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Masoomi Z, Nasirian AM, Namazi M, Zangiabadian M, Dayani A, Shahidi M, Saghafi H, Jolfayi AG. Prevalence of contrast-induced nephropathy after primary percutaneous coronary intervention at a tertiary referral hospital. Heliyon 2024; 10:e25926. [PMID: 38404852 PMCID: PMC10884434 DOI: 10.1016/j.heliyon.2024.e25926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/12/2023] [Revised: 01/01/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Objective This study aimed to quantify the incidence of Contrast-induced nephropathy (CIN) in patients undergoing primary percutaneous coronary intervention (PPCI) due to acute ST-elevation myocardial infarction (STEMI). Methods From April 2019 to March 2022, a prospective, observational study enrolled 213 consecutive STEMI patients referred to a tertiary hospital for PPCI. Participants were divided into tow groups based on the presence or absence of contrast-induced nephropathy. The chi-square test (χ2) and Student's t-test evaluated the data, with logistic regression identifying CIN's independent predictors. Results Results: In this study, the incidence of contrast-induced nephropathy was observed at 13.1% (N = 28). Several factors were more prevalent among patients exhibiting contrast-induced nephropathy. These factors encompassed: radial access for coronary angiography over the femoral method (P = 0.021), elevated contrast volume (P = 0.003), smoking (P = 0.009), diabetes (P = 0.04), heart failure (P = 0.049), a history of coronary artery bypass graft (P = 0.006), diminished left ventricular ejection fraction indicating systolic dysfunction (P = 0.012), cardiogenic shock (P = 0.046), increased BUN at the time of admission (P = 0.043), decreased initial GFR (P = 0.004), and prior consumption of medications such as aspirin (P = 0.002), diuretics (P = 0.046), beta blockers (P = 0.04), angiotensin-converting enzyme inhibitors (P = 0.033), angiotensin receptor blockers (P = 0.02). Other relevant conditions included anemia (P = 0.012), leukocytosis (P = 0.011), hypercholesterolemia (P = 0.034), and reduced HDL levels (P = 0.004).Through logistic regression, key predictors for the onset of contrast-induced nephropathy were determined, which included heart failure (OR: 5.52; 95% CI: 1.08-28.24), radial access (OR: 12.71; 95% CI: 1.45-110.9), hypercholesterolemia (OR: 1.02; 95% CI: 1.004-1.04), increased BUN upon admission (OR: 1.11; 95% CI: 1.006-1.24), and leukocytosis (OR: 2.03; 95% CI: 1.18-3.49). Conclusions While heart failure, radial access, hypercholesterolemia, elevated BUN at admission, and leukocytosis significantly influenced renal filtration deterioration post-PPCI, it's evident that CIN is multifactorial. Further studies are crucial to elucidate the underlying factors.
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Affiliation(s)
- Zahra Masoomi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Ali Mohammad Nasirian
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoor Namazi
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Moein Zangiabadian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Abdoreza Dayani
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shahidi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Hossein Saghafi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Amir Ghaffari Jolfayi
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Noppakun K, Jitraknatee J, Suteeka Y, Ruengorn C, Nochaiwong S, Gunaparn S, Phrommintikul A, Wongcharoen W. Effect of Curcuminoids on Contrast-Induced Acute Kidney Injury after Elective Coronary Angiography or Intervention: A Pilot Randomized, Double-Blind, Placebo-Controlled Study. Cardiorenal Med 2024; 14:160-166. [PMID: 38350427 DOI: 10.1159/000537710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION The role of curcuminoids, a striking antioxidant, in prevention of contrast-induced acute kidney injury (CI-AKI) remains unknown. We aimed to evaluate the efficacy and safety of curcuminoids in preventing CI-AKI in patients undergoing elective coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). METHODS We randomized 114 patients who were undergoing elective CAG and/or PCI to receive curcuminoids, 4 g/day (1 day before and 1 day after the procedure, n = 56), or placebo (n = 58). Serum creatinine was assessed at baseline, 12, 24, and 48 h after contrast exposure. The primary endpoint was development of CI-AKI defined as serum creatinine increase ≥0.3 mg/dL within 48 h after contrast exposure. The secondary endpoint was the occurrence of kidney injury defined by >30% increase in urine neutrophil gelatinase-associated lipocalin (NGAL). RESULTS Baseline characteristics were comparable between the two groups. Seven (12.7%) in curcuminoids group and eight (14.0%) in placebo group developed CI-AKI (p = 0.84). The incidence of increased urine NGAL was comparable in the placebo and curcuminoids group (39.6% vs. 50%, respectively; p = 0.34). None in both groups had drug-related adverse events. CONCLUSION This is a pilot study to demonstrate the safety and tolerability of curcuminoids in patients undergoing elective CAG and/or PCI. Curcuminoids have no protective effects against kidney injury after elective CAG and/or PCI.
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Affiliation(s)
- Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Janjira Jitraknatee
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yuttitham Suteeka
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Siriluck Gunaparn
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Losin I, Hagai KC, Pereg D. The Treatment of Coronary Artery Disease in Patients with Chronic Kidney Disease: Gaps, Challenges, and Solutions. Kidney Dis (Basel) 2024; 10:12-22. [PMID: 38322630 PMCID: PMC10843189 DOI: 10.1159/000533970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/23/2023] [Indexed: 02/08/2024]
Abstract
Background Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the leading cause of death in CKD patients. Despite the high cardiovascular risk, ACS patients with renal dysfunction are less commonly treated with guideline-based medical therapy and are less frequently referred for coronary revascularization. Summary The management of CAD is more challenging in patients with CKD than in the general population due to concerns regarding side effects and renal toxicity, as well as uncertainty regarding clinical benefit of guideline-based medical therapy and interventions. Patients with advanced CKD and especially those receiving dialysis have not traditionally been represented in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses are available. Recently published studies suggest that there are significant opportunities to substantially improve both cardiovascular and renal outcomes of patients with CAD and CKD, including new medications and interventions. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to improvement of both cardiovascular and renal outcomes. Key Messages Adequate medical therapy and coronary interventions using evidence-based strategies can improve both cardiac and renal outcomes in patients with CAD and CKD.
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Affiliation(s)
- Ilya Losin
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel
| | - Keren-Cohen Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Pereg
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Pan Q, Peng Y, Ni H, Lin L, Luo B, Huang X, Chen L, Lin Y. Blood-urea-nitrogen-to-serum-albumin ratio in predicting the value of patients with contrast-induced nephropathy for coronary heart disease. Int Urol Nephrol 2024:10.1007/s11255-023-03915-4. [PMID: 38281310 DOI: 10.1007/s11255-023-03915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/07/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The blood-urea-nitrogen (BUN)-to-serum-albumin (ALB) ratio (BAR) has been identified as a novel indicator of both inflammatory and nutritional status, exhibiting a correlation with adverse cardiovascular outcomes. This study aims to investigate the potential predictive value of BAR levels at admission for the development of CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). METHODS Retrospective data were collected from patients who were admitted and underwent CAG or PCI between January 2018 and December 2022 at the Cardiac Medical Center of Union Hospital of Fujian Medical University, and the patients were divided into CIN and non-CIN groups. The BAR was computed by dividing the BUN count by the ALB count. Using multiple variable logistic regression, risk variables associated with the development of CIN were found. RESULTS A total of 156 patients developed CIN (7.78%). The development of CIN was predicted by a BAR ratio > 4.340 with a sensitivity of 84.0% and a specificity of 70.2%, according to receiver operating characteristic (ROC) analysis. BAR, female gender, diuretic use, and statin medication use were found to be independent predictors of CIN using multifactorial analysis. CONCLUSIONS When patients are receiving CAG/PCI, BAR is a simple-to-use marker that can be used independently to predict the presence of CIN.
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Affiliation(s)
- Qiong Pan
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yanchun Peng
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Hong Ni
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Lingyu Lin
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Baolin Luo
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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Kadono M, Nakashima A, Ishiuchi N, Sasaki K, Miura Y, Maeda S, Fujita A, Sasaki A, Nagamatsu S, Masaki T. Adipose-derived mesenchymal stem cells cultured in serum-free medium attenuate acute contrast-induced nephropathy by exerting anti-apoptotic effects. Stem Cell Res Ther 2023; 14:337. [PMID: 37993965 PMCID: PMC10664307 DOI: 10.1186/s13287-023-03553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a major clinical problem associated with acute kidney injury during hospitalization. However, effective treatments for CIN are currently lacking. Mesenchymal stem cells (MSCs) have protective effects against kidney injury by suppressing inflammation and fibrosis. We previously showed that MSCs cultured in serum-free medium (SF-MSCs) enhance their anti-inflammatory and anti-fibrotic effects. However, whether SF-MSCs potentiate their anti-apoptotic effects is unknown. Here, we investigated the effects of SF-MSCs on a CIN mouse model. METHODS To create CIN model mice, we removed right kidney at first. One week later, the left renal artery was clamped for 30 min to cause ischemia-reperfusion injury, and mice were injected with iohexol. Then the kidney received 10 Gy of irradiation, and MSCs or SF-MSCs were injected immediately. At 24 h post-injection, mice were sacrificed, and their blood and kidneys were collected to evaluate renal function, DNA damage, and apoptosis. In addition, apoptosis was induced in HEK-293 cells by irradiation and cells were treated with conditioned medium from MSCs or SF-MSCs. RESULTS Treatment of CIN model mice with SF-MSCs markedly improved renal function compared with MSCs treatment. Cleaved caspase-3 levels and TUNEL-positive cell numbers were strongly suppressed in CIN model mice treated with SF-MSCs compared with the findings in those treated with MSCs. γH2AX levels, a chromosome damage marker, were reduced by MSCs and further reduced by SF-MSCs. In addition, cleaved caspase-3 in irradiated HEK-293 cells was more strongly suppressed by conditioned medium from SF-MSCs than by that from MSCs. Secretion of epidermal growth factor (EGF) was enhanced by culturing MSCs in serum-free medium. Knockdown of EGF by siRNA attenuated the inhibitory effects of SF-MSCs on CIN-induced renal dysfunction and tubular apoptosis. CONCLUSIONS These findings strongly suggest that SF-MSCs improve CIN in model mice by exerting anti-apoptotic effects in a paracrine manner. Thus, SF-MSCs represent a potential novel therapy for CIN.
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Affiliation(s)
- Mitsuki Kadono
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ayumu Nakashima
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
- Department of Stem Cell Biology and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Naoki Ishiuchi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshie Miura
- Department of Stem Cell Biology and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- TWOCELLS Company, Limited, 16-35 Hijiyama-Honmachi, Minami-ku, Hiroshima, 732-0816, Japan
| | - Satoshi Maeda
- Department of Stem Cell Biology and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- TWOCELLS Company, Limited, 16-35 Hijiyama-Honmachi, Minami-ku, Hiroshima, 732-0816, Japan
| | - Asuka Fujita
- Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ayano Sasaki
- Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shogo Nagamatsu
- Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Eitzman EA, Kroll RG, Yelavarthy P, Sutton NR. Predicting Contrast-induced Renal Complications. Interv Cardiol Clin 2023; 12:499-513. [PMID: 37673494 DOI: 10.1016/j.iccl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Chronic kidney disease is an independent risk factor for the development of coronary artery disease and overlaps with other risk factors such as hypertension and diabetes. Percutaneous coronary intervention is a cornerstone of therapy for coronary artery disease and requires contrast media, which can lead to renal injury. Identifying patients at risk for contrast-associated acute kidney injury (CA-AKI) is critical for preventing kidney damage, which is associated with both short- and long-term mortality. Determination of the potential risk for CA-AKI and a new need for dialysis using validated risk prediction tools identifies patients at high risk for this complication. Identification of patients at risk for renal injury after contrast exposure is the first critical step in prevention. Contrast media volume, age and sex of the patient, a history of chronic kidney disease and/or diabetes, clinical presentation, and hemodynamic and volume status are factors known to predict incident contrast-induced nephropathy. Recognition of at-risk patient subpopulations allows for targeted, efficient, and cost-effective strategies to reduce the risk of renal complications resulting from contrast media exposure.
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Affiliation(s)
- Emily A Eitzman
- Cardiovascular Research Center, 7301A MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0644, USA
| | - Rachel G Kroll
- Cardiovascular Research Center, 7301A MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0644, USA
| | | | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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Mehta R, Sorbo D, Ronco F, Ronco C. Key Considerations regarding the Renal Risks of Iodinated Contrast Media: The Nephrologist's Role. Cardiorenal Med 2023; 13:324-331. [PMID: 37757781 PMCID: PMC10664334 DOI: 10.1159/000533282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The administration of iodinated contrast medium during diagnostic and therapeutic procedures has always been associated with the fear of causing acute kidney injury (AKI) or an exacerbation of chronic kidney disease. This has led, on the one hand, to the deterrence, when possible, of the use of contrast medium (preferring other imaging methods with the risk of loss of diagnostic power), and on the other hand, to the trialling of multiple prophylaxis protocols in an attempt to reduce the risk of kidney injury. SUMMARY A literature review on contrast-induced (CI)-AKI risk mitigation strategies was performed, focussing on the recognition of individual risk factors and on the most recent evidence regarding prophylaxis. KEY MESSAGES Nephrologists can contribute significantly in the CI-AKI context, from the early stages of the decision-making process to stratifying patients by risk, individualising prophylaxis measures based on the risk profile, and ensuring appropriate evaluation of kidney function and damage post-procedure to improve care.
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Affiliation(s)
- Ravindra Mehta
- Division of Nephrology-Hypertension University of California – San Diego, San Diego, CA, USA
| | - David Sorbo
- Nephrology, Dialysis and Transplantation Unit, St. Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
| | - Federico Ronco
- Interventional Cardiology – Department of Cardiac Thoracic and Vascular Sciences Ospedale dell’Angelo – Mestre (Venice), Venice, Italy
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation Unit and International Renal Research Institute, St Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
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Abdollahi Moghaddam A, Baradaran Rahimi V, Morovatdar N, Rezaee R, Babalhekam SA. Oral Nicorandil effectively attenuates the incidence of contrast-induced nephropathy in patients undergoing cardiac catheterization: a randomized, controlled, open-label clinical trial. Int Urol Nephrol 2023; 55:2327-2334. [PMID: 36881267 DOI: 10.1007/s11255-023-03541-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE The contrast-induced nephropathy (CIN) rate is increasing globally and can increase the rate of mortality and long-term problems. This study aims to determine the effect of Nicorandil on preventing CIN among patients undergoing cardiac catheterization. METHODS In a controlled randomized open-labeled clinical trial, all included patients undergoing cardiac catheterization due to coronary problems and possessing at least two risk factors of contrast nephropathy were divided into two groups of intervention and control. The intervention group received oral Nicorandil and normal saline, while the control group was treated with intravenous normal saline. Serum creatinine was measured before and 48 h after the procedure, and patients were assessed regarding CIN. RESULTS In this study, 172 patients entered each group; 41.86% and 45.34% were male in the control and Nicorandil groups. We showed that the incidence of CIN was meaningfully lower in the Nicorandil group (12, 7%) than in the control group (34, 19.8%, P = 0.001). Additionally, the incidence of CIN was notably lower in the female patients in the Nicorandil (85.7%) than in the control group (14.3%, P = 0.001); however, these numbers were not significantly different among men (64.0% and 36.0%, respectively, P = 0.850). After the injection of the contrast agent, the serum levels of blood urea nitrogen (P = 0.248), creatinine (P = 0.081), and glomerular filtration rate (P = 0.386) showed no significant differences between the control and Nicorandil groups. Multivariate regression analysis showed that Nicorandil significantly lowered the odds of CIN [odds ratio (OR) = 0.299, 95% confidence interval (CI) 0.149-0.602; P = 0.001] after adjustment for baseline creatinine (OR = 1.404, 95% CI 0.431-4.572; P = 0.574). CONCLUSION Our results indicate that pre-procedural treatment with Nicorandil may be effective against CIN in contrast to agent-exposed patients.
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Affiliation(s)
- Alireza Abdollahi Moghaddam
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sadegh Alavi Babalhekam
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Fransson V, Mellander H, Ramgren B, Andersson H, Arena F, Ydström K, Ullberg T, Wassélius J. Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium. Neuroradiology 2023; 65:1333-1342. [PMID: 37452885 PMCID: PMC10425475 DOI: 10.1007/s00234-023-03190-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. METHODS Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40-200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers. RESULTS Qualitatively and quantitatively, VMI (40-60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40-50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40-50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar. CONCLUSION VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.
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Affiliation(s)
- Veronica Fransson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Helena Mellander
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Birgitta Ramgren
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Andersson
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Francesco Arena
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden
| | - Kristina Ydström
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Teresa Ullberg
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johan Wassélius
- Department of Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden.
- Department of Clinical Sciences, Lund University, Lund, Sweden.
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Feitosa MPM, Lima EG, Abizaid AAC, Mehran R, Lopes NHM, de Assis Fischer Ramos T, Hideo-Kajita A, Filho RK, Junior CVS. The safety of SGLT-2 inhibitors in diabetic patients submitted to elective percutaneous coronary intervention regarding kidney function: SAFE-PCI pilot study. Diabetol Metab Syndr 2023; 15:138. [PMID: 37365618 DOI: 10.1186/s13098-023-01107-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is one of the most performed well-succeeded therapeutic procedures worldwide, reducing symptoms and improving quality of life. Neutrophil Gelatinase-associated Lipocalin (NGAL) is a biomarker of acute kidney injury (AKI) produced early after an ischemic renal insult. Osmotic diuresis and the vasoconstriction of the afferent arteriole promoted by Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) generate a concern regarding the possibility of dehydration and consequent AKI. There is no consensus on the maintenance or discontinuation of SGTL2i in patients who will undergo PCI. This study aimed to evaluate the safety of empagliflozin in diabetic patients submitted to elective PCI regarding kidney function. METHODS SAFE-PCI trial is a prospective, open-label, randomized (1:1), single-center pilot study and a follow-up of 30 days. The SGLT2i empagliflozin 25 mg daily was initiated at least 15 days before PCI in the intervention group and maintained until the end of the follow-up period. Serum NGAL was collected 6 h after PCI and creatinine before PCI, 24 h, and 48 h after the procedure. As per protocol, both groups received optimal medical treatment and standard protocol of nephroprotection. RESULTS A total of 42 patients were randomized (22 patients in the iSGLT-2 group and 20 patients in the control group). There was no difference between-group baseline data. The primary outcome (NGAL and creatinine values post PCI) did not differ in both groups: the mean NGAL value was 199 ng/dL in the empagliflozin group and 150 ng/dL in the control group (p = 0.249). Although there was an initial increase in creatinine in the SGLT-2i group compared to the control group between baseline creatinine and pre-PCI and 24 h post-PCI creatinine, no difference was detected in creatinine 48 h post-PCI (p = 0.065). The incidence of CI-AKI, determined by KDIGO criteria, in the iSGLT2-group was 13.6% and 10.0% in the control group without statistical difference. CONCLUSION The present study showed that the use of empagliflozin is safe regarding kidney function during elective PCI in patients with T2D when compared with no use of SGLT2i. Trial registration Our clinical study is registered on ClinicalTrials.gov with the following number: NCT05037695.
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Affiliation(s)
- Mateus Paiva Marques Feitosa
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Av. Dr. Eneas de Carvalho Aguiar 44, Departamento de Aterosclerose, 2nd Floor, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Eduardo Gomes Lima
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Antônio Cunha Abizaid
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neuza Helena Moreira Lopes
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago de Assis Fischer Ramos
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Hideo-Kajita
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano Junior
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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11
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Chen F, Lu J, Yang X, Liu D, Wang Q, Geng X, Xiao B, Zhang J, Liu F, Gu G, Cui W. Different hydration methods for the prevention of contrast-induced nephropathy in patients with elective percutaneous coronary intervention: a retrospective study. BMC Cardiovasc Disord 2023; 23:323. [PMID: 37355592 PMCID: PMC10290803 DOI: 10.1186/s12872-023-03358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Hydration is currently the main measure to prevent contrast-induced nephropathy (CIN). We aimed to compare the preventive effect of preprocedure and postprocedure hydration on CIN in patients with coronary heart disease undergoing elective percutaneous coronary intervention (PCI). METHODS A retrospective study included 198 cases of postprocedure hydration and 396 cases of preprocedure hydration using propensity score matching. The incidence of CIN 48 h after PCI and adverse events within 30 days after contrast media exposure were compared between the two groups. Logistic regression analysis was used to analyse the risk factors for CIN. RESULTS The incidence of CIN in the postprocedure hydration group was 3.54%, while that in the preprocedure hydration group was 4.8%. There was no significant difference between the two groups (p = 0.478). Multivariate logistic regression analysis showed that diabetes mellitus, baseline BNP and cystatin C levels, and contrast agent dosage were independent risk factors for CIN. There was no significant difference in the incidence of major adverse events between the two groups (3.03% vs. 2.02%, p = 0.830). CONCLUSIONS Postprocedure hydration is equally effective compared to preoperative hydration in the prevention of CIN in patients with coronary heart disease undergoing elective PCI.
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Affiliation(s)
- Fei Chen
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Jingchao Lu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Xiuchun Yang
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Demin Liu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Qian Wang
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Xue Geng
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Bing Xiao
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Jie Zhang
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Fan Liu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Guoqiang Gu
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China
| | - Wei Cui
- Department of Cardiology, the Second Hospital of Hebei Medical University and the Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, 050000, China.
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12
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Ebisawa S, Tanaka H, Muramatsu T, Kishi K, Oikawa Y, Muto M, Okada H, Kawasaki T, Yoshikawa R, Hamazaki Y, Tsuchikane E. Impact of minimum contrast media volumes during percutaneous coronary intervention for chronic total occlusion lesion. Heart Vessels 2023:10.1007/s00380-023-02270-9. [PMID: 37310464 DOI: 10.1007/s00380-023-02270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/19/2023] [Indexed: 06/14/2023]
Abstract
Contrast media exposure is associated with contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Aim of this study is to assess the utility of minimum contrast media volume (CMV ≤ 50 mL) during CTO-PCI for CIN prevention in patients with chronic kidney disease (CKD). We extracted data from the Japanese CTO-PCI expert registry; 2863 patients with CKD who underwent CTO-PCI performed from 2014 to 2020 were divided into two groups: minimum CMV (n = 191) and non-minimum CMV groups (n = 2672). CIN was defined as an increased serum creatinine level of ≥ 25% and/or ≥ 0.5 mg/dL compared with baseline levels within 72 h of the procedure. In the minimum CMV group, the CIN incidence was lower than that in the non-minimum CMV group (1.0% vs. 4.1%; p = 0.03). Patient success rate was higher and complication rate was lower in the minimum CMV group than in the non-minimum CMV group (96.8% vs. 90.3%; p = 0.02 and 3.1% vs. 7.1%; p = 0.03). In the minimum CMV group, the primary retrograde approach was more frequent in the case of J-CTO = 1,2 and 3-5 groups compared to that in non-minimum CMV-PCI group (J-CTO = 0; 11% vs. 17.7%, p = 0.06; J-CTO = 1; 22% vs. 35.8%, p = 0.01; J-CTO = 2; 32.4% vs. 46.5%, p = 0.01; and J-CTO = 3-5; 44.7% vs. 80.0%, p = 0.02). Minimum CMV-PCI for CTO in CKD patients could reduce the incidence of CIN. The primary retrograde approach was observed to a greater extent in the minimum CMV group, especially in cases of difficult CTO.
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Affiliation(s)
- Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki-Shi, Okayama, 710-8602, Japan.
| | | | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Makoto Muto
- Division of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Etsuo Tsuchikane
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
- The Japanese CTO-PCI Expert Foundation, Okayama, Japan
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13
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Altıparmak İH, Tanrıverdi Z, Taşcanov MB, Fedai H. Response to Letter: C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast-Induced Nephropathy in Patients With Stable Angina Pectoris. Angiology 2023; 74:199-200. [PMID: 36206524 DOI: 10.1177/00033197221132354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Zülkif Tanrıverdi
- Faculty of Medicine, Department of Cardiology, 52966Harran University, Sanlıurfa, Turkey
| | | | - Halil Fedai
- Department of Cardiology, Sanlıurfa Education and Research Hospital, Sanlıurfa, Turkey
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14
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Ehmann MR, Mitchell J, Levin S, Smith A, Menez S, Hinson JS, Klein EY. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Intensive Care Med 2023; 49:205-215. [PMID: 36715705 DOI: 10.1007/s00134-022-06966-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Evidence of an association between intravenous contrast media (CM) and persistent renal dysfunction is lacking for patients with pre-existing acute kidney injury (AKI). This study was designed to determine the association between intravenous CM administration and persistent AKI in patients with pre-existing AKI. METHODS A retrospective propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients ≥ 18 years old meeting Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI at time of arrival to one of three emergency departments between 7/1/2017 and 6/30/2021 who did or did not receive intravenous CM. Outcomes included persistent AKI at hospital discharge and initiation of dialysis within 180 days of index encounter. RESULTS Our analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). CM was administered in 18.4% of all encounters. AKI resolved prior to hospital discharge for 69.1%. No association between intravenous CM administration and persistent AKI was observed after unadjusted multivariable logistic regression modeling (OR 1; 95% CI 0.89-1.11), propensity weighting (OR 0.93; 95% CI 0.83-1.05), and entropy balancing (OR 0.94; 95% CI 0.83-1.05). Sub-group analysis in those admitted to the ICU yielded similar results. Initiation of dialysis within 180 days was observed in 5.4% of the cohort. An association between CM administration and increased risk of dialysis within 180 days was not observed. CONCLUSION Among patients with pre-existing AKI, contrast administration was not associated with either persistent AKI at hospital discharge or initiation of dialysis within 180 days. Current consensus recommendations for use of intravenous CM in patients with stable renal disease may also be applied to patients with pre-existing AKI.
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Affiliation(s)
- Michael R Ehmann
- Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21287, USA.
| | - Jonathon Mitchell
- Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21287, USA
| | - Scott Levin
- Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21287, USA
| | - Aria Smith
- Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21287, USA
| | - Steven Menez
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeremiah S Hinson
- Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21287, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21287, USA
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
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15
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Moniwa N, Kimura A, Nishikawa R, Tanaka M. Marked bilateral global persistent CT nephrogram 48 h after percutaneous coronary intervention with contrast-induced nephropathy requiring transient hemodialysis with severe cardiac dysfunction. CEN Case Rep 2023; 12:1-6. [PMID: 35697998 PMCID: PMC9892387 DOI: 10.1007/s13730-022-00713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
An iodinated contrast medium (CM) is generally excreted into the urinary tract within 3 min after administration. However, some cases present a persistent kidney nephrogram several hours after administration of CM. This phenomenon seems to be associated with the development and acceleration of contrast-induced nephropathy (CIN). A 74-year-old woman with chronic kidney disease and a very low ejection fraction (EF) (11%) was admitted to Sapporo Medical University Hospital because of heart failure. Coronary angiography revealed occlusion of the left anterior descending artery (LAD) on day 21 of admission. Percutaneous coronary intervention (PCI) to the LAD using 218 ml of iohexol was performed with a preventive measure for CIN by saline infusion on day 28. After PCI, she developed CIN requiring hemodialysis. Non-contrast computed tomography 48 h after PCI showed a marked bilateral persistent nephrogram with a cortical attenuation value of 168 HU. Vicarious excretion of CM was noted in the small bowel and colon. Her kidney function gradually recovered and hemodialysis was discontinued after ten sessions on day 43. The findings from this case suggest that a patient with a very low EF is at a high risk for CIN through persistent retention of the CM in the kidney cortex.
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Affiliation(s)
- Norihito Moniwa
- Department of Nephrology, Teine Keijinkai Hospital, 1-40, 1 jo 12 chome Maeda Teine-ku, Sapporo, 006-8555, Japan.
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Ayumu Kimura
- Department of Nephrology, Hakodate Goryokaku Hospital, Hakodate, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Marenao Tanaka
- Department of Cardiovascular, Renal, and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- Tanaka Clinic, Yoichi, Japan
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16
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Luo M, Zhu Z, Zhang L, Zhang S, You Z, Chen H, Rao J, Lin K, Guo Y. Predictive Value of N-Terminal Pro B-Type Natriuretic Peptide for Contrast-Induced Nephropathy Non-Recovery and Poor Outcomes Among Patients Undergoing Percutaneous Coronary Intervention. Circ J 2023; 87:258-265. [PMID: 36288935 DOI: 10.1253/circj.cj-22-0399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI). The degree of recovery of renal function from CIN may affect long-term prognosis. N-terminal pro B-type natriuretic peptide (NT-proBNP) is a simple but useful biomarker for predicting CIN. However, the predictive value of preprocedural NT-proBNP for CIN non-recovery and long-term outcomes in patients undergoing PCI remains unclear.Methods and Results: This study prospectively enrolled 550 patients with CIN after PCI between January 2012 and December 2018. CIN non-recovery was defined as persistent serum creatinine >25% or 0.5 mg/dL over baseline from 1 week to 12 months after PCI in patients who developed CIN. CIN non-recovery was observed in 40 (7.3%) patients. Receiver operating characteristic analysis indicated that the best NT-proBNP cut-off value for detecting CIN non-recovery was 876.1 pg/mL (area under the curve 0.768; 95% confidence interval [CI] 0.731-0.803). After adjusting for potential confounders, multivariable analysis indicated that NT-proBNP >876.1 pg/mL was an independent predictor of CIN non-recovery (odds ratio 1.94; 95% CI 1.03-3.75; P=0.0042). Kaplan-Meier curves showed higher rates of long-term mortality among patients with CIN non-recovery than those with CIN recovery (Chi-squared=14.183, log-rank P=0.0002). CONCLUSIONS Preprocedural NT-proBNP was associated with CIN non-recovery among patients undergoing PCI. The optimal cut-off value for NT-proBNP to predict CIN non-recovery was 876.1 pg/mL.
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Affiliation(s)
- Manqing Luo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Zheng Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital
| | - Liwei Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Sicheng Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Zhebin You
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance.,Fujian Key Laboratory of Geriatrics, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Medical University
| | - Hanchuan Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Jingyi Rao
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Kaiyang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Yansong Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
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Abstract
OBJECTIVE This is the first study to explore the risk factors for nephropathy caused by gadolinium-based contrast agents and establish a prediction model to identify high-risk patients. METHODS A total of 1404 patients who received gadolinium-based contrast agents in our hospital were included. The participants were randomly assigned in a 7:3 ratio to the modeling and validation groups. The modeling group was divided into a contrast-induced nephropathy group and a non-contrast-induced nephropathy group. The clinical characteristics before the use of contrast agents were compared between the two groups. The risk factors for contrast-induced nephropathy were analyzed by logistic regression. A nomogram that could predict the incidence of contrast-induced nephropathy was plotted. The validation group was used to verify the predictive model. RESULTS The incidence of contrast-induced nephropathy caused by gadolinium-based contrast agents was 3.92% (55/1404). The logistic stepwise regression analysis showed that sex, systolic pressure (SBP), absolute neutrophil count, albumin, fasting blood glucose level, and furosemide use were significant predictors of contrast-induced nephropathy caused by gadolinium-based contrast agents. The above predictors were then included in the nomogram construction. The area under the receiver operating characteristic (ROC) curve was 0.82 (p < 0.001). The specificity and sensitivity corresponding to the optimal cutoff point (0.039) based on the area under the ROC curve were 71.9% and 80.5%, respectively. CONCLUSION Sex, SBP, absolute neutrophil count, albumin, fasting blood glucose levels, and furosemide use are significant predictors of contrast-induced nephropathy caused by gadolinium-based contrast agents. Therefore, the incidence of contrast-induced nephropathy may be estimated by the prediction model established in this study before the use of contrast agents.
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Affiliation(s)
- Huanhuan Zheng
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Zhejiang, China
| | - Guolang Wang
- Department of Vascular Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Zhejiang, China
| | - Qianqian Cao
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Zhejiang, China
| | - Wenkai Ren
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Zhejiang, China
| | - Lingyuan Xu
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Zhejiang, China
| | - Shuangshan Bu
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Zhejiang, China,CONTACT Shuangshan Bu Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, #60 Wuning West Road, Dongyang City, 322100, China
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18
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Sun X, Fan Z, Liu Z, Li J, Hua Q. Red blood cell distribution width-to-albumin ratio: a new inflammatory biomarker to predict contrast-induced nephropathy after emergency percutaneous coronary intervention. Int Urol Nephrol 2022; 54:3283-3290. [PMID: 35799040 DOI: 10.1007/s11255-022-03290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Contrast-induced nephropathy (CIN) remains a dreaded complication in the cardiac diagnostic and interventional area. We investigated the relationship between red blood cell distribution width-to-albumin ratio (RAR) and CIN in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). METHODS A total of 1532 elderly patients were enrolled and divided into the CIN group and the non-CIN group. The risk factors of CIN were evaluated by univariate and multivariate regression analysis. Receiver-operating characteristic (ROC) curve analysis was used to identify the best predictive value. RESULTS CIN occurred in 129 (8.42%) patients. Patients in the CIN group had significantly higher RAR than those in the non-CIN group (4.69 ± 0.73 vs. 3.18 ± 0.64, P < 0.001). In multivariate regression analysis, RAR was an independent risk factor for the development of CIN (OR: 1.506, 95% CI: 1.227-2.083, P = 0.025), along with age, creatinine, eGFR, hs-CRP and contrast agent dose. The AUC of RAR was 0.755 (95% CI 0.703-0.807), and an optimal cutoff value of 3.64 or higher predicted CIN with a sensitivity of 76.2% and specificity of 65.7%. CONCLUSION As a combined inflammatory-related index, RAR was an independent risk factor for the development of CIN in elderly patients with STEMI undergoing emergency PCI. The RAR could be a simple but relatively reliable parameter for identifying high-risk patients.
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Affiliation(s)
- Xipeng Sun
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Zhenxing Fan
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Zhi Liu
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Jing Li
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
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Guillemin L, Goronflot T, Desal H, Rozec B, Lakhal K. Early Acute Kidney Injury in Patients with Non-Traumatic Subarachnoid Hemorrhage who Undergo Catheter Angiography: Incidence, Associated Risk Factors and Impact on Outcome. J Stroke Cerebrovasc Dis 2022; 31:106488. [PMID: 35472654 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/23/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES After subarachnoid hemorrhage (SAH), potential renal insults are numerous but the burden of early acute kidney injury (AKI) is unclear. We determined its incidence, rate of persistence, risk factors, and impact on patients' outcomes. MATERIALS AND METHODS Patients with non-traumatic SAH were retrospectively included if they underwent catheter angiography within the 48 h after their admission to the intensive care unit. Early AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria, analyzed from the time of catheter angiography. Early AKI was considered as persistent if the KDIGO stage did not decrease between the 48th and the 60th hour. RESULTS Among 499 consecutive patients, early AKI (mostly oliguria) occurred in 132 (26%): stage 1, 2 and 3 in 72 (14%), 44 (9%), and 16 (3%) patients, respectively. It persisted in 36% of cases. Early AKI occurred more likely when SAH was severe or renal function was impaired at hospital admission: adjusted odds ratio of 2.76 [95% 1.77-4.30] and 3.32 [1.17-9.46], respectively. ICU and hospital lengths of stay were longer in patients who developed early AKI than in patients who did not: 16 [9-29] versus 12 [4-24] days (p = 0.0003) and 21 [14-43] versus 16 [11-32] days (p = 0.007), respectively. There was an independent link between early AKI and renal outcome (n = 274 in the model) but not with hospital mortality (n = 453). CONCLUSIONS One quarter of our population developed early AKI, mostly oliguria. It persisted beyond the 48th hour in one third of cases. The associated risk factors we identified were non-modifiable.
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Affiliation(s)
- Laureen Guillemin
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France
| | - Thomas Goronflot
- CHU de Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes F-44093, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France.
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20
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Mei Z, Luo S, Chen P, Zhang Q, Zhou L, Zhu C, Zhu H, Jin L. Efficacy of brain natriuretic peptide vs. nicorandil in preventing contrast-induced nephropathy: a network meta-analysis. PeerJ 2022; 10:e12975. [PMID: 35228908 PMCID: PMC8881910 DOI: 10.7717/peerj.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
This study aimed to conduct a network meta-analysis (NMA) to compare the efficacy of brain natriuretic peptide (BNP) vs nicorandil for preventing contrast-induced nephropathy (CIN). Databases of Pubmed, Cochrane, Embase, Web of Science were searched by keywords for eligible studies of randomized controlled trials investigating different agents (BNP, nicorandil, nitroglycerin, intravenous saline) for preventing CIN. The outcomes included a change in serum creatinine level at 48 h and the incidence of CIN after percutaneous coronary intervention (PCI) or coronary angiography (CAG). A total of 13 studies with 3,462 patients were included. Compared with intravenous saline alone, except for nitroglycerin (odds ratio [OR]: 1.02, 95% CI [0.36-2.88]), the other drugs significantly reduced the CIN incidence with OR of 0.35 (95% CI [0.24-0.51]) for BNP, 0.52 (0.29, 0.94) for usual-dose nicorandil, 0.28 (0.19, 0.43) for double-dose nicorandil. BNP and double-dose nicorandil significantly decreased the change of serum creatinine (SCr) levels with mean difference (MD) of -6.98, (-10.01, -3.95) for BNP, -8.78, (-11.63, -5.93) for double-dose nicorandil. No significant differences were observed in the change of SCr levels for nitroglycerin (-4.97, [-11.46, 1.52]) and usual-dose nicorandil (-2.32, [-5.52, 0.89]) compared with intravenous saline alone. For double-dose nicorandil, the CIN incidence and the change of SCr level in group of 4-5 days treatment course were more than group of less than or equal to 24 h treatment course (OR of 1.48, [0.63-3.46] and MD of 2.48, [-1.96, 6.91]). In conclusion, BNP and double-dose nicorandil can have effects on preventing the incidence of CIN and double-dose nicorandil performed better than BNP. In double-dose nicorandil groups, a course of less than or equal to 24 h before and after procedure performed with better efficacy than a course of 4-5 days.
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Affiliation(s)
- Ziwei Mei
- Pharmacy Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Songmei Luo
- Pharmacy Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Peipei Chen
- Pharmacy Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Qiankun Zhang
- Nephrology Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Limei Zhou
- Nephrology Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Chaoyong Zhu
- Nephrology Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Hong Zhu
- Nephrology Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
| | - Lie Jin
- Nephrology Department, Lishui Municipal Central Hospital, Lishui, Zhejiang, China
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21
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Peabody J, Paculdo D, Valdenor C, McCullough PA, Noiri E, Sugaya T, Dahlen JR. Clinical Utility of a Biomarker to Detect Contrast-Induced Acute Kidney Injury during Percutaneous Cardiovascular Procedures. Cardiorenal Med 2022; 12:11-19. [PMID: 35034025 DOI: 10.1159/000520820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Contrast-induced acute kidney injury (CI-AKI) is a major clinical complication of percutaneous cardiovascular procedures requiring iodinated contrast. Despite its relative frequency, practicing physicians are unlikely to identify or treat this condition. METHODS In a 2-round clinical trial of simulated patients, we examined the clinical utility of a urine-based assay that measures liver-type fatty acid-binding protein (L-FABP), a novel marker of CI-AKI. We sought to determine if interventional cardiologists' ability to diagnose and treat potential CI-AKI improved using the biomarker assay for 3 different patient types: pre-procedure, peri-procedure, and post-procedure patients. RESULTS 154 participating cardiologists were randomly divided into either control or intervention. At baseline, we found no difference in the demographics or how they identified and treated potential complications of AKI, with both groups providing less than half the necessary care to their patients (46.4% for control vs. 47.6% for intervention, p = 0.250). The introduction of L-FABP into patient care resulted in a statistically significant improvement of 4.6% (p = 0.001). Compared to controls, physicians receiving L-FABP results were 2.9 times more likely to correctly identify their patients' risk for AKI (95% CI 2.1-4.0) and were more than twice as likely to treat for AKI by providing volume expansion and withholding nephrotoxic medications. We found the greatest clinical utility in the pre-procedure and peri-procedure settings but limited value in the post-procedure setting. CONCLUSION This study suggests L-FABP as a clinical marker for assessing the risk of potential CI-AKI, has clinical utility, and can lead to more accurate diagnosis and treatment.
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Affiliation(s)
- John Peabody
- QURE Healthcare, San Francisco, California, USA.,University of California, School of Medicine, San Francisco, California, USA.,University of California, Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Peter A McCullough
- Texas Christian University and the University of North Texas Health Sciences Center School of Medicine, Dallas, Texas, USA
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.,National Center Biobank Network, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Sugaya
- Timewell Medical, Tokyo, Japan.,St. Marianna University School of Medicine, Kawasaki, Japan
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22
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Stocker TJ, Bull R, Buls N, Leipsic J, Chow B, Maurovich-Horvat P, Bittencourt MS, Bax JJ, Andreini D, Chen MY, Rubinshtein R, Hadamitzky M, Massberg S, Hausleiter J. Contrast agent volume for coronary computed tomography angiography imaging in current clinical practice. J Cardiovasc Comput Tomogr 2021; 16:191-193. [PMID: 34742666 DOI: 10.1016/j.jcct.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | | | - Nico Buls
- Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Belgium
| | | | - Benjamin Chow
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Marcio S Bittencourt
- Delboni/DASA, Sao Paulo, Brazil; University Hospital, University of São Paulo, São Paulo, Brazil
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dept of Cardiology, Turku University Hospital, Turku, Finland
| | - Daniele Andreini
- Centro Cardiologico Monzino, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA
| | | | - Martin Hadamitzky
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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23
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He C, Zhang S, He H, You Z, Lin X, Zhang L, Chen J, Lin K. Predictive value of plasma volume status for contrast-induced nephropathy in patients with heart failure undergoing PCI. ESC Heart Fail 2021; 8:4873-4881. [PMID: 34704403 PMCID: PMC8712793 DOI: 10.1002/ehf2.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022] Open
Abstract
Aims Contrast‐induced nephropathy remains a common complication of coronary procedure and increases poor outcomes, especially in patients with heart failure. Plasma volume expansion relates to worsening prognosis of heart failure. We hypothesized that calculated plasma volume status (PVS) might provide predictive utility for contrast‐induced nephropathy in patients with heart failure undergoing elective percutaneous coronary intervention (PCI). Methods and results We enrolled 441 patients with heart failure undergoing elective PCI from 2012 to 2018. Pre‐procedural estimated PVS by the Duarte's formula (Duarte‐ePVS) and Kaplan–Hakim formula (KH‐ePVS) were calculated for all patients. CIN was defined as an absolute serum creatinine (SCr) increase ≥0.5 mg/dL or a relative increase ≥25% compared with the baseline value within 48 h of contrast medium exposure. We assessed the association between PVS and CIN in patients with heart failure undergoing elective PCI. In 441 patients, 28 (6.3%) patients developed CIN. The median Duarte‐ePVS was 4.44 (3.87, 5.13) and the median KH‐ePVS was −0.03 (−0.09, 0.05). The best cutoff values for Duarte‐ePVS and KH‐ePVS to predict CIN were 4.64 (with 78.6% sensitivity and 61.7% specificity) and 0.04 (with 64.5% sensitivity and 75.5% specificity), respectively. After adjusting for potential confounding variables, KH‐ePVS > 0.04 [odds ratio (OR) 2.685, 95% confidence interval (CI) 1.012–7.123, P = 0.047] remained significantly associated with CIN whereas Duarte‐ePVS was not. Conclusions Pre‐procedural KH‐ePVS is an independent risk factor for CIN in patients with heart failure undergoing elective PCI. The best cutoff point of KH‐ePVS for predicting CIN was 0.04.
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Affiliation(s)
- Chen He
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Sicheng Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Haoming He
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Zhebin You
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Xueqin Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Liwei Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
| | - Jiankang Chen
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Kaiyang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fuzhou, Fujian, 350001, China
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24
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Lin J, Chen J, Wu D, Li X, Guo X, Shi S, Lin K. Biomarkers for the early prediction of contrast-induced nephropathy after percutaneous coronary intervention in adults: A systematic review and meta-analysis. Angiology 2021; 73:207-217. [PMID: 34461746 DOI: 10.1177/00033197211039921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contrast-induced nephropathy (CIN) is a complication of patients undergoing percutaneous coronary intervention (PCI). Promising biomarkers for the early prediction of CIN can significantly improve outcomes of these patients. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies. Trials reporting an area under the curve (AUC) for the utility of novel biomarkers in the early prediction of CIN in adults after PCI were included. In total, 42 studies comprising 11,984 adult patients undergoing PCI met the criteria. Four urinary biomarkers and four blood biomarkers were included. For urine biomarkers, the pooled AUCs for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid-binding protein (L-FABP), and kidney injury molecule-1 (KIM-1) were 0.91 (95% CI 0.89-0.94), 0.79 (0.75-0.82), 0.78 (0.74-0.82), and 0.79 (0.76-0.83), respectively. The blood biomarkers NGAL, cystatin C, brain natriuretic peptide (BNP), and C-reactive protein (CRP) had pooled AUCs of 0.93 (0.91-0.95), 0.92 (0.89-0.94), 0.78 (0.74-0.81), and 0.75 (0.71-0.79), respectively. Subgroup analysis showed that blood NGAL in early CIN predictive time (<6 h) was more effective in predicting CIN. The efficiency of cystatin C in predicting CIN was reduced, whereas that of L-FABP was increased among chronic kidney disease (CKD) patients.
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Affiliation(s)
- Jing Lin
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Jialong Chen
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Dansen Wu
- 74551Shengli Clinical Medical College of Fujian Medical University, China.,Department of Medical Intensive Care Unit, 117861Fujian Provincial Hospital, China
| | - Xiuhua Li
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Xiaolan Guo
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Songjing Shi
- 74551Shengli Clinical Medical College of Fujian Medical University, China.,Department of Medical Intensive Care Unit, 117861Fujian Provincial Hospital, China
| | - Kaiyang Lin
- 74551Shengli Clinical Medical College of Fujian Medical University, China.,Department of Cardiology, 117861Fujian Provincial Hospital, China
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25
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Seferovic JP, Tesic M, Lezaic V, Seferovic PM, Lalic NM. Contrast-induced nephropathy in a patient with type 2 diabetes and coronary artery disease: a case report. J Int Med Res 2021; 49:3000605211033177. [PMID: 34382462 PMCID: PMC8366166 DOI: 10.1177/03000605211033177] [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] [Indexed: 11/17/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is the impairment of kidney function defined as a serum creatinine increase of 25% or 44 µmol/L compared with baseline, usually occurring 24 to 48 hours after the use of intravenous contrast. Important risk factors for CIN include female sex, advanced age (>65 years), type 2 diabetes (T2D), kidney disease, advanced heart failure, and intravascular volume depletion. We herein present a male patient with T2D, moderately reduced renal function, no albuminuria, and a positive echocardiography stress test. He underwent percutaneous coronary intervention (PCI), and two drug-eluting stents (in the left anterior descending coronary artery) and three bare-metal stents (in the right coronary artery) were implanted. Despite adequate rehydration (0.9% intravenous NaCl with 8.4% sodium bicarbonate) before and after the procedures, he developed irreversible kidney injury after coronary angiography and PCI. This case report demonstrates the unpredictable clinical course of CIN. Patients with T2D are at high risk for the occurrence of CIN, so careful clinical assessment is recommended with global renal functional reserve evaluation.
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Affiliation(s)
- Jelena P Seferovic
- Endocrinology, Diabetes and Metabolic Disorder Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Visnja Lezaic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Nephrology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Petar M Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Nebojsa M Lalic
- Endocrinology, Diabetes and Metabolic Disorder Clinic, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
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26
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Shibata S, Moniwa N, Kuno A, Kimura A, Ohwada W, Sugawara H, Gocho Y, Tanaka M, Yano T, Furuhashi M, Tanno M, Miki T, Miura T. Involvement of necroptosis in contrast-induced nephropathy in a rat CKD model. Clin Exp Nephrol 2021; 25:708-717. [PMID: 33728555 DOI: 10.1007/s10157-021-02048-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The risk of contrast-induced nephropathy (CIN) is high in patients with chronic kidney disease (CKD). However, the mechanism of CIN in CKD is not fully understood. Here, we prepared a clinically relevant model of CIN and examined the role of necroptosis, which potentially cross-talks with autophagy, in CIN. METHODS In Sprague-Dawley rats, CKD was induced by subtotal nephrectomy (SNx, 5/6 nephrectomy) 4 weeks before induction of CIN. CIN was induced by administration of a contrast medium (CM), iohexol, following administration of indomethacin and N-omega-Nitro-L-arginine methyl ester. Renal function and tissue injuries were assessed 48 h after CM injection. RESULTS Serum creatinine (s-Cre) and BUN were increased from 0.28 ± 0.01 to 0.52 ± 0.02 mg/dl and from 15.1 ± 0.7 to 29.2 ± 1.2 mg/dl, respectively, after SNx alone. CM further increased s-Cre and BUN to 0.69 ± 0.03 and 37.2 ± 2.1, respectively. In the renal tissue after CM injection, protein levels of receptor-interacting serine/threonine-protein kinase (RIP) 1, RIP3, cleaved caspase 3, and caspase 8 were increased by 64 ~ 212%, while there was reduction in LC3-II and accumulation of p62. Necrostatin-1, an RIP1 inhibitor, administered before and 24 h after CM injection significantly suppressed elevation of s-Cre, BUN and urinary albumin levels, kidney injury molecule-1 expression and infiltration of CD68-positive macrophages in renal tissues after CM injection. CONCLUSION The results suggest that necroptosis of proximal tubular cells contributes to CIN in CKD and that suppression of protective autophagy by pro-necroptotic signaling may also be involved.
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Affiliation(s)
- Satoru Shibata
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Norihito Moniwa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Atsushi Kuno
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ayumu Kimura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Wataru Ohwada
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hirohito Sugawara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Yufu Gocho
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masaya Tanno
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takayuki Miki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
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27
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Aksoy F, Aydın Baş H, Bağcı A, Basri Savaş H. Predictive value of oxidant and antioxidant status for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Rev Port Cardiol 2021; 40:489-97. [PMID: 34274095 DOI: 10.1016/j.repce.2021.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a life-threatening complication after primary percutaneous coronary intervention (p-PCI). Oxidative stress and inflammation may play an important role in the development of CIN. OBJECTIVE We aimed to assess the relationship between total oxidant status, total antioxidant capacity, high-sensitivity C-reactive protein (hs-CRP), gamma-glutamyltransferase and uric acid (UA) in the development of CIN in patients presenting with ST-elevation myocardial infarction (STEMI). METHODS This prospective cohort study consisted of 341 patients with STEMI. Patients were divided into two groups: those with and those without CIN. Predictors of CIN were determined by multivariate regression analyses. RESULTS Multivariate regression analysis showed that initial glucose level, contrast media volume/glomerular filtration ratio (eGFR) ratio, hs-CRP, UA and oxidative status index were associated with the development of CIN in patients with STEMI. CONCLUSION The main finding of this study is that increased oxidative stress and inflammation parameters were associated with the development of CIN in patients with STEMI. Other independent predictors of CIN were contrast media volume/eGFR ratio, initial glucose level, UA and hs-CRP.
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Zhang H, Fu H, Fu X, Zhang J, Zhang P, Yang S, Zeng Z, Fu N, Guo Z. Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention. BMC Nephrol 2021; 22:206. [PMID: 34078303 PMCID: PMC8173735 DOI: 10.1186/s12882-021-02405-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/18/2020] [Accepted: 05/16/2021] [Indexed: 12/18/2022] Open
Abstract
Backgrounds Diabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN. Methods We reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN. Results Patients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829). Conclusions Studies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.
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Affiliation(s)
- H Zhang
- Clinical College of Chest,Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - H Fu
- Tianjin Medical University, Tianjin, China
| | - X Fu
- Tianjin Medical University, Tianjin, China
| | - J Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - P Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - S Yang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Z Zeng
- Tianjin Medical University, Tianjin, China
| | - N Fu
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
| | - Z Guo
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
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Wang J, Zhang C, Liu Z, Bai Y. Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis. J Int Med Res 2021; 49:3000605211005972. [PMID: 33878914 PMCID: PMC8072857 DOI: 10.1177/03000605211005972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022] Open
Abstract
Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). This study aimed to analyze the potential risk factors for CIN in patients undergoing PCI. Methods Patients with ACS who underwent PCI treatment from January 2017 to January 2020 were selected. The patients’ characteristics and medical information were collected and compared. Results A total of 1331 patients undergoing PCI were included. The incidence of CIN was 15.33%. Logistic regression analyses showed that a left ventricular ejection fraction ≤45% (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.10–7.36), serum creatinine levels ≤60 μmol/L (OR 3.03, 95% CI 1.21–5.57), age ≥65 years (OR 2.75, 95% CI 1.32–4.60), log N-terminal pro-B-type natriuretic peptide levels ≥2.5 pg/mL (OR 2.31, 95% CI 1.18–5.13), uric acid levels ≥350 μmol/L (OR 2.29, 95% CI 1.04–5.30), emergency percutaneous intervention (OR 1.35, 95% CI 0.34–3.12), and triglyceride levels ≤1.30 mmol/L (OR 1.10, 95% CI 0.01–2.27) were independent risk factors for CIN in patients who underwent PCI. Conclusions Early prevention is required to reduce the occurrence of CIN in patients who undergo PCI and have risk factors for CIN.
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Affiliation(s)
- Jing Wang
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Chunyu Zhang
- Nursing Teaching and Research Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Yan'an, China
| | - Zhina Liu
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Yanping Bai
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
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Chen CS, Ahn H, Shin JH, Li HL, Kim JW, Ibrahim A, Chu HH. Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: A 20-year single-center experience. Pak J Med Sci 2021; 37:1111-1117. [PMID: 34290792 PMCID: PMC8281160 DOI: 10.12669/pjms.37.4.3999] [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: 12/11/2020] [Revised: 12/15/2020] [Accepted: 02/25/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD). Methods This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed. Results Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications. Conclusions Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD.
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Affiliation(s)
- Cheng Shi Chen
- Cheng Shi Chen, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hyemin Ahn
- Hyemin Ahn, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Ji Hoon Shin, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Hai-Liang Li
- Hai-Liang Li, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jong Woo Kim
- Jong Woo Kim, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Alrashidi Ibrahim
- Alrashidi Ibrahim, MD. Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hee Ho Chu
- Hee Ho Chu, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
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Neilipovitz J, Rosenberg H, Hiremath S, Savage DW, Ohle R, Alaref A, Yadav K, Atkinson P. CJEM Debate Series: contrast-enhanced imaging should not be withheld for emergency department patients as contrast-induced acute kidney injury is very uncommon. CAN J EMERG MED 2021; 23:432-436. [PMID: 33811636 DOI: 10.1007/s43678-021-00126-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jonathan Neilipovitz
- Northern Ontario School of Medicine, Lakehead University, 980 Oliver Rd, Thunder Bay, ON, P7B 6V4, Canada
| | - Hans Rosenberg
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Swapnil Hiremath
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David W Savage
- Northern Ontario School of Medicine, Lakehead University, 980 Oliver Rd, Thunder Bay, ON, P7B 6V4, Canada.
| | - Robert Ohle
- Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada
| | - Amer Alaref
- Northern Ontario School of Medicine, Lakehead University, 980 Oliver Rd, Thunder Bay, ON, P7B 6V4, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul Atkinson
- Dalhousie University, Horizon Health Network, Saint John, NB, Canada
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Chen H, You Z, Zhang S, He C, He H, Luo M, Lin X, Zhang L, Lin K, Guo Y. Predictive value of preprocedural albuminuria for contrast-induced nephropathy non-recovery in patients undergoing percutaneous coronary intervention. Int Urol Nephrol 2021. [PMID: 33675474 DOI: 10.1007/s11255-021-02818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/13/2021] [Indexed: 11/27/2022]
Abstract
Objective The present study investigated the predictive value of albuminuria for contrast-induced nephropathy (CIN) non-recovery in patients undergoing percutaneous coronary intervention (PCI). Methods We retrospectively enrolled 550 consecutive patients inflicted with CIN after PCI and reassessing kidney function among 1 week–12 months between January 2012 and December 2018. Patients were stratified into three groups according to urine albumin: negative group (urine dipstick negative), trace group (urine dipstick trace) and positive group (urine dipstick ≥ 1 +). The primary outcomes were CIN non-recovery (a decrease of serum creatinine which remains ≥ 25% or 0.5 mg/dL over baseline at 1 week–12 months after PCI in patients inflicted with CIN). The odds ratio (OR) of CIN non-recovery was analyzed by logistic regression using the negative urine dipstick group as the reference group. Results Overall, 88 (16.0%) patients had trace urinary albumin, 74 (13.5%) patients had positive urinary albumin and 40 (7.3%) patients developed CIN non-recovery. Patients with positive urinary albumin had significantly higher incidence of CIN non-recovery [negative (3.4%), trace (11.4%) and positive (23.0%), respectively; P < 0.0001]. Multivariate analysis showed that trace and positive urinary albumin were associated with an increased risk of CIN non-recovery (trace vs negative: OR 2.88, P = 0.022; positive vs negative: OR 2.99, P = 0.021). These associations were consistent in subgroups of patients stratified by CIN non-recovery risk predictors. And CIN non-recovery was associated with an increased risk of long-term mortality during a mean follow-up period of 703 days (P < 0.001). Conclusion Preprocedural albuminuria was associated with CIN non-recovery in patients undergoing PCI.
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Chiesa E, Greco A, Dorati R, Conti B, Bruni G, Lamprou D, Genta I. Microfluidic-assisted synthesis of multifunctional iodinated contrast agent polymeric nanoplatforms. Int J Pharm 2021; 599:120447. [PMID: 33676989 DOI: 10.1016/j.ijpharm.2021.120447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/13/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Contrast Induced Nephropathy is the most severe side-effect arising after non-ionic iodinated contrast agents (CAs) intravenous administration. The use of antioxidants (i.e., N-Acetylcysteine; NAC) is one of the attempted prevention approaches. Herein, we describe the microfluidic-assisted synthesis of iodinated polymeric nanoparticles (NPs) as new multifunctional blood pool CA. The aim of this research is to co-encapsulate Iohexol (IOX; iodinated CA) and NAC (preventive agent) into poly-D,L-lactide-co-glycolide (PLGA) and PEGylated-PLGA (PLGA-PEG) NPs to exploit CA diagnostic proprieties and NAC preventing antioxidant activity. A microfluidic-assisted nanoprecipitation protocol has been set-up for PLGA and PLGA-PEG NPs, evaluating the effect of formulation and microfluidic parameters by analysing the size, PDI and IOX and NAC encapsulation efficiency. The optimized NPs (PLGA-PEG, L:G 50:50, 5% PEG, Mw 90 kDa) formulated with a size of 67 ± 2.8 nm with PDI < 0.2, spherical shape, and an IOX and NAC encapsulation efficiency of 38% and 20%, respectively. The IOX and NAC encapsulation was confirmed by FTIR and DSC. In vitro release study showed an IOX retention into the polymeric matrix and NAC sustained release up to 24-48 h stating microfluidics as powerful tool for the formulation of multifunctional nanoplatforms. Finally, the protective effect of NPs and NAC were preliminary assessed on human kidney cells.
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Zhao P, Zhu Y, Sun L, Zhu W, Lu Y, Zhang J, Mao Y, Chen Q, Zhang F. Circulating Exosomal miR-1-3p from Rats with Myocardial Infarction Plays a Protective Effect on Contrast-Induced Nephropathy via Targeting ATG13 and activating the AKT Signaling Pathway. Int J Biol Sci 2021; 17:972-985. [PMID: 33867822 PMCID: PMC8040303 DOI: 10.7150/ijbs.55887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Rationale: With the widespread development of the interventional technique for cardiovascular diseases and the widespread use of contrast medium (CM), the incidence of contrast-induced nephropathy (CIN) has been increasing, which is associated with poor prognosis for cardiovascular diseases. This study aims to explore the effect of circulating exosomal microRNA from patients with myocardial infarction (MI) on CIN and related molecular mechanism. Methods: A rat MI model was established by ligating the left anterior descending coronary artery. Circulating exosomes were isolated from control (Exo-NC) and MI rats (Exo-MI) using a commercial kit. The in vivo and in vitro models of CIN were created using iodixanol. Reverse transcription quantitative PCR (RT-qPCR) was utilized to detect the expression of miR-1-3p. Western blot (WB) was used to detect the expression of exosomal surface markers, and apoptosis-related and autophagy-related proteins. The apoptosis rate was examined by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) staining and flow cytometry (FC). Transmission electron microscopy (TEM) was utilized to observe the exosomes and autophagosomes. Rat kidney injury was assessed by hematoxylin and eosin (H&E) staining and kidney injury molecule-1 (KIM-1) immunohistochemical staining. Renal function of rats was assessed by detecting the levels of blood urea nitrogen (BUN) and serum creatinine (Cr). The dual luciferase reporter assay was performed to identify the target gene of miR-1-3p. Results: The treatment of CM induced NRK-52E cell damage, which manifested as enhanced cell autophagy and enhanced apoptosis. The Exo-MI treatment significantly inhibited the CM-induced autophagy and apoptosis of NRK-52E cells. Furthermore, the Exo-MI treatment increased the Bcl-2 expression, but decreased the Bax expression and the ratio of LC3II/LC3I. Furthermore, the results of the TUNEL staining and FC showed that Exo-MI can reduce apoptotic rate. Through TEM, it was found that Exo-MI reduced the number of autophagosomes in NRK-52E cells. The rescue experiments revealed that the function of Exo-MI is to inhibit the CM-induced autophagy and apoptosis of NRK-52E cells, which can be inhibited by the miR-1-3p inhibitor. Furthermore, it was found that the overexpression of miR-1-3p can also inhibit the CM-induced autophagy and apoptosis of NRK-52E cells. Through dual luciferase reporter assay, ATG13 was found to be the target of miR-1-3p. In addition, the overexpression of miR-1-3p significantly reversed the CM-induced decrease in phosphorylation level of AKT. Furthermore, ATG13 silencing can also inhibit the CM-induced autophagy and apoptosis of NRK-52E cells. In vivo, Exo-MI significantly alleviated the renal injury, reduced the renal fibrosis, and improved the renal function of CIN rats. Conclusion: The circulating exosomal miR-1-3p after MI inhibited the CM-induced apoptosis and autophagy of renal tubular epithelial cells, and improved the renal function of rats by targeting ATG13 and activating the AKT signaling pathway.
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Affiliation(s)
- Pengcheng Zhao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yeqian Zhu
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Ling Sun
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of Cardiology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Wenwu Zhu
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yao Lu
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jian Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yangming Mao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Alshogran OY, Nusair SD, El-Elimat T, Alzoubi KH, Obeidat A, Sweidan M. Evaluation of coenzyme Q10 combined with or without N-acetyl cysteine or atorvastatin for preventing contrast-induced kidney injury in diabetic rats. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1403-1410. [PMID: 33630121 DOI: 10.1007/s00210-021-02070-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Combined antioxidants effect for prevention of contrast-induced nephropathy (CIN) remains unclear. This study assessed the potential protective effects of coenzyme Q10 (CoQ10) alone or combined with N-acetyl cysteine (NAC) or atorvastatin against CIN in diabetic rats. Animals were randomly divided into five groups, including control and four disease groups with CIN and diabetes. Group 2 included diabetic rats with CIN. Groups 3-5 included diabetic rats that received CoQ10, CoQ10 and NAC, or CoQ10 and atorvastatin, respectively, before CIN induction. Serum, urine, and tissue were collected to evaluate renal protective effects of tested agents. Renal biomarkers, oxidative stress, and histopathological alterations were investigated. Rats with CIN showed significant renal impairment as revealed by the deleterious effects on kidney function and histology. While induction of CIN did not affect the renal levels of catalase, glutathione peroxidase (GPx), and thiobarbituric acid reactive substances, pretreatment of animals with CoQ10/NAC showed significant increase in GPx and catalase levels versus controls. Lastly, pretreatment with CoQ10/atorvastatin showed regenerative effect on distal tubules with mild kidney histology alterations relative to CIN rats. The combined use of CoQ10/atorvastatin could be a potential strategy to prevent CIN. However, future studies are warranted to test different combinations for longer prophylactic periods.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Shreen D Nusair
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Tamam El-Elimat
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Abdullah Obeidat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Maya Sweidan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Yan Y, Ye M, Dong X, Chen Q, Hong H, Chen L, Luo Y. Prevention of Contrast-Induced Nephropathy by Inferior Vena Cava Ultrasonography-Guided Hydration in Chronic Heart Failure Patients. Cardiology 2021; 146:187-194. [PMID: 33486475 DOI: 10.1159/000512434] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contrast-induced nephropathy (CIN) is a common complication resulting from the administration of contrast media. This study was designed to determine whether inferior vena cava (IVC) ultrasonography (IVCU)-guided hydration can reduce the risk of CIN in chronic heart failure patients undergoing coronary angiography or coronary angiography with percutaneous coronary intervention compared with standard hydration. METHODS This prospective clinical trial enrolled 207 chronic heart failure patients from February 2016 to November 2017, who were randomly assigned to either the IVCU-guided hydration group (n = 104) or the routine hydration group (n = 103). In the IVCU-guided group, the hydration infusion rate was set according to the IVC diameter determined by IVCU, while the control group received intravenous infusion of 0.9% saline at 0.5 mL/(kg·h). Serum Cr was measured before and 48-72 h after the procedure. All patients were followed up for 18 months. The incidence of nephropathy and major adverse cardiovascular or cerebrovascular events (MACCEs) was also compared between the 2 groups. RESULTS Statistically significant difference between the 2 groups regarding the occurrence of CIN was observed (12.5 vs. 29.1%, p = 0.004). The hydration volume of the IVCU-guided group was significantly higher than that of the routine group (p < 0.001). In addition, patients receiving IVCU-guided hydration had significantly lower risk of developing MACCEs than patients in the control group during the 18-month follow-up (14.4 vs. 27.2%, p = 0.027). CONCLUSION Our findings support that IVCU-guided hydration is superior to standard hydration in prevention of CIN and may substantially reduce longtime composite major adverse events.
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Affiliation(s)
- Yuanming Yan
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingfang Ye
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xianfeng Dong
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qin Chen
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huashan Hong
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yukun Luo
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,
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Si Y, Sun W, Zhao K, Liu X, Ren K. Impact of low serum hemoglobin on development of contrast-induced nephropathy (CIN) in patients with hepatocellular carcinoma (HCC) following transarterial chemoembolisation (TACE). Int Urol Nephrol 2021; 53:1189-1195. [PMID: 33392886 DOI: 10.1007/s11255-020-02712-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/04/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the association between low hemoglobin (Hb) level and development of contrast-induced nephropathy (CIN) for hepatocellular carcinoma (HCC) patients after transarterial chemoembolization (TACE). METHODS A retrospective analysis was performed on 284 patients undergoing 503 consecutive sessions of TACE. Propensity score matching (PSM) analysis was used to reduce the influence of the difference in variables in normal and low hemoglobin groups. Risk factors of CIN were assessed by univariate and multivariate logistic regression analysis. The relation between Hb level and CIN development was analyzed by receiver operating characteristic (ROC) curve. RESULTS CIN developed in 5.6% patients after TACE. Multivariate logistic regression analysis showed that hypertension, Hb and serum creatinine (Scr) were independent risk factors for the development of post-TACE CIN. Grouped by normal or low Hb, the incidence of CIN was 14.6% (16/110) in the low Hb group and 3.4% (4/116) in the normal Hb group after PSM. Multivariate logistic regression analysis revealed that Hb, lymphocyte count, and neutrophil to lymphocyte ratio (NLR) were independent risk factors for the development of post-TACE CIN. The optimal cut-off point at which the Hb concentration resulted in a high probability of developing CIN was 105.5 g/L in males. CONCLUSIONS Low Hb is an independent risk factor for post-TACE CIN. Therefore, HCC patients with low Hb levels should be closely monitored before and during TACE.
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Affiliation(s)
- Youjiao Si
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong, China
| | - Wenge Sun
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Kaikai Zhao
- Department of Radiation Oncology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong, China
| | - Xianchuang Liu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Ke Ren
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China.
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Liu X, Song W, Zhang X, Long F, Yin J, He X, Lv L. Downregulating LncRNA XIST attenuated contrast-induced nephropathy injury via regulating miR-133a-3p/NLRP3 axis. J Thromb Thrombolysis 2021; 52:440-453. [PMID: 33387208 DOI: 10.1007/s11239-020-02369-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Long non-coding RNA X-inactive specific transcript (LncRNA XIST) is involved in several diseases. However, the molecular mechanism of XIST and its relation with miR-133a-3p in contrast-induced nephropathy (CIN) remained vague. Sprague-Dawley (SD) rats were assigned to Control, Sham, and CIN groups at random (n = 15 for each group). Histological examination on the kidney tissues was performed using hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) staining. Mean serum creatinine (SCr) and blood urea nitrogen (BUN) contents was measured by colorimetric microplate method. Levels of inflammatory cytokines were detected by enzyme-linked immunosorbent assay (ELISA). The cells viability and apoptosis were respectively detected by MTT assay and flow cytometry. Target gene and potential binding sites between XIST, miR-133a-3p and NLR Family Pyrin Domain Containing 3 (NLRP3) were predicted using online databases and confirmed by dual-luciferase reporter assay. Relative mRNA and protein expressions of XIST, miR-133a-3p, NLRP3, apoptosis-associated speck-like protein (ASC) and Cleaved caspase-1 were measured with quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot as needed. In the rat CIN model, Ioversol induced kidney morphology changes, with increase on SCr and BUN contents, elevated levels of inflammatory cytokines and upregulated expressions of XIST, NLRP3, ASC and Cleaved caspase-1. Silencing XIST reversed the effects of Ioversol on cells. MiR-133a-3p could bind with XIST and target NLRP3, and downregulating miR-133a-3p reversed the effect of silencing XIST on Ioversol-treated cells. Moreover, downregulating XIST attenuated CIN injury via regulating miR-133a-3p/NLRP3 axis.
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Affiliation(s)
- Xingli Liu
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Wei Song
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Xiangmin Zhang
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Fangmin Long
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Junkun Yin
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Xiao He
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Liang Lv
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China.
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Galal H, Shehta M, Attia S, Bastawy I. Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography. J Saudi Heart Assoc 2020; 32:451-455. [PMID: 33299790 PMCID: PMC7721453 DOI: 10.37616/2212-5043.1146] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/22/2023] Open
Abstract
Objectives Contrast-induced nephropathy is considered a serious complication following coronary angiography increasing morbidity and mortality. Various drugs have been assessed to reduce the incidence of contrast-induced nephropathy. In this study, we compared trimetazidine and allopurinol as a pharmacological measure to reduce the incidence of contrast-induced nephropathy. Methods One hundred and twenty patients undergoing coronary angiography with baseline creatinine clearance more than 30 ml/minute were divided into three groups, 40 patients each. Group 1 received standard parenteral intravenous hydration in the form of isotonic saline at a rate of 1 ml/kg body weight per hour started 12 hours before angiography and up to 12 hours after the procedure. Group 2 received trimetazidine 35 mg twice per day for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Group 3 received allopurinol 300 mg once daily for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Serum creatinine and creatinine clearance were measured before and 72 hours after the procedure in addition to the volume of contrast media used. Results Trimetazidine and allopurinol failed to reduce contrast-induced nephropathy significantly. Among patients with contrast-induced nephropathy volume of contrast media was significantly higher. Conclusion Adding trimetazidine or allopurinol in addition to regular intravenous hydration with isotonic saline without targeting selectively high-risk patients did not reduce contrast-induced nephropathy following coronary angiography.
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Affiliation(s)
- Haitham Galal
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Shehta
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sameh Attia
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Bastawy
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Soliman MM, Sarkar D, Glezerman I, Maybody M. Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy. World J Nephrol 2020; 9:33-42. [PMID: 33312900 PMCID: PMC7701934 DOI: 10.5527/wjn.v9.i2.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 05/27/2020] [Revised: 08/19/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12% of such cases. Risk factors for CIN development can be divided into patient- and procedure-related. The former includes pre-existing chronic renal insufficiency and diabetes mellitus. The latter includes high contrast volume and repeated exposure over 72 h. The incidence of CIN is relatively low (up to 5%) in patients with intact renal function. However, in patients with known chronic renal insufficiency, the incidence can reach up to 27%.
AIM To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic (CT) images obtained immediately following hepatic artery embolization with development of CIN.
METHODS Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011 (n = 162) was performed. Patients without intraprocedural CT imaging (n = 51), combined embolization/ablation (n = 6) and those with chronic kidney disease (n = 21) were excluded. The study group comprised of 84 patients with 106 procedures. CIN was defined as 25% increase above baseline serum creatinine or absolute increase ≥ 0.5 mg/dL within 72 h post-embolization. Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications. The association between non-contrast CT findings and CIN development was examined by Fisher’s Exact Test.
RESULTS CIN occurred in 11/106 (10.3%) procedures (Group A, n = 10). The renal enhancement pattern in patients who did not experience CIN (Group B, n = 74 with 95/106 procedures) was late excretory in 93/95 (98%) and early excretory (EE) in 2/95 (2%). However, in Group A, there was a significantly higher rate of EE pattern (6/11, 55%) compared to late excretory pattern (5/11) (P < 0.001). A significantly higher percentage of patients that developed CIN had renal artery calcifications (6/11 vs 20/95, 55% vs 21%, P = 0.02).
CONCLUSION A hyperdense renal parenchyma relative to surrounding skeletal muscle (EE pattern) and presence of renal artery calcifications on immediate post-HAE non-contrast CT images in patients with low risk for CIN are independently associated with CIN development.
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Affiliation(s)
- Mohamed M Soliman
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Debkumar Sarkar
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Ilya Glezerman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Majid Maybody
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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Lakhal K, Ehrmann S, Robert-Edan V. Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review. Crit Care 2020; 24:641. [PMID: 33168006 PMCID: PMC7653744 DOI: 10.1186/s13054-020-03365-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/07/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France.
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep Network, CHRU Tours, Tours France and Centre d'étude des Pathologies Respiratoires INSERM U1100, Université de Tours, Tours, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France
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Kusirisin P, Chattipakorn SC, Chattipakorn N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches. J Transl Med 2020; 18:400. [PMID: 33081797 PMCID: PMC7576747 DOI: 10.1186/s12967-020-02574-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an iatrogenic acute kidney injury observed after intravascular administration of contrast media for intravascular diagnostic procedures or therapeutic angiographic intervention. High risk patients including those with chronic kidney disease (CKD), diabetes mellitus with impaired renal function, congestive heart failure, intraarterial intervention, higher volume of contrast, volume depletion, old age, multiple myeloma, hypertension, and hyperuricemia had increased prevalence of CIN. Although CIN is reversible by itself, some patients suffer this condition without renal recovery leading to CKD or even end-stage renal disease which required long term renal replacement therapy. In addition, both CIN and CKD have been associated with increasing of mortality. Three pathophysiological mechanisms have been proposed including direct tubular toxicity, intrarenal vasoconstriction, and excessive production of reactive oxygen species (ROS), all of which lead to impaired renal function. Reports from basic and clinical studies showing potential preventive strategies for CIN pathophysiology including low- or iso-osmolar contrast media are summarized and discussed. In addition, reports on pharmacological interventions to reduce ROS and attenuate CIN are summarized, highlighting potential for use in clinical practice. Understanding this contributory mechanism could pave ways to improve therapeutic strategies in combating CIN.
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Affiliation(s)
- Prit Kusirisin
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand.
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Digumarthy SR, Singh R, Rastogi S, Otrakji A, Homayounieh F, Zhang EW, McDermott S, Kalra MK. Low contrast volume dual-energy CT of the chest: Quantitative and qualitative assessment. Clin Imaging 2020; 69:305-310. [PMID: 33045474 DOI: 10.1016/j.clinimag.2020.10.006] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the image quality of chest CT performed on dual-energy scanners using low contrast volume for routine chest (DECT-R) and pulmonary angiography (DECTPA) protocols. MATERIALS AND METHODS This retrospective study included dual-energy CT scans of chest performed with low contrast volume in 84 adults (34M:50F; Age 69 ± 16 years: Weight 71 ± 16kg). There were 42 patients with DECT-R and 42 patients with DECT-PA protocols. Images were reviewed by two thoracic radiologists. Qualitative assessment was done on a four-point scale, for subjective assessment of contrast enhancement and artifacts (1 = Excellent, 2 = optimal, 3 = suboptimal, and 4 = Limited) in the pulmonary arteries and thoracic aorta, on virtual monoenergetic and material decomposition iodine (MDI) images. Quantitative assessment was performed by measuring the CT (Hounsfield) units in aorta and pulmonary arteries. The estimated glomerular filtration rate (eGFR) was calculated before and after CT scans. Two tailed student's t-test was performed to assess the significance of findings, and strength of correlation between readers was determined by Cohen's kappa test. RESULTS DECT-PA and DECT-R demonstrated excellent/adequate contrast density within the pulmonary arteries (up to segmental branch), and aorta. There was no suboptimal or limited examination. There was strong interobserver agreement for arterial enhancement in pulmonary arteries (kappa = 0.62-0.89) and for thoracic aorta (kappa = 0.62-0.94). Pulmonary emboli were seen in 3/42(7%) in DECT-R and in 5/42(12%) in DECT-PA. There was no significant change in eGFR before and after IV contrast injection (p = 0.46-0.52). CONCLUSION DECT-R and DECT-PA performed with low contrast volume provide diagnostic quality opacification of the pulmonary vessels and aorta vessels.
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Affiliation(s)
- Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Ramandeep Singh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shivam Rastogi
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Alexi Otrakji
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Fatemeh Homayounieh
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Eric W Zhang
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mannudeep K Kalra
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Zhang F, Lu Z, Wang F. Advances in the pathogenesis and prevention of contrast-induced nephropathy. Life Sci 2020; 259:118379. [PMID: 32890604 DOI: 10.1016/j.lfs.2020.118379] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 06/04/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
With the increasing application of medical imaging contrast materials, contrast-induced nephropathy has become one of the leading causes of iatrogenic renal insufficiency. The underlying mechanism is associated with renal medullary hypoxia, direct toxicity of contrast agents, oxidative stress, apoptosis, immune/inflammation and epigenetic regulation in contrast-induced nephropathy. Up to date, there is no effective therapy for contrast-induced nephropathy, and thus risk predication and effective preventive strategies are keys to reduce the occurrence of contrast-induced nephropathy. It was found that the proper use of contrast medium, personalized hydration, and high-dose statins may reduce the occurrence of contrast-induced nephropathy, while antioxidants have not shown significant therapeutic benefits. Additionally, the role of remote ischemia preconditioning and vasodilators in the prevention of contrast-induced nephropathy needs further study. This review aims to discuss the incidence, pathogenesis, risk prediction, and preventive strategies for contrast-induced nephropathy.
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Affiliation(s)
- Fangfei Zhang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zeyuan Lu
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Feng Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
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Mahesh NK, Gupta A, Barward P, Vijayvergiya R, Sharma P, Mahesh A. Study of saline optical coherence tomography-guided percutaneous coronary intervention (SOCT-PCI Study). Indian Heart J 2020; 72:239-243. [PMID: 32861376 PMCID: PMC7474129 DOI: 10.1016/j.ihj.2020.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/01/2019] [Revised: 02/01/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022] Open
Abstract
AIM The aim of this study was to evaluate the feasibility of heparinised saline as flushing media for frequency-domain optical coherence tomography (FD-OCT) image acquisition during percutaneous coronary intervention (PCI) optimisation. METHODS AND RESULTS Twenty-seven patients undergoing FD-OCT-guided PCI were enrolled. Heparinised saline was injected into the coronary during FD-OCT image acquisition. A total of 118 runs were analysed for image quality and diagnostic value. FD-OCT runs were categorised as follows: good runs (GRs), clinically usable runs (CURs) and clinically not usable runs (NURs); GRs and CURs were combined as clinically effective runs (ERs). Saline FD-OCT enabled visualisation of all possible coronary lesions. Of the 118 runs analysed, 61%, 27.1%, 11.9% and 88.1% were GRs, CURs, NURs and ERs, respectively. Sixty-one percent of total runs were left coronary system (LCS) and 39% were right coronary system (RCS) runs. Among LCS runs, 55.6%, 30.6%, 13.8% and 86.2% were GRs, CURs, NURs and ERs, respectively. Among RCS runs, 69.6%, 21.7%, 8.7% and 91.3% were GRs, CURs, NURs and ERs, respectively. CONCLUSION This is the first study to demonstrate the technical feasibility of isolated saline FD-OCT for PCI optimisation.
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Affiliation(s)
- Nalin K Mahesh
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
| | - Ankush Gupta
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India.
| | | | | | - Prafull Sharma
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
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Hu C, Zhou G, Liu K, Yin W, Zhou L, Wang J, Chen L, Zuo S, Xie Y, Zuo X. CaMKII as a key regulator of contrast-induced nephropathy through mPTP opening in HK-2 cells. Cell Signal 2020; 75:109734. [PMID: 32791339 DOI: 10.1016/j.cellsig.2020.109734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/25/2019] [Revised: 07/26/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
Contrast-induced nephropathy (CIN), refers to acute kidney injury observed after administration of contrast media during angiographic or other medical procedures such as urography, and accounting for 12% of all causes of acute renal failure, but no specific prevention or treatment strategy exists for its obscure pathophysiology. The aim of our study was to explore the influence of calcium/calmodulin-dependent protein kinase II (CaMKII) in CIN by using HK-2 cells. Knockdown of CypD was achieved by lentivirus, and CaMKII overexpression by transfection with the plasmid. In this study, we have demonstrated that CypD-mediated mPTP opening triggered mitochondrial dysfunction and tubule cells apoptosis in CIN. We also found that iohexol treatment was associated with mitochondrial ROS overloading, ATP depletion and LDH release. Inhibition of CypD with the pharmacologic inhibitor or knockdown of CypD abrogated mPTP opening, oxidative stress, mitochondria damage, and cell apoptosis induced by iohexol. In addition, we found that inhibition of the CaMKII activity alleviated iohexol-induced CypD expression, whereas also decreased mPTP opening, oxidative stress, mitochondria damage, and cell apoptosis, similarly to the inhibition of CypD did. Moreover, CaMKII overexpression enhanced iohexol-induced mPTP opening, mitochondrial damage and renal tubular epithelial cells apoptosis. These findings first identified the novel role of CaMKII in iohexol-induced tubular cells apoptosis and delineated the CaMKII-CypD/mPTP pathway during contrast-induced tubular cell damage. Hence, these results could provide a new strategy for CIN protection.
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Affiliation(s)
- Can Hu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Ge Zhou
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Kun Liu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Wenjun Yin
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Lingyun Zhou
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Jianglin Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Linhua Chen
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Shanru Zuo
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Yueliang Xie
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
| | - Xiaocong Zuo
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China; Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China.
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Gu D, Shi Y, Gong Z, Xia T, Ren H, He D, Yang J, Han Y, Zeng C. AdipoRon, an adiponectin receptor agonist, protects contrast-induced nephropathy by suppressing oxidative stress and inflammation via activation of the AMPK pathway. Clin Exp Nephrol 2020; 24:989-98. [PMID: 32734507 DOI: 10.1007/s10157-020-01944-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN), a complication caused by using contrast medium during diagnostic and interventional procedures, occurs frequently and lacks effective treatment. AdipoRon, the agonist of adiponectin receptors, has been shown to benefit many organs including the kidney. This study aimed to investigate the role of AdipoRon in treating CIN. METHODS CIN model was established via infusing iopromide (1.8 g/kg) in Sprague-Dawley (SD) rats; NRK52E cells were treated with iopromide (5-50 μM). Renal function, renal histopathology, levels of lactate dehydrogenase (LDH) release, cell vitality, oxidative stress and inflammatory markers were measured to evaluate the protective effects of AdipoRon. The level of pAMPK/AMPK was determined by western blot. RESULTS AdipoRon (50 mg/kg) significantly reversed serum creatinine, blood urea nitrogen, creatinine clearance and urinary kidney injury molecule-1 levels induced by iopromide in SD rats. Besides, it decreased the renal injury score and apoptosis of renal cells. AdipoRon also reversed the changes of antioxidant markers, pro-oxidant and inflammatory markers induced by iopromide. Moreover, the in vitro studies showed that AdipoRon decreased LDH release and increased cell vitality in NRK52E cells treated with iopromide. Then, we demonstrated that the protection of AdipoRon was accompanied by augmented AMPK phosphorylation. Both in vivo and in vitro studies demonstrated that compound c, an AMPK inhibitor, reversed the AdipoRon-mediated improvement in the CIN model. CONCLUSION Our data indicate that AdipoRon protects against the CIN by suppressing oxidative stress and inflammation via activating the AMPK pathway, showing that AdipoRon might be a potential candidate for the prevention and therapy of CIN.
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Deng J, Lu Y, Ou J, Shao X, Wang X, Xie H. Remote Ischemic Preconditioning Reduces the Risk of Contrast-Induced Nephropathy in Patients with Moderate Renal Impairment Undergoing Percutaneous Coronary Angiography: A Meta-Analysis. Kidney Blood Press Res 2020; 45:549-564. [PMID: 32688358 DOI: 10.1159/000507330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/03/2019] [Accepted: 03/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This meta-analysis evaluated the effects of remote ischemic preconditioning (RIPC) on the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention/coronary angiography (PCI/CA). METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that assessed the effect of RIPC on CIN in patients undergoing PCI/CA. The main outcomes of interest were the incidence of CIN 48-72 h after CA, the levels of serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin, and estimated glomerular filtration rate (eGFR), mortality, and requirement of hemodialysis and rehospitalization. The analysis was conducted using the random-effect model due to the expected heterogeneity among different studies. RESULTS In total, 16 trials covering 2,048 patients were identified. By assessing the methodological quality of the included studies through the Coch-rane risk of bias, we found that of the 16 RCTs, 3 had a low risk of bias, 6 a high, and 7 an unclear risk. The application of RIPC decreased the incidence of CIN (relative risk, RR, 0.50, 95% confidence interval, CI, 0.39-0.65; p < 0.001). Subgroup analyses showed that RIPC decreased the incidence of CIN in patients with eGFR <60 mL/min/1.73 m2 (RR 0.53, 95% CI 0.38-0.75; p < 0.001) but not in patients with eGRF ≥60 mL/min/1.73 m2 (RR 0.82, 95% CI 0.35-1.94; p = 0.66) at baseline. Furthermore, the increase in serum creatinine was significantly lower in patients with RIPC compared to control patients (standardized mean difference -1.41, 95% CI -2.46 to -0.35; p = 0.009). CONCLUSIONS Based on 16 RCTs, this meta-analysis shows that RIPC can reduce the risk of CIN in patients with moderate renal impairment undergoing PCI/CA. However, this needs to be confirmed by further high-quality evidence.
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Affiliation(s)
- Jin Deng
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, China,
| | - Yi Lu
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Jihong Ou
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Xiaofei Shao
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongping Xie
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, China
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Abstract
History of contrast dates back to the 1890s, with the invention of the radiograph. Nephrotoxicity has been a main limitation in ideal contrast media (CM). High-osmolar contrast media no longer are in clinical use due to overwhelming evidence supporting greater nephrotoxicity with these CM compared with current CM. Contrast-induced nephropathy (CIN) remains a common cause of in-hospital acute kidney injury. The choice contrast agent is determined mainly by cost and institution practice. This review focuses on the history, chemical properties, and experimental and clinical studies on the various groups of CM and their role in CIN.
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Affiliation(s)
- Sadichhya Lohani
- Renal-Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, 51N 39th Market Street, Suite 240, Philadelphia, PA 19104, USA.
| | - Michael R Rudnick
- Renal-Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, 51N 39th Market Street, Suite 240, Philadelphia, PA 19104, USA. https://twitter.com/MichaelRudnick7
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50
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Yamamoto Y, Yamamoto N, Kanematsu Y, Kuroda K, Yamaguchi I, Miyamoto T, Sogabe S, Shimada K, Takagi Y, Izumi Y. High White Blood Cell Count Is a Risk Factor for Contrast-Induced Nephropathy following Mechanical Thrombectomy for Acute Ischemic Stroke. Cerebrovasc Dis Extra 2020; 10:59-65. [PMID: 32610309 PMCID: PMC7383160 DOI: 10.1159/000507918] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although mechanical thrombectomy is a standard endovascular therapy for patients with acute ischemic stroke (AIS), the incidence of and risk factors for contrast-induced nephropathy (CIN) following mechanical thrombectomy are infrequently reported. OBJECTIVES The aim of this study was to investigate the incidence and risk factors for CIN following mechanical thrombectomy for AIS, and whether the incidence of CIN is related to a poor prognosis. METHODS We examined consecutive patients who underwent a mechanical thrombectomy in the period from January 2014 to March 2018. The patients' clinical backgrounds, treatments, and clinical prognoses were analyzed. CIN was defined as an increase in the serum creatinine level of ≥44.2 μmol/L (0.5 mg/dL) or 25% above baseline within 72 h after exposure to the contrast medium. RESULTS In total, 80 patients (46 men and 34 women aged 74.5 ± 11.5 years) who met our inclusion criteria were analyzed. CIN occurred in 8.8% (7/80) of the patients following mechanical thrombectomy. Although no patients needed permanent dialysis, 1 required temporary dialysis. The median amount of contrast medium was 109 mL. A comparison between the groups with and without CIN showed a significant difference in white blood cell (WBC) count at the time of admission (11.6 ± 2.7 × 103/μL and 8.1 ± 2.7 × 103/μL; p < 0.01) and the cut-off value was 9.70 × 103/μL. In multivariate analysis, contrast volume/estimated glomerular filtration rate by creatinine and WBC count were significantly associated with the incidence of CIN, with odds ratios of 1.64 (95% CI 1.02-2.65; p = 0.04) and 1.61 (95% CI 1.15-2.25; p < 0.01), respectively. CONCLUSIONS This study found that CIN occurred in 8.8% of patients with AIS following mechanical thrombectomy. High WBC count was associated with an increased risk of CIN and may be helpful for predicting CIN.
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Affiliation(s)
- Yuki Yamamoto
- Department of Neurology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan,
| | - Nobuaki Yamamoto
- Department of Neurology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kazutaka Kuroda
- Department of Neurology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeshi Miyamoto
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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