions were calculated with their odds ratios and prevalence among our cohort. Results During the median follow-up period of 7.0 (5.5; 8.7) years, CI-AKI was significantly associated with poorer outcome regardless of the definition (adjusted hazard ratios: 1.417–2.711). Among the three definitions of CI-AKI, the prevalence was the highest for CI-AKIC (18.77%), and PAR was the highest for CI-AKIA (11.62%, 95% CI: 4.99–19.71), followed by CI-AKIB (9.20%, 95% CI: 4.22–16.00) and CI-AKIC (7.26%, 95% CI: 0.21–15.62). Conclusions Our results suggested that CI-AKI is associated with long-term mortality in patients with AMI irrespective of its definitions. Cardiologists and studies regarding long-term prognosis should pay more attention to the presence of CI-AKI, especially CI-AKIA with the highest PAR.
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24
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Çınar T, Karabağ Y, Ozan Tanık V, Çağdaş M, Rencüzoğulları İ, Öz A. The investigation of TIMI risk index for prediction of contrast-induced acute kidney injury in patients with ST elevation myocardial infarction. Acta Cardiol 2020; 75:77-84. [PMID: 30678606 DOI: 10.1080/00015385.2018.1551263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Contrast-induced acute kidney injury (CI-AKI) is a well-known and life-threating complication in patients with ST-elevation myocardial infraction (STEMI) after primary percutaneous coronary intervention (PCI). Several studies demonstrated that the Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a useful risk model in predicting early mortality in patients with acute coronary syndrome. The objective of the present study is to evaluate the predictive value of admission TRI for the occurrence of CI-AKI in patients with STEMI treated with primary PCI.Methods: This retrospective study was consisted of a total of 660 consecutive STEMI patients who had undergone primary PCI from December 2015 to March 2017.The primary end-point was CI-AKI incidence after primary PCI during the in-hospital course.Results: The TRI of CI-AKI group was higher than the non-CI-AKI group (24.2 (19.3-32.2) vs. 17.5 (12.9-24.3), p < .001, respectively). In multivariable logistic regression analysis, TRI was found to be an independent predictors of CI-AKI (OR: 1.055, 95% CI: 1.027-1.083, p < .001). The discriminative power of TRI with regards to occurrence of CI-AKI was superior compared to its components.Conclusion: This study is the first to demonstrate that TRI can be used to predict the development of CI-AKI in patients with STEMI who undergo primary PCI. Health professionals might be able to use the TRI risk score to predict CI-AKI due to the simplicity and accessibility of this risk index.
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Affiliation(s)
- Tufan Çınar
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Karabağ
- Department of Cardiology, Kafkas University, Kars, Turkey
| | - Veysel Ozan Tanık
- Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Metin Çağdaş
- Department of Cardiology, Kafkas University, Kars, Turkey
| | | | - Ahmet Öz
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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25
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Zahler D, Rozenfeld KL, Merdler I, Peri Y, Shacham Y. Contrast Volume to Glomerular Filtration Ratio and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention. Cardiorenal Med 2019; 10:108-115. [PMID: 31801134 DOI: 10.1159/000504534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/01/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The ratio of contrast media volume to glomerular filtration rate (contrast/GFR) has been shown to correlate with the occurrence of contrast-induced acute kidney injury (CI-AKI) in unselected patient populations who underwent percutaneous coronary intervention (PCI). OBJECTIVE We evaluated the possible utilization of this marker and optimal cutoff among ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. METHODS We retrospectively included 419 patients with STEMI treated with primary PCI. The occurrence of CI-AKI was defined by the KDIGO criteria as an increase in serum creatinine of ≥0.3 mg/dL within 48 h following PCI. A receiver-operator characteristic (ROC) curve was used to identify the optimal cutoff value of contrast/GFR ratio to predict CI-AKI. This value was then assessed using multivariable logistic regression. RESULTS The overall incidence of CI-AKI was 9%. The contrast/GFR ratio was significantly higher among patients with CI-AKI (2.7 ± 1.2 vs. 1.9 ± 0.9; p < 0.001). According to the ROC curve analysis, the optimal cutoff value of contrast/GFR ratio to predict AKI was measured as ≥2.13, with 70% sensitivity and 60% specificity (AUC 0.65, 95% CI 0.56-0.74; p = 0.002). In a multivariate logistic regression model, contrast/GFR ratio ≥2.13 was independently associated with CI-AKI (OR 2.46, 95% CI 1.09-5.57; p = 0.03). CONCLUSIONS Among STEMI patients undergoing primary PCI, contrast/GFR ratio ≥2.13 was independently associated with CI-AKI.
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Affiliation(s)
- David Zahler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren-Lee Rozenfeld
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,
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26
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the Use of Iodinated Contrast Media in Patients With Kidney Disease 2018. Circ J 2019; 83:2572-2607. [PMID: 31708511 DOI: 10.1253/circj.cj-19-0783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshitaka Isaka
- Japanese Society of Nephrology.,Department of Nephrology, Osaka University Graduate School of Medicine
| | - Hiromitsu Hayashi
- Japan Radiological Society.,Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School
| | - Kazutaka Aonuma
- the Japanese Circulation Society.,Cardiology Department, Institute of Clinical Medicine, University of Tsukuba
| | - Masaru Horio
- Japanese Society of Nephrology.,Kansai Medical Hospital
| | - Yoshio Terada
- Japanese Society of Nephrology.,Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University
| | - Kent Doi
- Japanese Society of Nephrology.,Department of Acute Medicine, The University of Tokyo
| | - Yoshihide Fujigaki
- Japanese Society of Nephrology.,Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Hideo Yasuda
- Japanese Society of Nephrology.,First Department of Medicine, Hamamatsu University School of Medicine
| | - Taichi Sato
- Japanese Society of Nephrology.,First Department of Medicine, Hamamatsu University School of Medicine
| | - Tomoyuki Fujikura
- Japanese Society of Nephrology.,First Department of Medicine, Hamamatsu University School of Medicine
| | - Ryohei Kuwatsuru
- Japan Radiological Society.,Department of Radiology, Graduate School of Medicine, Juntendo University
| | - Hiroshi Toei
- Japan Radiological Society.,Department of Radiology, Graduate School of Medicine, Juntendo University
| | - Ryusuke Murakami
- Japan Radiological Society.,Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School
| | - Yoshihiko Saito
- the Japanese Circulation Society.,Department of Cardiovascular Medicine, Nara Medical University
| | - Atsushi Hirayama
- the Japanese Circulation Society.,Department of Cardiology, Osaka Police Hospital
| | - Toyoaki Murohara
- the Japanese Circulation Society.,Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akira Sato
- the Japanese Circulation Society.,Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Hideki Ishii
- the Japanese Circulation Society.,Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tadateru Takayama
- the Japanese Circulation Society.,Division of General Medicine, Department of Medicine, Nihon University School of Medicine
| | - Makoto Watanabe
- the Japanese Circulation Society.,Department of Cardiovascular Medicine, Nara Medical University
| | - Kazuo Awai
- Japan Radiological Society.,Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Seitaro Oda
- Japan Radiological Society.,Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
| | - Takamichi Murakami
- Japan Radiological Society.,Department of Radiology, Kobe University Graduate School of Medicine
| | - Yukinobu Yagyu
- Japan Radiological Society.,Department of Radiology, Kindai University, Faculty of Medicine
| | - Nobuhiko Joki
- Japanese Society of Nephrology.,Division of Nephrology, Toho University Ohashi Medical Center
| | - Yasuhiro Komatsu
- Japanese Society of Nephrology.,Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine
| | | | - Yugo Ito
- Japanese Society of Nephrology.,Department of Nephrology, St. Luke's International Hospital
| | - Ryo Miyazawa
- Japan Radiological Society.,Department of Radiology, St. Luke's International Hospital
| | - Yoshihiko Kanno
- Japanese Society of Nephrology.,Department of Nephrology, Tokyo Medical University
| | - Tomonari Ogawa
- Japanese Society of Nephrology.,Department of Nephrology & Hypertension, Saitama Medical Center
| | - Hiroki Hayashi
- Japanese Society of Nephrology.,Department of Nephrology, Fujita Health University School of Medicine
| | - Eri Koshi
- Japanese Society of Nephrology.,Department of Nephrology, Komaki City Hospital
| | - Tomoki Kosugi
- Japanese Society of Nephrology.,Nephrology, Nagoya University Graduate School of Medicine
| | - Yoshinari Yasuda
- Japanese Society of Nephrology.,Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine
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Isaka Y, Hayashi H, Aonuma K, Horio M, Terada Y, Doi K, Fujigaki Y, Yasuda H, Sato T, Fujikura T, Kuwatsuru R, Toei H, Murakami R, Saito Y, Hirayama A, Murohara T, Sato A, Ishii H, Takayama T, Watanabe M, Awai K, Oda S, Murakami T, Yagyu Y, Joki N, Komatsu Y, Miyauchi T, Ito Y, Miyazawa R, Kanno Y, Ogawa T, Hayashi H, Koshi E, Kosugi T, Yasuda Y. Guideline on the use of iodinated contrast media in patients with kidney disease 2018. Jpn J Radiol 2019; 38:3-46. [PMID: 31709498 DOI: 10.1007/s11604-019-00850-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiromitsu Hayashi
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazutaka Aonuma
- Cardiology Department, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Fujigaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Taichi Sato
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroshi Toei
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryusuke Murakami
- Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadateru Takayama
- Division of General Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiro Komatsu
- Department of Healthcare Quality and Safety, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Yugo Ito
- Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Ryo Miyazawa
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Tomonari Ogawa
- Department of Nephrology and Hypertension, Saitama Medical Center, Saitama, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Eri Koshi
- Department of Nephrology, Komaki City Hospital, Aichi, Japan
| | - Tomoki Kosugi
- Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshinari Yasuda
- Department of CKD Initiatives/Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan
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28
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Usai MV, Gerwing M, Gottschalk A, Sporns P, Heindel W, Oberhuber A, Wildgruber M, Köhler M. Intra-arterial catheter-directed CT angiography for assessment of endovascular aortic aneurysm repair. PLoS One 2019; 14:e0221375. [PMID: 31504047 PMCID: PMC6736289 DOI: 10.1371/journal.pone.0221375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety as well as associated image quality of catheter-directed CT angiography (CCTA) with a low dose of iodine contrast agent compared to intravenous CTA in patients undergoing endovascular aortic aneurysm repair (EVAR). METHODS Retrospective data analysis of 92 patients undergoing EVAR between January 2009 and December 2017 was performed. Patients were divided in two groups; those receiving CTA (n = 59) after intravenous contrast agent application and those receiving CCTA (n = 33) via an intraarterial catheter placed in the descending aorta. Demographic and cardiovascular risk factors as well as renal function parameters before, immediately after and 6-60 months after EVAR were evaluated. As primary endpoint, changes in serum creatinine levels in the two groups were evaluated. Secondary endpoints encompassed complications associated with intraarterial catheter placement. Objective (signal-to-noise ratios) and subjective image quality (5-point Likert scale) were compared. RESULTS Amount of contrast medium was significantly lower in CCTA compared to i.v. CTA (23 ± 7 ml vs. 119 ± 15 ml, p<0.0001). Patients undergoing catheter-directed CTA had higher baseline creatinine values compared to the group with intravenous iodine application (1.9 ± 0.6 mg/dl vs. 1.3 ± 0.5 mg/dl; p<0.0001). Follow-up serum creatinine levels however did not show significant alterations between the two groups (1.9 ± 0.4 mg/dl vs. 1.3 ± 0.5 mg/dl). No major complications were detected in the CCTA group. Signal-to-noise ratio (SNR) was comparable between i.v. CTA and CCTA (8.5 ± 4.6 vs. 7.7 ± 4.0; p = 0.37) and subjective image similarly revealed no differences with a good interobserver agreement (ICC = 0.647). CONCLUSIONS Catheter-directed CTA is safe and provides comparable image quality with a substantial retrenchment of the needed amount of iodine-based contrast medium. However, no benefit of the reduced contrast medium protocol with respect to renal function was observed.
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Affiliation(s)
- Marco V. Usai
- Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Antje Gottschalk
- Department of Anesthesiology, Intensive Care and Pain Medicine, Münster, University Hospital Münster, Germany
| | - Peter Sporns
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany
| | - Moritz Wildgruber
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
- * E-mail:
| | - Michael Köhler
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
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29
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Shacham Y. Acute kidney injury in acute myocardial infarction — A never-ending story? Int J Cardiol 2019; 283:64-65. [DOI: 10.1016/j.ijcard.2019.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
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30
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Liu Y, Hong D, Wang AY, Guo R, Smyth B, Liu J, Sun G, Chen S, Tan N, Jardine M, Brieger D, Shaman A, Islam S, Chen J, Gallagher M. Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2019; 19:87. [PMID: 30961544 PMCID: PMC6454772 DOI: 10.1186/s12872-019-1054-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/20/2019] [Indexed: 02/05/2023] Open
Abstract
Background The role of intravenous hydration at the time of primary percutaneous intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. Guidelines are vague, supported by low level evidence, and hydration is used less often than other clinical settings.To perform a systematic review and meta-analysis of all randomized controlled trials assessing intravenous hydration compared with non-hydration for prevention of contrast induced nephropathy (CIN) and In-hospital mortality in patients with STEMI undergoing primary PCI. Methods Medline, EMBASE and the Cochrane Register were searched to September 2018. Included studies reported the incidence of CIN, In-hospital mortality, requirement for dialysis and heart failure. Relative risks with 95% confidence intervals (CIs) for individual trials were pooled using a random effects model. Results Three moderate quality trials were identified including 1074 patients. Overall, compared with no hydration, intravenous hydration significantly reduced the incidence of CIN by 42% (RR 0.58; 95% CI: 0.45 to 0.74, p < 0.001). The estimated effects upon all-cause mortality (RR 0.56; 95% CI: 0.30 to 1.02, p = 0.057) and the requirement for dialysis (RR 0.52, 95% CI 0.14–1.88, p = 0.462) were not statistically significant. The outcome of heart failure was not consistently reported. Conclusions Intravenous hydration likely reduces the incidence of CIN in patients with STEMI undergoing primary PCI. However, for key clinical outcomes such as mortality, heart failure and dialysis the effect estimates were imprecise. Further high quality studies are needed to clarify the appropriate volume of fluid and effects on outcomes. Electronic supplementary material The online version of this article (10.1186/s12872-019-1054-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangzhou, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.,The George Institute for Global Health, the University of Sydney, Camperdown, Australia
| | - Daqing Hong
- Renal Department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China
| | - Amanda Ying Wang
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia.
| | - Rui Guo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Brendan Smyth
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia
| | - Jin Liu
- Department of Cardiology, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangzhou, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Guoli Sun
- Department of Cardiology, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangzhou, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangzhou, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangzhou, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Meg Jardine
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia
| | - David Brieger
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia
| | - Ahmed Shaman
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia.,King Saud University, Riyadh, Saudi Arabia
| | - Shariful Islam
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia
| | - Jiyan Chen
- Department of Cardiology, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology Guangzhou, Guangzhou, Guangdong, China. .,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Martin Gallagher
- The George Institute for Global Health, the University of Sydney, Camperdown, Australia. .,Concord Clinical School, Sydney Medical School, University of Sydney, Camperdown, Australia.
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31
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Long-term renal outcomes and mortality following renal injury among myocardial infarction patients treated by primary percutaneous intervention. Coron Artery Dis 2019; 30:87-92. [DOI: 10.1097/mca.0000000000000678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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32
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Negishi Y, Tanaka A, Ishii H, Takagi K, Inoue Y, Uemura Y, Umemoto N, Yoshioka N, Morishima I, Asano H, Watarai M, Shibata N, Suzuki S, Murohara T. Contrast-Induced Nephropathy and Long-Term Clinical Outcomes Following Percutaneous Coronary Intervention in Patients With Advanced Renal Dysfunction (Estimated Glomerular Filtration Rate <30 ml/min/1.73 m 2). Am J Cardiol 2019; 123:361-367. [PMID: 30477803 DOI: 10.1016/j.amjcard.2018.10.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
Abstract
The incidence of contrast-induced nephropathy (CIN) increases with the progression of renal dysfunction. Recent reports have shown that percutaneous coronary intervention (PCI) can be safely performed even in patients with advanced renal dysfunction by appropriate CIN-prevention strategies. However, data are limited regarding the occurrence and prognostic influence of CIN in patients with advanced renal dysfunction. We examined the data obtained from 323 consecutive patients with advanced renal dysfunction (eGFR <30 ml/min/1.73 m2) who underwent PCI at 5 hospitals. CIN was defined as a ≥25% increase in baseline serum creatinine levels and/or a ≥0.5 mg/dl increase in absolute serum creatinine levels within 72 hours after PCI. Incidence of all-cause death and the initiation of permanent dialysis were examined during follow-up. The prevalence of emergency/urgent PCI was 53.3%. Intravascular ultrasound was used in 266 patients (82.4%), and the volume of contrast used was 71.7 ± 57.2 ml. CIN was observed in 31 patients (9.7%). The median follow-up duration was 656 days (interquartile range 257-1143 days). The cumulative rates of all-cause death or the initiation of permanent dialysis, all-cause death, and the initiation of permanent dialysis were 38.1%, 25.9%, and 18.2%, respectively, at 2 years. A comparison between patients with and without CIN showed no significant intergroup differences in the occurrence of the aforementioned events. In conclusion, the incidence of CIN was not high in Japanese patients with advanced renal dysfunction in routine clinical practice. Whereas, the long-term prognosis following PCI is observed to be poor in this studied population, and CIN did not show a significant prognostic influence.
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33
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Fortrie G, de Geus HRH, Betjes MGH. The aftermath of acute kidney injury: a narrative review of long-term mortality and renal function. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:24. [PMID: 30678696 PMCID: PMC6346585 DOI: 10.1186/s13054-019-2314-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/07/2019] [Indexed: 12/21/2022]
Abstract
Acute kidney injury (AKI) is a frequent complication of hospitalization and is associated with an increased risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality. While AKI is a known risk factor for short-term adverse outcomes, more recent data suggest that the risk of mortality and renal dysfunction extends far beyond hospital discharge. However, determining whether this risk applies to all patients who experience an episode of AKI is difficult. The magnitude of this risk seems highly dependent on the presence of comorbid conditions, including cardiovascular disease, hypertension, diabetes mellitus, preexisting CKD, and renal recovery. Furthermore, these comorbidities themselves lead to structural renal damage due to multiple pathophysiological changes, including glomeruloscleroses and tubulointerstitial fibrosis, which can lead to the loss of residual capacity, glomerular hyperfiltration, and continued deterioration of renal function. AKI seems to accelerate this deterioration and increase the risk of death, CDK, and ESRD in most vulnerable patients. Therefore, we strongly advocate adequate hemodynamic monitoring and follow-up in patients susceptible to renal dysfunction. Additionally, other potential renal stressors, including nephrotoxic medications and iodine-containing contrast fluids, should be avoided. Unfortunately, therapeutic interventions are not yet available. Additional research is warranted and should focus on the prevention of AKI, identification of therapeutic targets, and provision of adequate follow-up to those who survive an episode of AKI.
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Affiliation(s)
- Gijs Fortrie
- Department of Internal Medicine, Division of Nephrology, and Transplantation, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Hilde R H de Geus
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Department of Internal Medicine, Division of Nephrology, and Transplantation, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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34
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Yang Y, George KC, Luo R, Cheng Y, Shang W, Ge S, Xu G. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol 2018; 19:374. [PMID: 30577763 PMCID: PMC6303898 DOI: 10.1186/s12882-018-1161-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 11/28/2018] [Indexed: 01/20/2023] Open
Abstract
Background Recent studies have shown associations between contrast-induced acute kidney injury (CI-AKI) and increased risk of adverse clinical outcomes in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI); however, the estimates are inconsistent and vary widely. Therefore, this meta-analysis aimed to evaluate the precise associations between CI-AKI and adverse clinical consequences in patients undergoing PCI for ACS. Methods EMBASE, PubMed, Web of Science™ and Cochrane Library databases were systematically searched from inception to December 16, 2016 for cohort studies assessing the association between CI-AKI and any adverse clinical outcomes in ACS patients treated with PCI. The results were demonstrated as pooled risk ratios (RRs) with 95% confidence intervals (CI). Heterogeneity was explored by subgroup analyses. Results We identified 1857 articles in electronic search, of which 22 (n = 32,781) were included. Our meta-analysis revealed that in ACS patients undergoing PCI, CI-AKI significantly increased the risk of adverse clinical outcomes including all-cause mortality (18 studies; n = 28,367; RR = 3.16, 95% CI 2.52–3.97; I2 = 56.9%), short-term all-cause mortality (9 studies; n = 13,895; RR = 5.55, 95% CI 3.53–8.73; I2 = 60.1%), major adverse cardiac events (7 studies; n = 19,841; RR = 1.49, 95% CI: 1.34–1.65; I2 = 0), major adverse cardiovascular and cerebrovascular events (3 studies; n = 2768; RR = 1.86, 95% CI: 1.42–2.43; I2 = 0) and stent restenosis (3 studies; n = 130,678; RR = 1.50, 95% CI: 1.24–1.81; I2 = 0), respectively. Subgroup analyses revealed that the studies with prospective cohort design, larger sample size and lower prevalence of CI-AKI might have higher short-term all-cause mortality risk. Conclusions CI-AKI may be a prognostic marker of adverse outcomes in ACS patients undergoing PCI. More attention should be paid to the diagnosis and management of CI-AKI. Electronic supplementary material The online version of this article (10.1186/s12882-018-1161-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi Yang
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Kaisha C George
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Ran Luo
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Yichun Cheng
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Weifeng Shang
- Department of Nephrology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, People's Republic of China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China.
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
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35
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Zhang E, Lu Y, Chen G, Huang L, Zhang J, Wang C, Qin Q. Predictive Value of Hepatorenal Status in Contrast-Induced Nephropathy Among Patients Receiving Coronary Angiography and/or Intervention: A Systematic Review and Meta-Analysis. Angiology 2018; 70:633-641. [PMID: 30525915 DOI: 10.1177/0003319718816206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Low serum albumin, high blood urea nitrogen (BUN), and uric acid are regarded closely related to the incidence of contrast-induced nephropathy (CIN), whereas it remains unclear whether they can function as predictors of CIN onset. The objective of this systematic review and meta-analysis was to explore the association between abovementioned indicators and CIN incidence rate in patients receiving coronary angiography (CAG) and/or intervention. METHODS Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and ScienceDirect from their inception to July 13, 2018. Meta-analysis was performed on pooled eligible studies to determine whether these hepatorenal indicators were associated with CIN. RESULTS A total of 18 studies involving 16 171 patients were included in the meta-analysis. Pooled analysis results revealed that patients with hypoalbuminemia (odds ratio [OR] = 3.09, 95% confidence interval [CI] = 1.44-6.64, P = .004) and hyperuricemia (OR = 1.32, 95% CI = 1.15-1.50, P < .0001) both exhibited significantly higher CIN rates, regardless of the study design, renal function, and whether urgent clinical situation or not. However, there was no significant association between serum BUN and CIN risk. CONCLUSION Hypoalbuminemia and hyperuricemia are independently associated with the occurrence of CIN among the patients undergoing CAG and/or intervention.
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Affiliation(s)
- Enyuan Zhang
- 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yaru Lu
- 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Gang Chen
- 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Lingyu Huang
- 2 Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
| | - Jingkun Zhang
- 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chengjian Wang
- 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Qin Qin
- 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.,2 Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
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Otsuka K, Shimada K, Katayama H, Nakamura H, Ishikawa H, Takeda H, Fujimoto K, Kasayuki N, Yoshiyama M. Prognostic significance of renal dysfunction and its change pattern on outcomes in patients with acute coronary syndrome treated with emergent percutaneous coronary intervention. Heart Vessels 2018; 34:735-744. [DOI: 10.1007/s00380-018-1291-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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Yuan Y, Qiu H, Hu XY, Luo T, Gao XJ, Zhao XY, Zhang J, Wu Y, Qiao SB, Yang YJ, Gao RL. Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention. Chin Med J (Engl) 2018; 131:2041-2048. [PMID: 30127213 PMCID: PMC6111677 DOI: 10.4103/0366-6999.239316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI). Methods Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed. Results A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min-1·1.73 m-2), 26.0% (118/454) in Group 2 (120 ml·min-1·1.73 m-2> eGFR ≥90 ml·min-1·1.73m-2), 18.3% (86/469) in Group 3 (90 ml·min-1·1.73 m-2> eGFR ≥60 ml·min-1·1.73 m-2), 21.8% (26/119) in Group 4 (60 ml·min-1·1.73 m-2> eGFR ≥30 ml·min-1·1.73 m-2), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min-1·1.73 m-2), with statistical significance (χ2 = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min-1·1.73 m-2). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ2 = 16.26, P = 0.009 at 6-month follow-up, and χ2 = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients. Conclusions High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.
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Affiliation(s)
- Ying Yuan
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hong Qiu
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Ying Hu
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Tong Luo
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiao-Jin Gao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xue-Yan Zhao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Zhang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yuan Wu
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu-Bin Qiao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yue-Jin Yang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Run-Lin Gao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Lin KY, Wu ZY, You ZB, Zheng WP, Lin CJ, Jiang H, Ruan JM, Guo YS, Zhu PL. Pre-Procedural N-Terminal Pro-B Type Natriuretic Peptide Predicts Contrast-Induced Acute Kidney Injury and Long-Term Outcome in Elderly Patients After Elective Percutaneous Coronary Intervention. Int Heart J 2018; 59:926-934. [PMID: 30158378 DOI: 10.1536/ihj.17-573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study is to evaluate the association of pre-procedural N-terminal pro-B type natriuretic peptide (NT-proBNP) with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in elderly patients undergoing elective percutaneous coronary intervention (PCI).A total of 540 patients aged ≥ 75 years who had undergone elective PCI between January 2012 and December 2015 were enrolled in this study. Admission NT-proBNP levels were measured before PCI. CI-AKI was defined as a relative increase in serum creatinine (SCr) of ≥50%, or an absolute increase of ≥ 0.3 mg/dL, occurring within 48 hours after contrast medium exposure. The predictive value of NT-proBNP for predicting CI-AKI was assessed by receiver operating characteristic (ROC) and multivariable logistic regression analysis.A total of 54 (10.0%) patients developed CI-AKI. The best cutoff value of NT-pro-BNP for detecting CI-AKI was 1133 pg/mL with 66.7% sensitivity and 70.8% specificity according to the ROC analysis (C statistic = 0.719; 95% CI, 0.679-0.756). Multivariable analysis demonstrated that Lg-NT-proBNP is significantly related to CI-AKI (odds ratio [OR] = 3.892; 95% CI, 1.996-7.590; P < 0.001). Cox regression analysis showed that Lg-NT-proBNP is associated with long-term mortality (adjusted hazard ratio [HR] = 2.158; 95% CI, 1.246-3.740; P = 0.006) during follow-up.Pre-procedural NT-proBNP is a significant and independent predictor of CI-AKI and long-term mortality in elderly patients following elective PCI, and the best cutoff point for predicting CI-AKI was 1133 pg/mL.
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Affiliation(s)
- Kai-Yang Lin
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute
| | - Zhi-Yong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute
| | - Zhe-Bin You
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University
| | - Wei-Ping Zheng
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University
| | - Chun-Jin Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University
| | - Hui Jiang
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute
| | - Jing-Ming Ruan
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University
| | - Yan-Song Guo
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute
| | - Peng-Li Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University
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Pickering JW, Blunt IRH, Than MP. Acute Kidney Injury and mortality prognosis in Acute Coronary Syndrome patients: A meta-analysis. Nephrology (Carlton) 2018; 23:237-246. [PMID: 27990707 DOI: 10.1111/nep.12984] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to provide a robust estimate of mortality risk in acute coronary syndrome (ACS)-associated acute kidney injury (AKI) to inform clinical practice and policy. METHODS A meta-analysis of cohort studies evaluating outcomes of ACS and which reported AKI and AKI-associated mortality. Studies were excluded if they incorporated patients not admitted through the emergency department (i.e. for elective procedures), were limited to cardiogenic shock or cardiac arrest, or relied on registry data for outcomes without further adjudication. The predictor was ACS-associated AKI and outcomes early (30 day or in-hospital) mortality and late-mortality (post-hospital discharge). RESULTS Thirty-six studies with 37 unique cohorts comprising 100 476 patients were included. The pooled rate of ACS-associated AKI was 15.8%. In 32 cohorts reporting early mortality, the crude early mortality rate was 15.0% amongst those with AKI compared with 2.0% amongst those without AKI. The pooled estimate of the relative risk of AKI-associated early mortality was 4.1 (95% confidence interval: 3.3 to 5.0) with high heterogeneity between studies (I 2 = 84% (61% to 88%)). When heterogeneity was accounted for mathematically using credibility ceilings, the risk of mortality was lower, but still clinically significant (3.1 (2.6 to 3.6)). In 19 cohorts reporting late mortality (1 to 10 years), the relative risk of AKI-associated mortality was 2.6 (2.0 to 3.3) with moderate heterogeneity (I 2 = 65 % [35% to 88%]). Following application of credibility ceiling relative risk estimate dropped to 2.2 (1.9 to 2.6). CONCLUSIONS Acute coronary syndrome-associated AKI is associated with more than a three-fold increase in early mortality and more than two-fold in long-term mortality.
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Affiliation(s)
- John W Pickering
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Emergency Department, Christchurch hospital, Christchurch, New Zealand
| | | | - Martin P Than
- Emergency Department, Christchurch hospital, Christchurch, New Zealand
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40
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Women and acute kidney injury in myocardial infarction. J Nephrol 2018; 31:713-719. [DOI: 10.1007/s40620-018-0504-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/25/2018] [Indexed: 11/25/2022]
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41
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Lin KY, Shang XL, Guo YS, Zhu PL, Wu ZY, Jiang H, Ruan JM, Zheng WP, You ZB, Lin CJ. Association of Preprocedural Hyperglycemia With Contrast-Induced Acute Kidney Injury and Poor Outcomes After Emergency Percutaneous Coronary Intervention. Angiology 2018; 69:770-778. [PMID: 29463106 DOI: 10.1177/0003319718758140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We investigated whether preprocedural hyperglycemia was associated with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in patients with acute coronary syndrome (ACS) who underwent emergency percutaneous coronary intervention (PCI). Patients (n = 558) with ACS who underwent emergency PCI were consecutively enrolled. Preprocedural hyperglycemia was defined as glucose levels >198 mg/dL (11 mmol/L). The primary outcome was CI-AKI (≥0.3 mg/dL absolute or ≥50% relative serum creatinine increase 48 hours after contrast medium exposure). Overall, 103 (18.5%) patients had preprocedural hyperglycemia and 89 (15.9%) patients developed CI-AKI. The incidence of CI-AKI was significantly higher in patients with hyperglycemia than without (28.2% vs 13.2%; P < .01). Multivariate analysis indicated that preprocedural hyperglycemia was an independent predictor of CI-AKI (odds ratio = 1.971, 95% confidence interval [CI]: 1.129-3.441; P < .05). In addition, preprocedural hyperglycemia was associated with an increased risk of all-cause mortality during the 2-year follow-up (hazard ratio = 2.440, 95% CI: 1.394-4.273; P = .002). Preprocedural hyperglycemia is a significant and independent predictor of CI-AKI and long-term outcomes.
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Affiliation(s)
- Kai-Yang Lin
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China.,2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Ling Shang
- 3 Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Yan-Song Guo
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Peng-Li Zhu
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Zhi-Yong Wu
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Hui Jiang
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Jing-Ming Ruan
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China.,2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Wei-Ping Zheng
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Zhe-Bin You
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Chun-Jin Lin
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
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The Incidence and the Prognostic Impact of Acute Kidney Injury in Acute Myocardial Infarction Patients: Current Preventive Strategies. Cardiovasc Drugs Ther 2018; 32:81-98. [DOI: 10.1007/s10557-017-6766-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Margolis G, Gal-Oz A, Letourneau-Shesaf S, Khoury S, Keren G, Shacham Y. Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrol 2017; 31:423-428. [PMID: 29185210 DOI: 10.1007/s40620-017-0461-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) following acute ST elevation myocardial infarction (STEMI) is associated with adverse outcomes. The recently proposed KDIGO criteria suggested modifications to the consensus classification system for AKI, namely lowering the threshold of increase in absolute serum creatinine and extending the time frame for AKI detection to 7 days. We evaluated the incidence, risk factors, and long-term mortality associated with AKI as classified by the KDIGO definition in a large single center cohort of consecutive STEMI patients. METHODS We retrospectively studied 2122 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). Recruited patients were admitted between January 2008 and May 2016 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of the KDIGO and consensus criteria for the diagnosis of AKI and its relation to long term mortality. RESULTS The KDIGO criteria allowed the identification of more patients as having AKI (10.6 vs. 5.6%, p < 0.001) compared to the consensus criteria. Even mild elevation of serum creatinine (≥ 0.3 mg/dL) was associated with a marked increase in all-cause mortality (HR 4.7, 95% CI 3.1-6.43, p < 0.001). Patients with AKI whose renal function resolved prior to hospital discharge still had significantly higher mortality compared to patients with no AKI (23 vs. 8%, HR 3.1, 95% CI 2.09-4.90, p < 0.001). CONCLUSION KDIGO criteria is more sensitive than the consensus criteria in defining AKI in STEMI patients and identifying populations at risk for long term adverse outcomes.
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Affiliation(s)
- Gilad Margolis
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sevan Letourneau-Shesaf
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Shafik Khoury
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel.
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Yuan Y, Qiu H, Song L, Hu X, Luo T, Zhao X, Zhang J, Wu Y, Qiao S, Yang Y, Gao R. A New Risk Factor Profile for Contrast-Induced Acute Kidney Injury in Patients Who Underwent an Emergency Percutaneous Coronary Intervention. Angiology 2017; 69:523-531. [PMID: 29082747 DOI: 10.1177/0003319717736157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We developed a new risk factor profile for contrast-induced acute kidney injury (CI-AKI) under a new definition in patients who underwent an emergency percutaneous coronary intervention (PCI). Consecutive patients (n = 1061) who underwent an emergency PCI were divided into a derivation group (n = 761) and a validation group (n = 300). The rates of CI-AKI were 23.5% (definition 1: serum creatinine [SCr] increase ≥25% in 72 hours), 4.3% (definition 2: SCr increase ≥44.2 μmol/L in 72 hours), and 7.0% (definition 3: SCr increase ≥44.2 μmol/L in 7 days). Due to the high sensitivity of definition 1 and the high rate of missed cases for late diagnosis of CI-AKI under definition 2, definition 3 was used in the study. The risk factor profile included body surface area <1.6 m2 ( P = .030), transient ischemic attack/stroke history ( P = .001), white blood cell count >15.00 × 109/L ( P = .047), estimated glomerular filtration rate <60 mL/min/1.73 m2 ( P = .002) or baseline SCr >133 μmol/L ( P = .007), intra-aortic balloon pump application ( P = .006), and diuretics administration ( P < .001), showing a significant predictive power in the derivation group and validation group. The new risk factor profile of CI-AKI under a new CI-AKI definition in emergency PCI patients is easily applicable with a useful predictive value.
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Affiliation(s)
- Ying Yuan
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Qiu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoying Hu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong Luo
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhao
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Wu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Abstract
PURPOSE OF REVIEW Reduction of kidney function and heart disease frequently coexisted in the seam patient. The relation between renal and heart function is quite complex and bring out some unresolved questions about diagnosis (mostly related to the biomarkers levels interpretation), pharmacological therapy (mostly related to drugs kinetics and efficacy), and non-pharmacological therapy. RECENT FINDINGS Patients with kidney dysfunction (KD) are frequently excluded and underrepresented in the large trials. It is well-known that coronary revascularization reduces mortality also in KD patients presenting with acute coronary syndrome. However, acute kidney injury (AKI), primarily related at contrast medium administration, is worse prognosis. For this reason, prevention, early diagnosis, and effective therapy of ACK are key elements in assistance of these patients. In this context, recently, some new biomarkers of renal function have been proposed. Frequently, patients with acute coronary syndromes and kidney disease are undertreated, worsening their prognosis. Undertreatment and comorbidities associated with renal dysfunction explain the higher mortality of these patients.
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Gohbara M, Hayakawa A, Akazawa Y, Furihata S, Kondo A, Fukushima Y, Tomari S, Endo T, Kimura K, Tamura K. Association Between Acidosis Soon After Reperfusion and Contrast-Induced Nephropathy in Patients With a First-Time ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.006380. [PMID: 28835362 PMCID: PMC5586466 DOI: 10.1161/jaha.117.006380] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Contrast‐induced nephropathy (CIN) is associated with poor outcomes in patients with acute myocardial infarction. However, the predictors of CIN have yet to be fully elucidated. Methods and Results The study included 273 consecutive patients with a first‐time ST‐segment elevation myocardial infarction who underwent reperfusion within 12 hours of symptom onset. The exclusion criteria were hemodialysis, mechanical ventilation, or previous coronary artery bypass grafting. All patients underwent arterial blood gas analysis soon after reperfusion. CIN was defined as an increase of 0.5 mg/dL in serum creatinine or a 25% increase from baseline between 48 and 72 hours after contrast medium exposure. Acidosis was defined as an arterial blood pH <7.35. CIN was observed in 35 patients (12.8%). Multivariable logistic regression analysis with forward stepwise algorithm revealed a significant association between CIN and the following: reperfusion time, the prevalence of hypertension, peak creatine kinase‐MB, high‐sensitivity C‐reactive protein on admission, and the incidence of acidosis (P<0.05). Multivariable logistic regression analysis revealed that the incidence of acidosis was associated with CIN when adjusted for age, male sex, body mass index, amount of contrast medium used, estimated glomerular filtration rate on admission, glucose level on admission, high‐sensitivity C‐reactive protein on admission, and left ventricular ejection fraction (P<0.05). Moreover, the incidence of acidosis was associated with CIN when adjusted for the Mehran CIN risk score (odds ratio: 2.229, P=0.049). Conclusions The incidence of acidosis soon after reperfusion was associated with CIN in patients with a first‐time ST‐segment elevation myocardial infarction.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Azusa Hayakawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yusuke Akazawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Shuta Furihata
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Ai Kondo
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yusuke Fukushima
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Sakie Tomari
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Tsutomu Endo
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Sato A, Hoshi T, Aonuma K. No prophylaxis is non-inferior and cost-saving to prophylactic intravenous hydration in preventing contrast-induced nephropathy on requiring iodinated contrast material administration. J Thorac Dis 2017; 9:1440-1442. [PMID: 28740652 DOI: 10.21037/jtd.2017.05.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Japan
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Japan
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Bei WJ, Chen SQ, Li HL, Wu DX, Duan C, Chen PY, Chen JY, Tan N, Xie NJ, Liu Y. Comparing common doses (double-dose vs usual-dose) of atorvastatin for preventing contrast-induced acute kidney injury and mortality after coronary angiography. Medicine (Baltimore) 2017; 96:e7501. [PMID: 28746193 PMCID: PMC5627819 DOI: 10.1097/md.0000000000007501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
High-dose atorvastatin pretreatment was proved reducing the risk of contrast-induced acute kidney injury (CI-AKI), especially in patients with high C-reactive protein (CRP) levels. We evaluated the effects of common atorvastatin doses (double vs usual) on the risk of CI-AKI and mortality.We recorded outcomes from 1319 patients who were administered periprocedural common doses of atorvastatin. The risks of CI-AKI and mortality between double-dose (40 mg/d) and usual-dose atorvastatin (20 mg/d) were compared using multivariable regression models in all patients or CRP tertile subgroups.Seventy-six (5.8%) patients developed CI-AKI. Double-dose atorvastatin compared with usual-dose did not further reduce the risk of CI-AKI (adjusted odds ratio [OR]: 2.28, 95% confidence interval [CI]: 0.92-5.62, P = .074), even for patients in the highest CRP tertile (>8.33 mg/L; adjusted OR: 3.76, 95% CI: 0.83-17.05, P = .086). Similar results were observed in reducing mortality in all patients (adjusted hazard ratio: 0.47, 95% CI: 0.10-2.18; P = .339) and in the highest CRP tertiles (P = .424). In the subgroup analysis, double-dose atorvastatin increased risk of CI-AKI in patients with creatinine clearance (CrCl) < 60 mL/min, anemia, contrast volume > 200 mL and > 2 stents implanted (P = .046, .009, .024, and .026, respectively).Daily periprocedural double-dose atorvastatin was not associated with a reduced risk of CI-AKI compared with usual-dose, and did not provide an improved long-term prognosis, even in patients with high CRP levels. However, it increased the risk of CI-AKI in patients with a high contrast volume/CrCl.
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Affiliation(s)
- Wei-Jie Bei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
| | - Shi-Qun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
- Department of Biostatistics, South China College of Cardiovascular Research, Guangdong Society of Interventional Cardiology, Guangzhou
| | - Hua-Long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
| | - Deng-Xuan Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
| | - Chongyang Duan
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ping-Yan Chen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
| | - Nian-Jin Xie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong
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Valle JA, McCoy LA, Maddox TM, Rumsfeld JS, Ho PM, Casserly IP, Nallamothu BK, Roe MT, Tsai TT, Messenger JC. Longitudinal Risk of Adverse Events in Patients With Acute Kidney Injury After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004439. [PMID: 28404621 DOI: 10.1161/circinterventions.116.004439] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post-PCI AKI is poorly defined, and the relationship between AKI and outcomes after hospital discharge remains understudied. METHODS AND RESULTS Using the National Cardiovascular Data Registry CathPCI registry, we assessed the incidence of AKI among Medicare beneficiaries after PCI from 2004 to 2009 and subsequent post-discharge adverse events at 1 year. AKI was defined using Acute Kidney Injury Network (AKIN) criteria. Adverse events included death, myocardial infarction, bleeding, and recurrent kidney injury. Using Cox methods, we determined the relationship between in-hospital AKI and risk of post-discharge adverse events by AKIN stage. In a cohort of 453 475 elderly patients undergoing PCI, 39 850 developed AKI (8.8% overall; AKIN stage 1, 85.8%; AKIN 2/3, 14.2%). Compared with no AKI, in-hospital AKI was associated with higher post-discharge hazard of death, myocardial infarction, or bleeding (AKIN 1: hazard ratio [HR], 1.53; confidence interval [CI], 1.49-1.56 and AKIN 2/3: HR, 2.13; CI, 2.01-2.26), recurrent AKI (AKIN 1: HR, 1.70; CI, 1.64-1.76; AKIN 2/3: HR, 2.22; CI, 2.04-2.41), and AKI requiring dialysis (AKIN 1: HR, 2.59; CI, 2.29-2.92; AKIN 2/3: HR, 4.73; CI, 3.73-5.99). For each outcome, the highest incidence was within 30 days. CONCLUSIONS Post-PCI AKI is associated with increased risk of death, myocardial infarction, bleeding, and recurrent renal injury after discharge. Post-PCI AKI should be recognized as a significant risk factor not only for in-hospital adverse events but also after hospital discharge.
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Affiliation(s)
- Javier A Valle
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.).
| | - Lisa A McCoy
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Thomas M Maddox
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - John S Rumsfeld
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - P Michael Ho
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Ivan P Casserly
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Brahmajee K Nallamothu
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Matthew T Roe
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Thomas T Tsai
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - John C Messenger
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
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50
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Huber M, Ozrazgat-Baslanti T, Thottakkara P, Scali S, Bihorac A, Hobson C. Cardiovascular-Specific Mortality and Kidney Disease in Patients Undergoing Vascular Surgery. JAMA Surg 2017; 151:441-50. [PMID: 26720406 DOI: 10.1001/jamasurg.2015.4526] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Acute kidney injury (AKI) affects as many as 40% of patients undergoing surgery and is associated with increased all-cause mortality. Chronic kidney disease (CKD) is a well-known risk factor for cardiovascular mortality. OBJECTIVE To determine the association between kidney disease and long-term cardiovascular-specific mortality after vascular surgery. DESIGN, SETTING, AND PARTICIPANTS A single-center cohort of 3646 patients underwent inpatient vascular surgery from January 1, 2000, to November 30, 2010, at a tertiary care teaching hospital. To determine cause-specific mortality for patients undergoing vascular surgery, a proportional subdistribution hazards regression analysis was used to model long-term cardiovascular-specific mortality while treating any other cause of death as a competing risk. Kidney disease constituted the main covariate after adjusting for baseline patient characteristics, surgery type, and admission hemoglobin level. Final follow-up was completed July 2014 to assess survival through January 31, 2014, and data were analyzed from June 1, 2014, to September 7, 2015. MAIN OUTCOMES AND MEASURES Perioperative AKI, presence of CKD, and overall and cause-specific mortality. RESULTS Among the 3646 patients undergoing vascular surgery, perioperative AKI occurred in 1801 (49.4%) and CKD was present in 496 (13.6%). The top 2 causes among the 1577 deaths in our cohort were cardiovascular disease (845 of 1577 [53.6%]) and cancer (173 of 1577 [11.0%]). Adjusted cardiovascular mortality estimates at 10 years were 17%, 31%, 30%, and 41%, respectively, for patients with no kidney disease, AKI without CKD, CKD without AKI, and AKI with CKD. Adjusted hazard ratios (95% CIs) for cardiovascular mortality were significantly elevated among patients with AKI without CKD (2.07 [1.74-2.45]), CKD without AKI (2.01 [1.46-2.78]), and AKI with CKD (2.99 [2.37-3.78]) and were higher than those for other risk factors, including increasing age (1.03 per 1-year increase; 1.02-1.04), emergent surgery (1.47; 1.27-1.71), and admission hemoglobin levels lower than 10 g/dL (1.39; 1.14-1.69) compared with a hemoglobin level of 12 g/dL or higher. CONCLUSIONS AND RELEVANCE Perioperative AKI is common in patients undergoing vascular surgery and is associated with a high risk for cardiovascular-specific mortality comparable to that seen with CKD. These findings reinforce the importance of preoperative and postoperative risk stratification for kidney disease and the implementation of strategies now available to help prevent perioperative AKI.
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Affiliation(s)
- Matthew Huber
- Department of Anesthesiology, University of Florida, Gainesville
| | | | - Paul Thottakkara
- Department of Anesthesiology, University of Florida, Gainesville
| | - Salvatore Scali
- Department of Surgery, University of Florida, Gainesville3Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida
| | - Azra Bihorac
- Department of Anesthesiology, University of Florida, Gainesville
| | - Charles Hobson
- Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida4Department of Health Services Research, Management, and Policy, University of Florida, Gainesville
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