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Murray JS, Williams CJ, Lendrem C, Smithson J, Allinson C, Robinson J, Walker A, Winter A, Simpson AJ, Newton J, Wroe C, Jones WS. Patient self-testing of kidney function at home, a prospective clinical feasibility study in kidney transplant recipients. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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2
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Mohammed-Ali Z, Bagherpoor S, Diker P, Hoang T, Vidovic I, Cursio C, Leung F, Brinc D. Performance evaluation of all analytes on the epoc® Blood Analysis System for use in hospital surgical and intensive care units. Pract Lab Med 2021; 22:e00190. [PMID: 34589568 PMCID: PMC8461111 DOI: 10.1016/j.plabm.2020.e00190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the performance of the epoc hand-held analyzer against the RAPIDPoint 500 blood gas analyzer and laboratory analyzers where applicable. Methods Venous or arterial whole blood samples collected in balanced heparinized syringes were obtained from 69 patients (35 females, 34 males) predominantly (77%) from the surgical unit and intensive care unit (ICU). Method comparison was performed for all analytes on the epoc System against the RAPIDPoint 500 Blood gas analyzer or laboratory analyzers where applicable. Results: Mean bias was <5% for blood gases, electrolytes, lactate and glucose. Hematocrit showed a bias of -6.76% (95% CI = -8.91, - 4.61) compared to the HemataSTAT-II method, whereas calculated total hemoglobin showed a bias of 1.51% (95% CI = -1.04, 4.06) against the Sysmex XN-10 hematology analyzer. Creatinine showed the largest bias relative to laboratory analyzers, Abbott Architect c8000 Jaffe method (13.54%, 95% CI = 5.43, 21.65) and Roche Cobas c702 enzymatic method (30.01%, 95% CI = 12.64, 47.38). Conclusions: The epoc system is fit for use in the surgical and ICU setting for the measurement of all analytes except for creatinine.
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Affiliation(s)
- Zahraa Mohammed-Ali
- Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, ON, Canada
| | | | | | - Thuy Hoang
- Michener Institute for Applied Health Sciences, Toronto, ON, Canada
| | | | | | - Felix Leung
- Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, ON, Canada.,Mount Sinai Hospital, Toronto, ON, Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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3
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Delclos GL. Pilot study determining the feasibility of implementing the Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol, point-of-care field measurements and a new module on risk factors for chronic kidney disease of unknown origin in Hispanic outdoor workers. BMC Nephrol 2021; 22:88. [PMID: 33711949 PMCID: PMC7953681 DOI: 10.1186/s12882-021-02288-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To field test the Disadvantaged Populations eGFR Epidemiology (DEGREE) protocol, outdoor point-of-care (POC) testing for serum creatinine, and a new risk factor module on chronic kidney disease of undetermined origin (CKDu) in U.S. outdoor Hispanic workers. METHODS Fifty workers were interviewed in Houston (TX). DEGREE and CKDu questionnaires were completed indoors. Anthropometrics and paired blood samples for POC and laboratory assay were completed outdoors over two periods (November-December 2017, April-May 2018). RESULTS Administration of DEGREE and CKDu questionnaires averaged 10 and 5 min, respectively, with all questions easily understood. We observed high correlations between POC and IDMS creatinine (r = 0.919) and BUN (r = 0.974). The POC device would disable testing when outdoor temperatures were above 85 °F or below 65 °F; this was adjustable. CONCLUSIONS Implementation of DEGREE and the new CKDu module was straightforward and well understood. The POC device performed well in the field, with some adjustment in methods when temperature readings were out of range.
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Affiliation(s)
- Erika Figueroa-Solis
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
| | - David Gimeno Ruiz de Porras
- grid.267309.90000 0001 0629 5880Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX USA ,grid.5612.00000 0001 2172 2676Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - George L. Delclos
- grid.267308.80000 0000 9206 2401Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX USA ,grid.5612.00000 0001 2172 2676Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Epidemiología y Salud Pública, Madrid, Spain
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4
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Mathur N, Lu ZX, MacKay L, Lau T, Kuganesan A, Lau KK. Is point of care renal function testing reliable screening pre-IV contrast administration? Emerg Radiol 2020; 28:77-82. [PMID: 32725604 DOI: 10.1007/s10140-020-01829-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Intravenous iodinated contrast is a commonly used diagnostic aid to improve image quality on computed tomography. There exists a small risk of post-contrast acute kidney injury in patients receiving IV contrast. One of the biggest risk factors for developing PC-AKI is the presence of pre-existing renal dysfunction, making it important to measure the renal function prior to contrast administration. Point of care (POC) devices offer a quick estimation of renal function, potentially improving workflows in radiology departments. METHOD Two POC devices were evaluated, the Nova StatSensor and Abbott iSTAT. Patients undergoing routine radiological investigations had blood collected and analysed by a POC method and the laboratory method (Beckman AU5800). The two values were analysed and compared. Renal function was calculated using eGFR via the CKD-EPI result. eGFR values were stratified as high risk (eGFR < 30), moderate risk (eGFR 30-59) and low risk (eGFR ≥ 60). RESULTS One hundred eighty-six patients were included in the study. One hundred one patients underwent the Abbott iSTAT analysis, 139 patients underwent Nova StatSensor analysis, and 53 had both. Statistical analysis revealed that the StatSensor R2 value was 0.77, and coefficient variation was 10.65%. iSTAT had a R2 value of 0.83 and coefficient variation of 7.36%. The POC devices did not miss any high-risk patients but underreported eGFR values in certain patients. CONCLUSION POC devices are moderately accurate at detecting renal impairment in patients undergoing radiological investigations. They seem to be a good screening tool; however, any low eGFR values should be further examined.
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Affiliation(s)
- Namit Mathur
- Emergency Department, Monash Health, Clayton, Victoria, Australia.
| | - Zhong X Lu
- Monash Pathology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa MacKay
- Monash Pathology, Monash Health, Clayton, Victoria, Australia
| | - Theodore Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | | | - Kenneth K Lau
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Monash Imaging, Monash Health, Clayton, Victoria, Australia
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5
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Pizarro Sánchez C, Sáez PO, Fernandez-calle P, Suescun Giménez M, Alonso Díaz RM, Perez Zafra E, Capell NE, Buno Soto A. Analytical Evaluation of ABL90 Flex Plus Blood Gas Analyzer for Urea and Creatinine. Point of Care 2020; 19:37-42. [DOI: 10.1097/poc.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Weber R, van Hal R, Stracke P, Hadisurya J, Nordmeyer H, Chapot R. Incidence of Acute Kidney Injury After Computed Tomography Angiography±Computed Tomography Perfusion Followed by Thrombectomy in Patients With Stroke Using a Postprocedural Hydration Protocol. J Am Heart Assoc 2020; 9:e014418. [PMID: 32067579 PMCID: PMC7070223 DOI: 10.1161/jaha.119.014418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The risk of contrast-induced acute kidney injury (AKI) in patients with stroke receiving both computed tomography (CT) angiography and mechanical thrombectomy has been investigated only in small case series. No studies have investigated whether additional CT perfusion or chronic kidney disease (CKD) are associated with higher rates of AKI. Methods and Results Retrospective analysis of the AKI incidence in 1089 consecutive patients receiving CT angiography and mechanical thrombectomy from 2015 to 2017 and in subgroups with CKD (n=99) and CT perfusion (n=104) was performed. Patients received a standardized hydration protocol. Data on kidney function after mechanical thrombectomy were available in 1017 patients. A total of 59 (5.8%) patients developed AKI, and only 4 (6.8%) patients needed hemodialysis, all with known CKD. Patients with AKI significantly more often had known CKD (20.3% versus 8.4%, P=0.002), diabetes mellitus (33.9% versus 20.9%, P=0.018), and tandem occlusion (32.2% versus 16.2%, P=0.003) and a significantly higher in-hospital mortality (20.3% versus 7.0%, P<0.001) compared with patients without AKI. However, there were no significant independent predictors for AKI in multivariable logistic regression analysis. Sex (odds ratio [OR], 2.03; 95% CI, 1.17-3.52 [P=0.012]), higher National Institutes of Health Stroke Scale (OR, 1.10; 95% CI, 1.05-1.14 [P<0.001]), AKI (OR, 3.52; 95% CI, 1.63-7.64 [P=0.001]), diuretic use (OR, 1.80; 95% CI, 1.02-3.19), futile or incomplete recanalization (OR, 0.19; 95% CI, 0.09-0.40 [P<0.001]), and total volume of contrast agent volume (OR, 1.007; 95% CI, 1.002-1.011 [P=0.004]) were independently associated with in-hospital death. Two thirds of the patients with AKI died of severe brain damage and not AKI itself. Conclusions Post-contrast AKI rarely occurs in patients with stroke receiving a contrast agent for CT angiography/CT perfusion and subsequent mechanical thrombectomy. Patients with known CKD had higher rates of AKI and only these patients needed hemodialysis, but CKD was not independently associated with AKI or in-hospital mortality.
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Affiliation(s)
- Ralph Weber
- Department of Neurology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine Ruhr-University Bochum Germany
| | - Robert van Hal
- Department of Neurology Alfried Krupp Krankenhaus Essen Germany
| | - Paul Stracke
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine University Hamburg Germany
| | | | - Hannes Nordmeyer
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine University Witten-Herdecke Germany
| | - René Chapot
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany
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7
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McGaha PK, Johnson J, Garwe T, Sarwar Z, Motghare P, Daly W, Letton R. Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients. Am Surg 2019. [DOI: 10.1177/000313481908500101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post–CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.
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Affiliation(s)
- Paul K. McGaha
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Jeremy Johnson
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Tabitha Garwe
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Zoona Sarwar
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Prasenjeet Motghare
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - William Daly
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Robert Letton
- From the Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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8
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Griffin BR, Butler-Dawson J, Dally M, Krisher L, Cruz A, Weitzenkamp D, Sorensen C, Tenney L, Johnson RJ, Newman LS. Unadjusted point of care creatinine results overestimate acute kidney injury incidence during field testing in Guatemala. PLoS One 2018; 13:e0204614. [PMID: 30261074 PMCID: PMC6160126 DOI: 10.1371/journal.pone.0204614] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/11/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Acute kidney injury (AKI) occurs at high rates among agricultural workers (12-33%) in tropical environments. Because of the remote locations affected, traditional laboratory services are often unavailable. In this study we compare point of care (POC) creatinine values to standardized laboratory values, and examine the effect of POC testing on the interpretation of AKI rates under tropical field conditions. METHODS Blood samples were collected from 104 sugarcane workers from two time points in January 2018 as a derivation cohort, and from 105 workers from February to April 2017 as a validation cohort. Finger stick and venipuncture samples were drawn at the end of a worker's shift to measure creatinine. Laboratory samples were tested in Guatemala City, Guatemala, in duplicate using the Jaffe Generation 2 method. An adjustment factor to improve agreement with serum creatinine was statistically derived and validated, and then used to determine impact on observed rates of acute kidney injury based on across shift changes in creatinine. RESULTS POC creatinine and serum creatinine measures showed that POC consistently overestimated the creatinine by an average of 22% (95% CI: 19.8%, 24.7%) and the disagreement appeared greater at higher values of serum creatinine. An adjustment factor of 0.7775 was applied, which led to significantly greater agreement between the two measures. Rates of AKI in the two combined groups fell from 72% before adjustment to 57% afterwards. CONCLUSIONS POC testing under tropical field conditions routinely overestimates creatinine compared to laboratory testing, which leads to overestimation of rates of acute kidney injury. The application of an adjustment factor significantly improved the accuracy of the POC value.
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Affiliation(s)
- Benjamin R. Griffin
- Division of Renal Diseases and Hypertension/Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Jaime Butler-Dawson
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - David Weitzenkamp
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Cecilia Sorensen
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Emergency Medicine, School of Medicine, University of Colorado Denver, Aurora, CO, United States of America
| | - Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension/Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Lee S. Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
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9
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Bargnoux AS, Beaufils O, Oguike M, Lopasso A, Dupuy AM, Sebbane M, Badiou S, Fesler P, Cristol JP. Point-of-care creatinine testing in patients receiving contrast-enhanced computed tomography scan. Clin Chim Acta 2018; 478:111-113. [DOI: 10.1016/j.cca.2017.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/17/2017] [Accepted: 12/17/2017] [Indexed: 12/01/2022]
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10
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van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, Clement O, Heinz-Peer G, Stacul F, Webb JAW, Thomsen HS. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28:2845-2855. [PMID: 29426991 PMCID: PMC5986826 DOI: 10.1007/s00330-017-5246-5] [Citation(s) in RCA: 262] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Abstract
Purpose The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. Areas covered in part 1 Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. Key Points • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.
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Affiliation(s)
- Aart J. van der Molen
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Peter Reimer
- Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestraße 90, D-76133 Karlsruhe, Germany
| | - Ilona A. Dekkers
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Georg Bongartz
- Department of Diagnostic Radiology, University Hospitals of Basel, Petersgaben 4, CH-4033 Basel, Switzerland
| | - Marie-France Bellin
- Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807 Villejuif, France
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Strada di Fiume 447, I-34149 Trieste, Italy
| | - Olivier Clement
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, Paris Cedex 15, F-71015 Paris, France
| | - Gertraud Heinz-Peer
- Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straße 4, AT-3100 St. Pölten, Austria
| | - Fulvio Stacul
- S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, I-34129 Trieste, Italy
| | - Judith A. W. Webb
- Department of Radiology, St. Bartholomew’s Hospital, University of London, West Smithfield, London, EC1A 7BE UK
| | - Henrik S. Thomsen
- Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark
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11
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Houben IPL, van Berlo CJLY, Bekers O, Nijssen EC, Lobbes MBI, Wildberger JE. Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study. Contrast Media Mol Imaging 2017; 2017:5670384. [PMID: 29097928 DOI: 10.1155/2017/5670384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/20/2017] [Accepted: 08/08/2017] [Indexed: 12/05/2022]
Abstract
Purpose To evaluate whether a handheld point-of-care (POC) device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN) prior to iodine-based contrast media delivery. Methods and Materials Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM) with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT) and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. Results A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m2, necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%), leading to (at that stage) unwanted contrast administration. Two patients subsequently developed CIN after 2–5 days, which was self-limiting after 30 days. Conclusion The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.
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12
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Karamasis GV, Hampton-Till J, Al-Janabi F, Mohdnazri S, Parker M, Ioannou A, Jagathesan R, Kabir A, Sayer JW, Robinson NM, Aggarwal RK, Clesham GJ, Gamma RA, Kelly PA, Tang KH, Davies JR, Keeble T. Impact of point-of-care pre-procedure creatinine and eGFR testing in patients with ST segment elevation myocardial infarction undergoing primary PCI: The pilot STATCREAT study. Int J Cardiol 2017; 240:8-13. [DOI: 10.1016/j.ijcard.2017.03.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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13
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Abstract
Objective. To determine the accuracy of Point-Of-Care testing (PoCT) creatinine values when compared to standard central laboratory testing (IDMS) and to demonstrate if and how a discrepancy could lead to improper risk stratification for contrast induced nephropathy (CIN). Methods. We conducted a descriptive retrospective chart review of patients seen in the Emergency Department of a single suburban, community, and academic medical center. We included patients who presented to the department between March 2013 and September 2014 who had blood samples analyzed by both PoCT and IDMS. Results. Mean IDMS creatinine values were 0.23 mg/dL higher when compared with i-Stat values. 95% of the time, the IDMS creatinine value was variable and ranged from −0.45 mg/dL to +0.91 mg/dL when compared to the i-Stat creatinine. When using i-Stat creatinine values to calculate GFR, 47 out of 156 patients had risk category variations compared to using the IDMS value. This affected 30.1% of the total eligible sample population (22.9% to 37.3% with 95% CI). Conclusion. We found a significant discrepancy between PoCT and IDMS creatinine values and found that this discrepancy could lead to improper risk stratification for CIN.
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14
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Stawicki SP, Stoltzfus JC, Aggarwal P, Bhoi S, Bhatt S, Kalra OP, Bhalla A, Hoey BA, Galwankar SC, Paladino L, Papadimos TJ. Academic College of Emergency Experts in India's INDO-US Joint Working Group and OPUS12 Foundation Consensus Statement on Creating A Coordinated, Multi-Disciplinary, Patient-Centered, Global Point-of-Care Biomarker Discovery Network. Int J Crit Illn Inj Sci 2014; 4:200-8. [PMID: 25337481 PMCID: PMC4200545 DOI: 10.4103/2229-5151.141398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Biomarker science brings great promise to clinical medicine. This is especially true in the era of technology miniaturization, rapid dissemination of knowledge, and point-of-care (POC) implementation of novel diagnostics. Despite this tremendous progress, the journey from a candidate biomarker to a scientifically validated biomarker continues to be an arduous one. In addition to substantial financial resources, biomarker research requires considerable expertise and a multidisciplinary approach. Investigational designs must also be taken into account, with the randomized controlled trial remaining the “gold standard”. The authors present a condensed overview of biomarker science and associated investigational methods, followed by specific examples from clinical areas where biomarker development and/or implementation resulted in tangible enhancements in patient care. This manuscript also serves as a call to arms for the establishment of a truly global, well-coordinated infrastructure dedicated to biomarker research and development, with focus on delivery of the latest discoveries directly to the patient via point-of-care technology.
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Affiliation(s)
- Stanislaw P Stawicki
- Department of Research and Innovation, Research Institute, Bethlehem, Pennsylvania ; Department of Research and Innovation, OPUS 12 Foundation Global, Columbus, USA
| | - Jill C Stoltzfus
- Department of Research and Innovation, Research Institute, Bethlehem, Pennsylvania ; Department of Research and Innovation, Research Institute, Bethlehem, Pennsylvania
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Bhatt
- Department of Anesthesiology, University of Toledo, College of Medicine, Toledo, USA
| | - O P Kalra
- Department of Medicine, University College of Medical Sciences, New Delhi, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Brian A Hoey
- Department of Research and Innovation, OPUS 12 Foundation Global, Columbus, USA ; Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania
| | - Sagar C Galwankar
- Department of Research and Innovation, OPUS 12 Foundation Global, Columbus, USA ; Department of Emergency Medicine, University of Florida and Winter Haven Hospital, Florida, USA
| | - Lorenzo Paladino
- Department of Emergency Medicine, SUNY Downstate Medical Center, Long Island College Hospital, New York, USA
| | - Thomas J Papadimos
- Department of Research and Innovation, OPUS 12 Foundation Global, Columbus, USA ; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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