Contrast-induced nephropathy in non-cardiac vascular procedures, a narrative review: Part 1

Comparative Evaluation of Intermountain Risk Score With Mehran Risk Score for Risk Estimation of Contrast-Induced Nephropathy and Short-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients

Contrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.

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

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

Evaluation of coronavirus-2019-related arterial thrombosis in noncontrast spectral computed tomography with electron density imaging

Thrombosis can be associated with coronavirus disease 2019 infection. Computed tomography is essential for the diagnosis of pneumonia in these patients and conventionally contrast agents are required for the assessment of thrombus. In this study, we report a patient with coronavirus disease 2019 who was diagnosed with thrombosis using spectral noncontrast computed tomography with electron density imaging. The patient was a 76-year-old man who presented with a 2-day history of lower-leg pain. Tachycardia and atrial fibrillation were identified, with elevated D-dimer, N-terminal pro-B-type natriuretic peptide, creatine kinase, and C-reactive protein levels. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2 was positive. Conventional computed tomography showed pulmonary changes consistent with coronavirus disease 2019 and no changes in the aorta, but spectral computed tomography with electron density imaging of noncontrast computed tomography showed a thrombus in the right external iliac artery. Spectral computed tomography with electron density imaging provides more data compared with conventional computed tomography and has the potential to depict thrombus without the use of contrast media.

Incidence of Contrast-Induced Nephropathy and Post-Operative Outcomes in Patients Undergoing Chimney Endovascular Aortic Aneurysm Repair

Chimney endovascular aortic aneurysm repair (ch-EVAR) has become a valid alternative to treat complex aneurysms but the occurrence of contrast-induced kidney injury (CI-AKI) is poorly known. This study investigated the incidence and the impact of CI-AKI on post-operative outcomes after ch-EVAR. Consecutive patients who underwent ch-EVAR between July 2010 and 2021 were retrospectively included. CI-AKI was defined based on plasma creatinine levels within 7 days after the intervention according to the "Kidney Disease Improving Global Outcomes" (KDIGO) classification. Among 102 patients included, CI-AKI occurred in 14 cases (13.7%). The 30-day post-operative mortality and complications were significantly higher in patients who developed CI-AKI compared with those who did not (50 vs 9.1%, P = .001 and 57.1 vs 20.5%, P = .007). Over a median follow-up of 24 months (3-39), overall mortality was also significantly higher (78.6 vs 33.0%, P = .002). The pre-operative platelet-to-lymphocyte ratio (PLR) was significantly higher in patients who developed CI-AKI (224.5 vs 147.6, P = .008). CI-AKI is frequent after ch-EVAR and is associated with worse post-operative outcomes. This should increase awareness of clinicians to optimize preventive and therapeutic strategies.