151
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Orlacchio A, Guastoni C, Beretta GD, Cosmai L, Galluzzo M, Gori S, Grassedonio E, Incorvaia L, Marcantoni C, Netti GS, Passamonti M, Porta C, Procopio G, Rizzo M, Roma S, Romanini L, Stacul F, Casinelli A. SIRM-SIN-AIOM: appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations-consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM). Radiol Med 2022; 127:534-542. [PMID: 35303246 PMCID: PMC9098565 DOI: 10.1007/s11547-022-01483-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
The increasing number of examinations and interventional radiological procedures that require the administration of contrast medium (CM) in patients at risk for advanced age and/or comorbidities highlights the problem of CM-induced renal toxicity. A multidisciplinary group consisting of specialists of different disciplines—radiologists, nephrologists and oncologists, members of the respective Italian Scientific Societies—agreed to draw up this position paper, to assist clinicians increasingly facing the challenges posed by CM-related renal dysfunction in their daily clinical practice. The major risk factor for acute renal failure following CM administration (post-CM AKI) is the preexistence of renal failure, particularly when associated with diabetes, heart failure or cancer. In accordance with the recent guidelines ESUR, the present document reaffirms the importance of renal risk assessment through the evaluation of the renal function (eGFR) measured on serum creatinine and defines the renal risk cutoff when the eGFR is < 30 ml/min/1.73 m2 for procedures with intravenous (i.v.) or intra-arterial (i.a.) administration of CM with renal contact at the second passage (i.e., after CM dilution with the passage into the pulmonary circulation). The cutoff of renal risk is considered an eGFR < 45 ml/min/1.73 m2 in patients undergoing i.a. administration with first-pass renal contact (CM injected directly into the renal arteries or in the arterial district upstream of the renal circulation) or in particularly unstable patients such as those admitted to the ICU. Intravenous hydration using either saline or Na bicarbonate solution before and after CM administration represents the most effective preventive measure in patients at risk of post-CM AKI. In the case of urgency, the infusion of 1.4% sodium bicarbonate pre- and post-CM may be more appropriate than the administration of saline. In cancer patients undergoing computed tomography, pre- and post-CM hydration should be performed when the eGFR is < 30 ml/min/1.73 m2 and it is also advisable to maintain a 5 to 7 days interval with respect to the administration of cisplatin and to wait 14 days before administering zoledronic acid. In patients with more severe renal risk (i.e., with eGFR < 20 ml/min/1.73 m2), particularly if undergoing cardiological interventional procedures, the prevention of post-CM AKI should be implemented through an internal protocol shared between the specialists who treat the patient. In magnetic resonance imaging (MRI) using gadolinium CM, there is a lower risk of AKI than with iodinated CM, particularly if doses < 0.1 mmol/kg body weight are used and in patients with eGFR > 30 ml/min/1.73 m2. Dialysis after MRI is indicated only in patients already undergoing chronic dialysis treatment to reduce the potential risk of systemic nephrogenic fibrosis.
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Affiliation(s)
- Antonio Orlacchio
- Radiology Unit, Department of Surgical Science, University of Rome "Tor Vergata", Rome, Italy. .,Emergency Radiology, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | | | | | - Laura Cosmai
- Nephology Unit, Azienda Ospedaliera San Carlo Borromeo di Milano, Milan, Italy
| | - Michele Galluzzo
- Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Stefania Gori
- Department of Oncology, IRCC Ospedale Sacro Cuore Don Calabria, Negrar Valpolicella, Italy
| | | | | | - Carmelita Marcantoni
- Nephology UnitSan Marco Hospital, Azienda Ospedaliero Universitaria, Catania, Italy
| | | | | | | | - Giuseppe Procopio
- Genito-Urinary Medical Oncology, Fondazione Istituto Nazionale Tumori, Milano, Italy
| | - Mimma Rizzo
- Oncology Unit, Hospital Santa Chiara, Trento, Italy
| | - Silvia Roma
- Radiology Unit, Hospital F. Spaziani, Frosinone, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Fulvio Stacul
- Department of Radiology, Maggiore Hospital, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alice Casinelli
- Emergency Radiology, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
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152
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Briguori C, Mathew RO, Huang Z, Mavromatis K, Hickson LJ, Lau WL, Mathew A, Mahajan S, Wheeler DC, Claes KJ, Chen G, Nolasco FEB, Stone GW, Fleg JL, Sidhu MS, Rockhold FW, Chertow GM, Hochman JS, Maron DJ, Bangalore S. Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA-CKD. J Am Heart Assoc 2022; 11:e022003. [PMID: 35261290 PMCID: PMC9075321 DOI: 10.1161/jaha.121.022003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/10/2021] [Indexed: 01/21/2023]
Abstract
Background In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. Methods and Results In ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non-dialysis-requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow-up of 23 months (25th-75th interquartile range, 14-32 months), dialysis was initiated in 18.9% of participants (36/190) in the invasive strategy and 16.9% of participants (29/172) in the conservative strategy (P=0.22). The median time to dialysis initiation was 6.0 months (interquartile range, 3.0-16.0 months) in the invasive group and 18.2 months (interquartile range, 12.2-25.0 months) in the conservative group (P=0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%; P=0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5-unit decrease, 2.08 [95% CI, 1.72-2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28-4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09-58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22-4.47]; P=0.010). Conclusions In participants with non-dialysis-requiring CKD in ISCHEMIA-CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01985360.
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Affiliation(s)
| | | | - Zhen Huang
- Duke Clinical Research InstituteDuke University Medical CenterDurhamNC
| | - Kreton Mavromatis
- Atlanta VA Healthcare System and Emory University School of MedicineAtlantaGA
| | | | - Wei Ling Lau
- Division of NephrologyDepartment of MedicineUniversity of California‐IrvineIrvineCA
| | - Anoop Mathew
- University of Alberta HospitalEdmontonAlbertaCanada
| | | | | | | | - Gang Chen
- Peking Union Medical College HospitalBeijingChina
| | | | - Gregg W. Stone
- Icahn School of Medicine at Mount SinaiNew YorkNY
- Cardiovascular Research FoundationNew YorkNY
| | | | | | - Frank W. Rockhold
- Duke Clinical Research InstituteDuke University Medical CenterDurhamNC
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153
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Wang R, Xie Z, Li B, Zhang P. Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review. Ther Adv Neurol Disord 2022; 15:17562864221083620. [PMID: 35646161 PMCID: PMC9133867 DOI: 10.1177/17562864221083620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background The association between renal impairment (RI) and stroke outcome after endovascular thrombectomy (EVT) remains unclear, which limits the estimation of patient prognosis by clinicians involved in EVT decision-making. Purpose This study aimed to investigate the association between RI and acute ischemic stroke (AIS) outcomes in patients treated with EVT. Methods Studies involving the association between RI at admission and AIS outcomes after EVT were retrieved from the PubMed and Embase databases from their inception to 17 January 2022. A fixed-effects model was used to synthesize the data of the included studies. Sensitivity analysis was performed to identify the source of heterogeneity. Results Overall, 11 studies, including 5053 patients with stroke receiving EVT, were included in the full analysis. In unadjusted analyses, RI was associated with 3-month poor functional outcome and mortality; the odds ratios (ORs) were 2.13 [10 studies; 95% confidence interval (CI), 1.77-2.56; I 2 = 45%] and 2.42 (8 studies; 95% CI, 2.02-2.90; I 2 = 58%), respectively. In adjusted analyses, the above associations remained significant; the OR of the 3-month poor functional outcome was 1.49 (5 studies; 95% CI, 1.17-1.90; I 2 = 58%), and the OR of the 3-month mortality was 1.84 (6 studies; 95% CI, 1.45-2.33; I 2 = 74%). Similar results were obtained in sensitivity analyses. Conclusion Our results suggest that in patients with AIS who underwent EVT, RI at admission was associated with 3-month poor functional outcome and mortality.
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Affiliation(s)
- Rui Wang
- Department of Epidemiology and Biostatistics,
School of Public Health, Jilin University, Changchun, ChinaDepartment of
Thoracic Surgery, The First Hospital of Jilin University, Changchun,
China
| | - Zechun Xie
- Department of Epidemiology and Biostatistics,
School of Public Health, Jilin University, Changchun, China
| | - Bo Li
- Department of Epidemiology and Biostatistics,
School of Public Health, Jilin University, 1163 Xinmin Street, Changchun
130021, China
| | - Peng Zhang
- Clinical Trial and Research Center for Stroke,
Department of Neurology, The First Hospital of Jilin University, 1 Xinmin
Street, Changchun 130021, China
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154
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Li D, Jiang H, Yang X, Lin M, Gao M, Chen Z, Fu G, Lai D, Zhang W. An Online Pre-procedural Nomogram for the Prediction of Contrast-Associated Acute Kidney Injury in Patients Undergoing Coronary Angiography. Front Med (Lausanne) 2022; 9:839856. [PMID: 35360720 PMCID: PMC8961873 DOI: 10.3389/fmed.2022.839856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/22/2022] [Indexed: 12/23/2022] Open
Abstract
BackgroundIdentifying high-risk patients for contrast-associated acute kidney injury (CA-AKI) helps to take early preventive interventions. The current study aimed to establish and validate an online pre-procedural nomogram for CA-AKI in patients undergoing coronary angiography (CAG).MethodsIn this retrospective dataset, 4,295 patients undergoing CAG were enrolled and randomized into the training or testing dataset with a split ratio of 8:2. Optimal predictors for CA-AKI were determined by Least Absolute Shrinkage and Selection Operator (LASSO) and Random Forest (RF) algorithm. Nomogram was developed and deployed online. The discrimination and accuracy of the nomogram were evaluated by receiver operating characteristic (ROC) and calibration analysis, respectively. Clinical usefulness was estimated by decision curve analysis (DCA) and clinical impact curve (CIC).ResultsA total of 755 patients (17.1%) was diagnosed with CA-AKI. 7 pre-procedural predictors were identified and integrated into the nomogram, including age, gender, hemoglobin, N-terminal of the prohormone brain natriuretic peptide, neutrophil-to-lymphocyte ratio, cardiac troponin I, and loop diuretics use. The ROC analyses showed that the nomogram had a good discrimination performance for CA-AKI in the training dataset (area under the curve, AUC = 0.766, 95%CI [0.737 to 0.794]) and testing dataset (AUC = 0.737, 95%CI [0.693 to 0.780]). The nomogram was also well-calibrated in both the training dataset (P = 0.965) and the testing dataset (P = 0.789). Good clinical usefulness was identified by DCA and CIC. Finally, this model was deployed in a web server for public use (https://duanbin-li.shinyapps.io/DynNomapp/).ConclusionAn easy-to-use pre-procedural nomogram for predicting CA-AKI was established and validated in patients undergoing CAG, which was also deployed online.
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Affiliation(s)
- Duanbin Li
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Hangpan Jiang
- Department of Cardiology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Xinrui Yang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- Department of Cardiology, The Hangzhou Lin’an People’s Hospital, Hangzhou, China
| | - Maoning Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Menghan Gao
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhezhe Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Dongwu Lai
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- Dongwu Lai,
| | - Wenbin Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- *Correspondence: Wenbin Zhang,
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155
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Zhou D, Lun Z, Wang B, Liu J, Liu L, Chen G, Ying M, Li H, Chen S, Tan N, Chen J, Liu Y, Ye J. Association Between Non-Recovered Contrast-Associated Acute Kidney Injury and Poor Prognosis in Patients Undergoing Coronary Angiography. Front Cardiovasc Med 2022; 9:823829. [PMID: 35321105 PMCID: PMC8934940 DOI: 10.3389/fcvm.2022.823829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrevious studies have shown that renal function recovery after acute kidney injury (AKI) was associated with decreased risk of all-cause mortality. However, little is known about the correlation between renal function recovery and long-term prognosis in patients with contrast-associated acute kidney injury (CA-AKI) undergoing coronary angiography (CAG).MethodsWe retrospectively enrolled 5,865 patients who underwent CAG. CA-AKI was defined as an increase in serum creatinine (SCr) ≥ 50% or ≥ 0.3 mg/dl from baseline within 72 h post procedure. Recovered CA-AKI was defined as a decrease in SCr to baseline or no CA-AKI level. The first endpoint was long-term all-cause mortality. Kaplan–Meier analysis and Cox regression analysis were used to investigate the association between kidney function recovery and long-term mortality.ResultsDuring the median follow-up period of 5.25 years, the overall long-term mortality was 20.07%, and the long-term mortality in patients with recovered CA-AKI and non-recovered CA-AKI was 17.46 and 27.44%, respectively. After multivariate Cox hazard regression, non-recovered CA-AKI was significantly associated with long-term mortality, while recovered CA-AKI was not [recovered CA-AKI vs. no CA-AKI, hazard ratio (HR) = 1.06, 95% confidence interval (CI): 0.81–1.39, p = 0.661; non-recovered CA-AKI vs. no CA-AKI, HR = 1.39, 95% CI: 1.21–1.60, p < 0.001]. In the subgroup of CAD, both recovered CA-AKI and non-recovered CA-AKI were associated with increased risk of long-term all-cause mortality. However, in other subgroup analyses, only non-recovered CA-AKI was associated with increased risk of long-term all-cause mortality.ConclusionOur results found that non-recovered CA-AKI is significantly associated with long-term mortality. In patients with CAD, recovered CA-AKI can still increase the risk of all-cause mortality. Clinicians need to pay more attention to patients suffering from CA-AKI, whose kidney function has not recovered. In addition, active prevention treatments should be taken by patients with CAD.
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Affiliation(s)
- Dianhua Zhou
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Zhubin Lun
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China
| | - Bo Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liwei Liu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Guanzhong Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Ying
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huanqiang Li
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Yong Liu
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
- Jianfeng Ye
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156
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Maragkos GA, Cho LD, Legome E, Wedderburn R, Margetis K. Prognostic Factors for Stage 3 Acute Kidney Injury in Isolated Serious Traumatic Brain Injury. World Neurosurg 2022; 161:e710-e722. [PMID: 35257954 DOI: 10.1016/j.wneu.2022.02.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stage 3 acute kidney injury (AKI) has been observed to develop following serious traumatic brain injury (TBI) and is associated with worse outcomes, though its incidence is not consistently established. This study aims to report the incidence of stage 3 AKI in serious isolated TBI in a large, national trauma database, and explore associated predictive factors. METHODS This was a retrospective cohort study using 2015-2018 data from the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP), a national database of trauma patients. Adult trauma patients admitted to the hospital with isolated serious TBI were included. Variables relating to demographics, comorbidities, vitals, hospital presentation, and course of stay were assessed. Imputed multivariable logistic regression assessed factors predictive of stage 3 AKI development. RESULTS A total of 342,675 patients with isolated serious TBI were included, 1,585 (0.5%) of whom developed stage 3 AKI. Variables associated with stage 3 AKI in multivariable analysis were older age, male sex, Black race, higher BMI, history of hypertension, diabetes, peripheral artery disease, chronic kidney disease, higher injury severity score, higher heart rate on arrival, lower oxygen saturation and motor Glasgow coma scale (GCS), admission to the intensive care unit (ICU) or operating room, development of catheter-associated urinary tract infections (CAUTI) or acute respiratory distress syndrome (ARDS), longer ICU stay and ventilation duration. CONCLUSIONS Stage 3 AKI occurred in 0.5% of serious TBI cases. Complications of ARDS and CAUTI are more likely to co-occur with stage 3 AKI in serious TBI patients.
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Affiliation(s)
- Georgios A Maragkos
- Department of Neurosurgery, Mount Sinai Morningside Hospital, Icahn School of Medicine, New York, NY
| | - Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eric Legome
- Department of Emergency Medicine, Mount Sinai West and Mount Sinai Morningside Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Raymond Wedderburn
- Department of Surgery, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Konstantinos Margetis
- Department of Neurosurgery, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
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157
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Open Abdominal Aortic Aneurysm Surgery and Renal Dysfunction; Association of Demographic and Clinical Variables with Proximal Clamp Location. Ann Vasc Surg 2022; 84:239-249. [PMID: 35247532 DOI: 10.1016/j.avsg.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND While cross-clamp site is a known risk factor for postoperative acute and chronic renal dysfunction following open abdominal aortic aneurysm surgery (AAA), the additive impact of patient demographic and clinical factors is lacking. In this study, we investigated the impact of body mass index (BMI), surgical duration and aneurysm diameter on the association between proximal cross-clamp location and postoperative renal dysfunction. METHODS In this study, we conducted a retrospective analysis of 4,197 patients undergoing open AAA surgery between 2011 and 2018 using data housed in the American College of Surgeons National Safety Quality Improvement Program (ACS-NSQIP) database. The primary outcome was renal dysfunction, which was defined as patients requiring dialysis within 30 days or patients with ≥2 mg/dL rise in creatinine from baseline. We assessed the incidence of renal dysfunction with regard to clamp location and subsequently used multivariable logistic regression to assess clinical and demographic factors associated with renal dysfunction. We used a regression model to plot the association of BMI, surgical duration, and aneurysm diameter with an adjusted probability of postoperative acute and chronic renal dysfunction for individual cross-clamp locations. RESULTS Of the 4,197 patients analyzed, 405 patients (9.6%) developed renal dysfunction within 30 days with 287 patients requiring dialysis. Patients with supraceliac clamp location had the highest incidence of renal dysfunction (20.4%). Our data showed a significant association of renal dysfunction with higher BMI patients [OR 1.04 (1.02, 1.07), P = 0.001], longer operative times [OR1.01 (1.01, 1.02), P < 0.001], clamp location between the superior mesenteric artery (SMA) and renal artery [OR 1.80 (1.17, 2.78), P = 0.007] and supraceliac clamp location [OR 2.47 (1.62, 3.76), P < 0.001]. CONCLUSIONS The incidence of renal dysfunction increases with suprarenal clamps. Patients with higher BMI, longer operative times, and increasing aneurysm diameter, and a suprarenal clamp have a significantly increased risk of renal dysfunction compared to those who also had a suprarenal clamp but lower BMI, shorter operative times and smaller aneurysm diameter.
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158
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Magnetic Resonance Imaging of Contrast-Induced Acute Renal Injury and Related Pathological Alterations In Vivo. Anal Cell Pathol (Amst) 2022; 2022:6984200. [PMID: 35256925 PMCID: PMC8898140 DOI: 10.1155/2022/6984200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background. The definitive mechanisms of CI-AKI include contrast medium (CM) nephrotoxicity and CM disturbances in renal blood flow, but how the immune system responds to CM has rarely been mentioned in previous studies, and different cell death pathways have not been clearly distinguished. Aim. To confirm whether MRI detect early CI-AKI and to investigate whether immunity-related responses, pyroptosis, and mitophagy participate in contrast-induced acute renal injury (CI-AKI). Methods. C57BL/6 mice with CI-AKI were established by tail vein injection of iodixanol 320. Magnetic resonance imaging of 9.4 T scanner and microscopic appearance of renal H&E staining were tools to test the occurrence of CI-AKI at different times. Immunohistochemistry and NGAL were used to examine the immune responses in the kidneys with CI-AKI. Transmission electron microscopy and western blot methods were used to distinguish various cell death pathways in CI-AKI. Key Results. The densitometry of T2WI, DTI, and BOLD presents CI-AKI in a regular way. The microscopic appearance presents the strongest renal damage in CI-AKI mice that existed between 12 h (
) and 24 h (
) after contrast medium (CM) injection. Strong correlation may exist between MRI densitometry (T2WI, DTI, and BOLD) and pathology. Neutrophil and macrophage chemotaxis occurred in CI-AKI, and we observed that Ly6G was the strongest at 48 h (
). Pyroptosis (Nlrp3/caspase-1,
), mitophagy (BNIP/Nix,
), and apoptosis (Bax,
) occurred in CI-AKI. Conclusions. fMRI can detect early CI-AKI immediately after CM injection. NLRP3 inflammasomes are involved in CI-AKI, and mitophagy may play a role in mitigating kidney injury. The mitochondrion is one of the key organelles in the tubular epithelium implicated in CI-AKI.
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159
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Li J, Wang Z, Zhang B, Zheng D, Lu Y, Li W. Predictive value of combining the level of fibrinogen and CHA2DS2-VASC Score for contrast-induced acute kidney injury in patients with acute coronary syndromes undergoing percutaneous coronary intervention. Int Urol Nephrol 2022; 54:2385-2392. [PMID: 35182313 DOI: 10.1007/s11255-022-03149-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present study aimed to investigate the value of preprocedural fibrinogen (FIB) combined with CHA2DS2-VASC scores in the risk prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). METHOD A total of 934 patients (mean age 63.9 ± 11.5 years, and 32.1% female), who were admitted to our hospital for ACS and underwent PCI, were retrospectively enrolled. The patients were divided into two groups: non-CI-AKI group (n = 787) and CI-AKI group (n = 147). Contrast-induced acute kidney injury was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% serum creatinine within 48-72 h after PCI. Spearman correlation analysis was used to determine the relationship between FIB and CHA2DS2-VASC scores. RESULTS Patients with high baseline FIB levels and high CHA2DS2-VASC scores had higher CI-AKI incidence. On spearman correlation analysis, FIB and CHA2DS2-VASC scores were positively correlated (R = 0.236, P < 0.001). The ROC statistical analysis showed that the combination had 63.3% sensitivity with 72.6% specificity for the development of CI-AKI (area under the curve: 0.727, 95% CI 0.697-0.755, P < 0.001). A total of 934 ACS patients were divided into low-risk group (404 cases), medium-risk group (383 cases) and high-risk group (147 cases) according to the cut-off values of FIB and CHA2DS2-VASC scores. The incidence of CI-AKI was higher in the high-risk group than in the low-risk and medium-risk groups (Log-rank χ2 = 104.505, 56.647. P < 0.001). Multivariate analysis revealed that albumin (OR = 0.913, 95% CI 0.867-0.962), FIB (OR = 1.451, 95% CI 1.185-1.77), CHA2DS2-VASC score (OR = 1.271, 95% CI 1.504-1.78) were the independent risk factors of CI-AKI (p < 0.05). CONCLUSION The preprocedural fibrinogen combined with CHA2DS2-VASC score is independently associated with the risk of CI-AKI in ACS patients treated by PCI.
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Affiliation(s)
- Jing Li
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China
| | - Zhen Wang
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China
| | - BaiXiang Zhang
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Di Zheng
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Yuan Lu
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Wenhua Li
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China. .,Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
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Yandrapalli S, Christy J, Malik A, Wats K, Harikrishnan P, Aronow W, Frishman W. Impact of Acute and Chronic Kidney Disease on Heart Failure Hospitalizations After Acute Myocardial Infarction. Am J Cardiol 2022; 165:1-11. [PMID: 34893301 DOI: 10.1016/j.amjcard.2021.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
Very few studies evaluated the impact of acute kidney injury (AKI) and chronic kidney disease (CKD) on heart failure (HF) hospitalization risk following an acute myocardial infarction (AMI). For this retrospective cohort analysis, we identified adult AMI survivors from January to June 2014 from the United States Nationwide Readmissions Database. Outcomes were a 6-month HF, fatal HF, composite of HF during the AMI or a 6-month HF, and a composite of 6-month HF or death during a non-HF-related admission. We analyzed differences in outcomes across categories of patients without renal injury, AKI without CKD, stable CKD, AKI on CKD, and end-stage renal disease (ESRD). Of 237,549 AMI survivors, AKI was present in 13.8%, CKD in 16.5%, ESRD in 3.4%, and AKI on CKD in 7.7%. Patients with renal failure had lower coronary revascularization rates and higher in-hospital HF. A 6-month HF hospitalization occurred in 12,934 patients (5.4%). Compared with patients without renal failure (3.3%), 6-month HF admission rate was higher in patients with AKI on CKD (14.6%; odds ratio [OR] 1.99; 95% confidence interval [CI] 1.81 to 2.19), ESRD (11.2%; OR 1.57; 95% CI 1.36 to 1.81), stable CKD (10.7%; OR 1.72; 95% CI 1.56 to 1.88), and AKI (8.6%; OR 1.52; 95% CI 1.36 to 1.70). Results were generally homogenous in prespecified subgroups and for the other outcomes. In conclusion, 1 in 4 AMI survivors had either acute or chronic renal failure. The presence of any form of renal failure was associated with a substantially increased risk of 6-month HF hospitalizations and associated mortality with the highest risk associated with AKI on CKD.
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Affiliation(s)
- Srikanth Yandrapalli
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - John Christy
- Department of Internal Medicine, Kent Memorial Hospital and Warren Alpert Medical School of Brown University, Warwick, Rhode Island
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Karan Wats
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | | | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - William Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
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161
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Li Q, Pan S. Contrast-Associated Acute Kidney Injury: Advances and Challenges. Int J Gen Med 2022; 15:1537-1546. [PMID: 35210826 PMCID: PMC8857968 DOI: 10.2147/ijgm.s341072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
A decrease in renal function that follows intravascular administration of contrast medium (CM) within a few days is reported as contrast-induced acute kidney injury (CI-AKI). In clinical practice, the imaging procedure is frequently deferred when clinicians consider that the renal risks caused by CM outweigh the benefits of enhanced imaging. However, with an in-depth understanding of AKI and contrast medium, scholars have realized that the decrease in renal function after CM is caused by contrast medium factors and noncontrast medium factors (such as anemia and hemodynamic instability). Therefore, acute kidney injury caused by CM has been overestimated in the past. The term “contrast-associated acute kidney injury (CA-AKI)” has been increasingly used to indicate AKI after intravascular administration of contrast medium compared with CI-AKI. CA-AKI can increase the risk of death and chronic kidney disease. However, its pathophysiological mechanism has not been fully elucidated, and the effectiveness of various preventive and therapeutic measures have been questioned. These present challenges for us. In this article, we will review the diagnostic criteria, epidemiology, risk factors, pathophysiological mechanisms and treatment of CA-AKI to provide optimized imaging procedures in clinical practice.
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Affiliation(s)
- Qingqing Li
- Department of Intensive Care Medicine, Qingdao Municipal Hospital, Qingdao, People’s Republic of China
- Correspondence: Qingqing Li, Department of Intensive Care Medicine, Qingdao Municipal Hospital, Qingdao, People’s Republic of China, Email
| | - Shengqi Pan
- Department of Intensive Care Medicine, Qingdao Municipal Hospital, Qingdao, People’s Republic of China
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Ohta R, Hattori S, Inoue K, Sano C. Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an Immunocompromised Patient. Cureus 2022; 14:e21774. [PMID: 35251844 PMCID: PMC8890593 DOI: 10.7759/cureus.21774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/22/2022] Open
Abstract
Prostate abscesses often occur in immunocompromised individuals. Contrast-enhanced imaging tests can aid diagnosis; however, they can be difficult to perform in older patients with renal insufficiency. Various organisms can cause prostate abscesses, and poor antibiotic penetration into the prostate can hinder treatment. Here, we report a case of prostate abscess manifesting as fever of unknown origin. The patient, a 78-year-old man with a history of heart failure, renal failure, and liver cirrhosis, presented with dyspnea and fever. He was initially diagnosed with aspiration pneumonia. However, the fever persisted, and urinary tract infection was diagnosed and treated with antibiotics and antifungal drugs. Further investigation with contrast-enhanced computed tomography revealed a prostate abscess. This case demonstrates the importance of aggressive investigation of fever of unknown origin in older patients with renal insufficiency. Furthermore, the problem of tissue penetration of antimicrobial agents should be thoroughly considered when treating prostate abscesses.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 558] [Impact Index Per Article: 279.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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164
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 159] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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165
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The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy. Diagnostics (Basel) 2022; 12:diagnostics12010180. [PMID: 35054347 PMCID: PMC8774832 DOI: 10.3390/diagnostics12010180] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.
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166
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Tao J, Ye C, Dai W, Li D, Zhou M, Li Y. Serum Level of Complement C1q is Associated with Contrast-Associated Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention. J Inflamm Res 2022; 14:7331-7339. [PMID: 34992420 PMCID: PMC8714012 DOI: 10.2147/jir.s343715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background As an inflammatory factor, complement C1q is related to the prevalence and progression of atherosclerosis; however, in patients undergoing emergency percutaneous coronary intervention (PCI), it is unclear whether C1q is related to the prevalence of contrast-associated acute kidney injury (CA-AKI). Methods From November 2018 to March 2021, 1182 patients who underwent emergency PCI were continuously recruited. Patients were divided into CA-AKI group (n = 234) and non-CA-AKI group (n = 948). CA-AKI was defined as an increase in serum creatinine from the baseline level (≥25% or ≥0.5 mg/dL) 48–72 hours after contrast exposure. All subjects were tested for serum C1q levels when they were admitted to the hospital. Results Among the 1182 patients undergoing emergency PCI, 234 patients (19.80%) developed CA-AKI. The level of preoperative serum complement C1q in the CA-AKI group was significantly higher than that in the non-CA-AKI group. Logistic regression and restricted cubic spline analyses showed that the incidence of CA-AKI was positively associated with the serum C1q level pre-PCI. Univariate and multivariate logistic regression analyses showed that C1q was an independent predictor of whether CA-AKI occurred after emergency PCI. The area under the curve (AUC) of the C1q was 0.703 [95% confidence interval (CI) 0.667–0.739] in patients receiving emergency PCI. CA-AKI model included the following three predictors: C1q, eGFR, and IABP use. The AUC of forecast probability was 0.718 [95% CI 0.682–0.754]. Conclusion In patients receiving emergency PCI procedure, a high C1q level before PCI is associated with the increased risk of CA-AKI.
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Affiliation(s)
- Jun Tao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Chenglin Ye
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Wen Dai
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Di Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Man Zhou
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
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167
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Zhang X, Yao C, Xiao Q, Wu J, Wu G. Enhanced external counterpulsation: A new method to alleviate contrast-induced acute kidney injury. Contemp Clin Trials 2022; 113:106653. [PMID: 34999282 DOI: 10.1016/j.cct.2021.106653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is a common complication after exposure to contrast media. Renal ischaemia occurs in the initial stage of CI-AKI, however, there are very few effective measures to improve renal perfusion. METHODS A total of 114 patients with an estimated glomerular filtration rate (eGFR) of 60-89 ml/min/1.73m2 were randomly assigned to two groups: enhanced external counterpulsation (EECP) group (N = 57) and control group (N = 57). Two hours after contrast exposure, EECP group received EECP treatment for 1 h while no intervention was performed control group. The primary outcome was the incidence of serum cystatin C concentration to 10% above the baseline concentration at 24 h after contrast administration. The secondary outcomes were the incidence of CI-AKI (defined as an increase in serum creatinine concentration to ≥0.5 mg/dl or by 25% compare to the baseline after contrast exposure), contrast clearance and adverse clinical events. RESULTS The primary outcome was observed in 26 patients (6 EECP and 20 control; 11% vs. 35%; P = 0.002). CI-AKI occurred in four patients (0 EECP and 4 control; 0% vs. 7%; P = 0.042). The clearance rate of iopromide in the initial 3 h was significantly different between EECP and control group (59.92 ± 8.84 vs 46.80 ± 9.26 ml/min/1.73 m2; P < 0.001). No adverse clinical events were observed in this study. CONCLUSIONS This study demonstrates that EECP increases the contrast clearance and may have an effect in reducing the risk of CI-AKI. The study has been registered in Chinese Clinical Trial Registry (ChiCTR 2,000,039,190).
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Affiliation(s)
- Xiaocong Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China; Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chun Yao
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China; Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qunlin Xiao
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jiansheng Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Guifu Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, Guangdong, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong, China.
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168
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Ying J, Wang J, Ying Z, Ran X, Zeng X, Chen D, Gao Y, Zhong L. Exploring the relationship between post-contrast acute kidney injury and different baseline creatinine standards: A retrospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1042312. [PMID: 36714583 PMCID: PMC9877403 DOI: 10.3389/fendo.2022.1042312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE According to previous studies, the incidence of post-contrast acute kidney injury(PC-AKI) in diabetic is far higher than that in the general population. Therefore, we explored the relationship between the incidence of PC-AKI and different baseline serum creatinine (SCr) levels, and determined the relationship between PC-AKI and different types of contrast media (CMs), different doses of CM, and different examination methods in this specific population. MATERIALS AND METHODS Patients with diabetes in whom CM was used between 2010 and 2020 at our institution were included. Participants were identified according to the following three schemes: Scheme 1 (n=5911), SCr was detected before and within 72 h after using CM; Scheme 2 (n=2385), SCr was detected within 24 h before and within 24-72 h after using CM; and Scheme 3 (n=81), SCr was detected within 24 h before and within 0-24, 24-48, and 48-72 h after using CM. The incidence of PC-AKI with different types of CM, incidence of PC-AKI on digital subtraction angiography (DSA) and enhanced computed tomography (CT), proportion of PC-AKI with different doses of CM, and baseline SCr at different stages of PC-AKI were compared. Multivariate logistic regression analysis was used to explore risk factors for PC-AKI. RESULTS A total of 29,081 patients were included in this study. The incidence of PC-AKI in Scheme 3 (22.22%) was higher than those in Schemes 1 (6.19%) and 2 (7.71%). The incidence of PC-AKI on DSA was higher than that on enhanced CT (8.30% vs. 5.80%; P<0.05). The incidence of PC-AKI in the increased-dose CM group was higher than that in the non-increased-dose CM group (7.9% vs. 5.7%; P<0.01). Moreover, there were differences in baseline SCr values at different stages of PC-AKI (P<0.01). Multivariate logistic regression analysis showed that hypertension, chronic kidney disease, heart failure, peripheral vascular disease, metformin, diuretics, and CM dose were risk factors for PC-AKI. CONCLUSION The incidence of PC-AKI increased significantly with increasing time requirement and frequency of SCr detection. Moreover, before using CM, we should control the blood pressure and heart failure, stop using metformin and diuretics, and use CMs at the minimum dose to avoid PC-AKI.
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Affiliation(s)
- Jixiang Ying
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology and Metabolism, West China Longquan Hospital Sichuan University, and The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Junren Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran, ; Xiaoxi Zeng,
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran, ; Xiaoxi Zeng,
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Gao
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhong
- Department of Endocrinology and Metabolism, West China Longquan Hospital Sichuan University, and The First People’s Hospital of Longquanyi District, Chengdu, China
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Guo Y, Xu X, Xue Y, Zhao C, Zhang X, Cai H. Mehran 2 Contrast-Associated Acute Kidney Injury Risk Score: Is it Applicable to the Asian Percutaneous Coronary Intervention Population? Clin Appl Thromb Hemost 2022; 28:10760296221116353. [PMID: 35924367 PMCID: PMC9358571 DOI: 10.1177/10760296221116353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) can occur after percutaneous coronary intervention (PCI). The Mehran score is the gold standard for predicting CA-AKI risk, and it has recently been updated. The Mehran 2 CA-AKI risk score, based on existing variables in patients undergoing PCI, can accurately differentiate the risk of CA-AKI. This study aimed to verify whether the new Mehran score is applicable to the Asian PCI population. The study included the clinical data of 2487 patients undergoing PCI from August 2020 to February 2022. The goodness-of-fit test (Hosmer-Lemeshow) was used to evaluate the correction ability of the Mehran 2 score, and the area under the receiver operating characteristic curve (ROC) was used to evaluate the accuracy of the Mehran 2 score in predicting CA-AKI. CA-AKI occurred in 28 of 2487 patients, with an incidence rate of 1.12%. The proportion of high risk factors for AKI in the cohort was lower than that in the Mehran 2 cohort (a large contemporary PCI cohort to develop the Mehran 2 score). The Mehran 2 risk score had excellent goodness-of-fit (χ2 = 5.320, df = 6, P = 0.503) and high predictive accuracy (area under the ROC curve 0.836, P < 0.0001). The Mehran 2 score shows good predictive and correction performance in the Asian population and has good clinical application value. The inclusion of the Mehran 2 risk score in patients hospitalised for coronary angiography appears to be good practice.
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Affiliation(s)
- Ying Guo
- Department of Radiology, 117890Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xue Xu
- Department of Radiology, 117890Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, 117890Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Chunling Zhao
- Department of Radiology, 117890Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaohong Zhang
- Department of Radiology, 117890Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hongfu Cai
- Department of Pharmacy, 117890Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
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Ma K, Li J, Shen G, Zheng D, Xuan Y, Lu Y, Li W. Development and Validation of a Risk Nomogram Model for Predicting Contrast-Induced Acute Kidney Injury in Patients with Non-ST-Elevation Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention. Clin Interv Aging 2022; 17:65-77. [PMID: 35115770 PMCID: PMC8801515 DOI: 10.2147/cia.s349159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To establish a nomogram model to predict the risk of contrast-induced acute kidney injury (CI-AKI) by analyzing the risk factors of CI-AKI and to evaluate its effectiveness. Methods Retrospectively analyze the clinical data of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI) in our cardiology department from September 2018 to June 2021. Of these, patients who underwent PCI in an earlier period formed the training cohort (70%; n = 809) for nomogram development, and those who underwent PCI thereafter formed the validation cohort (30%; n = 347) to confirm the model’s performance. The independent risk factors of CI-AKI were determined by LASSO regression and multivariable logistic regression analysis. By using R software from which nomogram models were subsequently generated. The nomogram was developed and evaluated based on discrimination, calibration, and clinical efficacy using the concordance statistic (C-statistic), calibration plot, and decision curve analysis (DCA), respectively. Results The nomogram consisted of six variables: age >75, left ventricular ejection fraction, diabetes mellitus, fibrinogen-to-albumin ratio, high-sensitive C-reactive protein, and lymphocyte count. The C-index of the nomogram is 0.835 (95% CI: 0.800–0.871) in the training cohort and 0.767 (95% CI: 0.711–0.824) in the validation cohort, respectively. The calibration plots exhibited that the nomogram was in good agreement between prediction and observation in the training and validation cohorts. Decision curve analysis and clinical impact curve suggested that the predictive nomogram had clinical utility. Conclusion The nomogram model established has a good degree of differentiation and accuracy, which is intuitively and individually to screen high-risk groups and has a certain predictive value for the occurrence of CI-AKI in NSTE-ACS patients after PCI.
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Affiliation(s)
- Kai Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Jing Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Guoqi Shen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Di Zheng
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Yongli Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Wenhua Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
- Correspondence: Wenhua Li, Tel +86 18052268293, Email
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van der Molen AJ, Dekkers IA, Bedioune I, Darmon-Kern E. A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol in more than 57,000 patients: part 1-intravenous administration. Eur Radiol 2022; 32:5532-5545. [PMID: 35312790 PMCID: PMC9279198 DOI: 10.1007/s00330-022-08636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intravenous (IV) administration of ioversol. MATERIALS AND METHODS A systematic literature search (1980-2021) of studies documenting IV use of ioversol and presence or absence of ADRs, HSRs, or PC-AKI was performed. Key information including patients' characteristics, indication and dose of ioversol, safety outcome incidence, intensity and seriousness were extracted. RESULTS Thirty-one studies (> 57,000 patients) were selected, including 4 pediatric studies. The incidence of ADRs in adults was reported in 12 studies from ioversol clinical development with a median (range) of 1.65% (0-33.3%), and 3 other studies with an incidence between 0.13 and 0.28%. The incidence of HSRs (reported in 2 studies) ranged from 0.20 to 0.66%, and acute events (4 studies) from 0.23 to 1.80%. Severe reactions were rare with a median (range) of 0 (0-4%), and none were reported among pediatric patients. The incidence of ADRs and HSRs with ioversol, especially those of severe intensity, was among the lowest in studies comparing different iodinated contrast media (ICM) of the same class. PC-AKI incidence was variable (1-42% in 5 studies); however, ioversol exposure per se did not increase the incidence. CONCLUSIONS When administered by the IV route, ioversol has a good safety profile comparable to that of other ICM within the same class, with a low incidence of severe/serious ADRs overall, and particularly HSRs. PC-AKI incidence does not seem to be increased compared to patients who did not receive ioversol. Further well-designed studies are warranted to confirm these results. KEY POINTS • Ioversol has a good safety profile in adult and pediatric patients when IV administered. • ADR and HSR incidence with ioversol, especially those of severe intensity, was among the lowest compared to other ICM. • IV administration of ioversol per se did not increase PC-AKI incidence.
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Affiliation(s)
- Aart J. van der Molen
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Ilona A. Dekkers
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Ibrahim Bedioune
- Clinical Development Department, Guerbet, Roissy CDG Cedex, France
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OUP accepted manuscript. Nephrol Dial Transplant 2022; 37:1191-1194. [DOI: 10.1093/ndt/gfac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 11/14/2022] Open
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173
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El Hussein MT, Ha C. CHIPS: Prevention of contrast-induced nephropathy before and after cardiac catheterization. Nurse Pract 2021; 46:32-39. [PMID: 34808645 DOI: 10.1097/01.npr.0000804164.94431.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Contrast-induced nephropathy is the leading cause of acute kidney injury in hospital settings. Practitioners must have a comprehensive understanding of preventive interventions. This article provides a mnemonic NPs can use to prevent contrast-induced nephropathy. The mnemonic, CHIPS, addresses Contrast minimizations, Hemofiltration, Iso-osmolar/low osmolar contrast, Pharmacologic interventions, and Saline I.V. hydration.
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Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, Nicolas J, Pivato CA, Nardin M, Krishnan P, Kini A, Sharma S, Pocock S, Dangas G. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet 2021; 398:1974-1983. [PMID: 34793743 DOI: 10.1016/s0140-6736(21)02326-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contrast-associated acute kidney injury can occur after percutaneous coronary intervention (PCI). Prediction of the contrast-associated acute kidney injury risk is important for a tailored prevention and mitigation strategy. We sought to develop a simple risk score to estimate contrast-associated acute kidney injury risk based on a large contemporary PCI cohort. METHODS Consecutive patients undergoing PCI at a large tertiary care centre between Jan 1, 2012, and Dec 31, 2020, with available creatinine measurements both before and within 48 h after the procedure, were included; only patients on chronic dialysis were excluded. Patients treated between 2012 and 2017 comprised the derivation cohort and those treated between 2018 and 2020 formed the validation cohort. The primary endpoint was contrast-associated acute kidney injury, defined according to the Acute Kidney Injury Network. Independent predictors of contrast-associated acute kidney injury were derived from multivariate logistic regression analysis. Model 1 included only pre-procedural variables, whereas Model 2 also included procedural variables. A weighted integer score based on the effect estimate of each independent variable was used to calculate the final risk score for each patient. The impact of contrast-associated acute kidney injury on 1-year deaths was also evaluated. FINDINGS 32 378 PCI procedures were performed and screened for inclusion in the present analysis. After the exclusion of patients without paired creatinine measurements, patients on chronic dialysis, and multiple procedures, 14 616 patients were included in the derivation cohort (mean age 66·2 years, 29·2% female) and 5606 were included in the validation cohort (mean age 67·0 years, 26·4% female). Contrast-associated acute kidney injury occurred in 860 (4·3%) patients. Independent predictors of contrast-associated acute kidney injury included in Model 1 were: clinical presentation, estimated glomerular filtration rate, left ventricular ejection fraction, diabetes, haemoglobin, basal glucose, congestive heart failure, and age. Additional independent predictors in Model 2 were: contrast volume, peri-procedural bleeding, no flow or slow flow post procedure, and complex PCI anatomy. The occurrence of contrast-associated acute kidney injury in the derivation cohort increased gradually from the lowest to the highest of the four risk score groups in both models (2·3% to 34·9% in Model 1, and 2·0% to 38·8% in Model 2). Inclusion of procedural variables in the model only slightly improved the discrimination of the risk score (C-statistic in the derivation cohort: 0·72 for Model 1 and 0·74 for model 2; in the validation cohort: 0·84 for Model 1 and 0·86 for Model 2). The risk of 1-year deaths significantly increased in patients with contrast-associated acute kidney injury (10·2% vs 2·5%; adjusted hazard ratio 1·76, 95% CI 1·31-2·36; p=0·0002), which was mainly due to excess 30-day deaths. INTERPRETATION A contemporary simple risk score based on readily available variables from patients undergoing PCI can accurately discriminate the risk of contrast-associated acute kidney injury, the occurrence of which is strongly associated with subsequent death. FUNDING None.
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Affiliation(s)
- Roxana Mehran
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mauro Chiarito
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Samantha Sartori
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johny Nicolas
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo Andrea Pivato
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Matteo Nardin
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Prakash Krishnan
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin Sharma
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart Pocock
- London School of Hygiene & Tropical Medicine, London, UK
| | - George Dangas
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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175
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Shah A, Bazemore T, Wolf H, Yang H, Liu Y, Stouffer GA. Length of Preprocedure Fasting Was Associated With Contrast Associated-Acute Kidney Injury in High-Risk Patients Undergoing Coronary Angiography. Am J Cardiol 2021; 159:1-7. [PMID: 34656310 DOI: 10.1016/j.amjcard.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
Hydration is recommended to prevent contrast associated-acute kidney injury (CA-AKI) but interactions between blood pressure, left ventricular end diastolic pressure (LVEDP) and hydration status on CA-AKI are incompletely understood. This analysis presents the results of a single-center prospective study of patients undergoing coronary angiography with a predicted risk of CA-AKI >14%. 146 patients were enrolled with a mean (±SD) age of 71 ± 11 years; 94 (64.4%) were men, 142 (97.3%) had hypertension, 96 (65.8%) had diabetes mellitus and the mean (SD) serum creatinine was 1.21 ± 0.36 mg/dl. CA-AKI occurred in 31 (21%) patients. There were no significant differences in demographics, comorbidities, renal function, LVEDP, systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure or pulse pressure in patients who developed versus those who did not develop CA-AKI. There was no association between the amount of peri-procedure intravenous fluids and change in creatinine postprocedure. In multivariate analysis, hemoglobin, the time that the patient was fasting from solids (NPO time), and contrast volume were associated with the development of CA-AKI. There was a highly significant interaction (p = 0.0028) between the amount of intravenous fluids, NPO time and contrast volume and changes in postprocedure creatinine. In summary, hemoglobin, NPO time and contrast volume, but not hemodynamic variables, correlated with worsening renal function following coronary angiography in this population of high-risk patients. Results suggested that intravenous hydration is important in subgroups of patients depending on NPO time and contrast volume.
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Affiliation(s)
- Anand Shah
- Department of Medicine, Duke University, Durham, North Carolina
| | - Taylor Bazemore
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Hope Wolf
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Hannan Yang
- Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Yan Liu
- Division of Cardiology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - George A Stouffer
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina.
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176
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Feasibility of Aortic Annular Measurements Using Noncontrast-Enhanced Cardiac Computed Tomography in Preprocedural Evaluation of Transcatheter Aortic Valve Replacement. J Comput Assist Tomogr 2021; 46:50-55. [DOI: 10.1097/rct.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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177
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Jung RG, Di Santo P, Mathew R, Abdel‐Razek O, Parlow S, Simard T, Marbach JA, Gillmore T, Mao B, Bernick J, Theriault‐Lauzier P, Fu A, Lau L, Motazedian P, Russo JJ, Labinaz M, Hibbert B. Implications of Myocardial Infarction on Management and Outcome in Cardiogenic Shock. J Am Heart Assoc 2021; 10:e021570. [PMID: 34713704 PMCID: PMC8751815 DOI: 10.1161/jaha.121.021570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022]
Abstract
Background The randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non-AMICS. Methods and Results Patients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all-cause in-hospital mortality, cardiac arrest, non-fatal myocardial infarction, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30-days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non-AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47-3.30; P=0.0001). The primary end point was driven by increased rates of all-cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30-day mortality, and RRT after adjustment for age, sex, procedural contrast use, multivessel disease, and inotrope type. Conclusions AMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascularization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non-AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.
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Affiliation(s)
- Richard G. Jung
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Faculty of MedicineUniversity of OttawaOntarioCanada
- Department of Cellular and Molecular MedicineUniversity of OttawaOntarioCanada
| | - Pietro Di Santo
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Rebecca Mathew
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of Critical CareDepartment of MedicineUniversity of OttawaOntarioCanada
| | - Omar Abdel‐Razek
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Simon Parlow
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Trevor Simard
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Department of Cellular and Molecular MedicineUniversity of OttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Jeffrey A. Marbach
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of Critical CareTufts Medical CenterBostonMA
| | | | - Brennan Mao
- Faculty of MedicineUniversity of OttawaOntarioCanada
| | - Jordan Bernick
- Cardiovascular Research Methods CentreUniversity of Ottawa Heart InstituteOttawaCanada
| | - Pascal Theriault‐Lauzier
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Angel Fu
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Lawrence Lau
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | | | - Juan J. Russo
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Marino Labinaz
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Benjamin Hibbert
- CAPITAL Research GroupDivision of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Department of Cellular and Molecular MedicineUniversity of OttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOntarioCanada
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
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178
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Qin Y, Qiao Y, Wang D, Yan G, Tang C, Ma G. The Predictive Value of Soluble Urokinase-Type Plasminogen Activator Receptor in Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention. Int J Gen Med 2021; 14:6497-6504. [PMID: 34675617 PMCID: PMC8504866 DOI: 10.2147/ijgm.s339075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Soluble urokinase-type plasminogen activator receptor (SuPAR) is a circulating protein and a novel identified promising biomarker for various renal diseases and kidney injury. However, it remains unknown on the predictive value of suPAR in contrast induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). Methods A total of 399 patients undergoing PCI were enrolled in the research from June 2020 to June 2021 in Zhongda Hospital. Patients were divided into CI-AKI and non-CI-AKI groups according to the preoperative and postoperative serum creatinine levels. Plasma suPAR level was detected through enzyme-linked immunosorbent assay on admission. Demographic data, hematological parameters, coronary angiography data and medications were recorded and compared between CI-AKI and non-CI-AKI groups. Logistic regression analysis and receiver operator characteristic (ROC) curve analysis were performed for identifying the independent risk factors of CI-AKI and assessment of the predictive value of suPAR for CI-AKI. Results CI-AKI occurred in 65 (16.3%) patients undergoing PCI. The level of suPAR in CI-AKI group was significantly higher than that in the non-CI-AKI group. Multivariate logistic regression indicated diabetes, lower LVEF, lower hydration rate, lower baseline eGFR, higher plasma suPAR (OR = 2.875, 95% CI = 2.038–3.672, P < 0.001) and volume of contrast media were all independent risk factors for CI-AKI after adjustment of the confounding factors. ROC analysis illustrated that the optimal area under the curve was 0.765, indicating plasma suPAR was a splendid predictor for CI-AKI. The corresponding cut-off value was 3.305 ng/mL, and the sensitivity and specificity were 63.1% and 82.3%, respectively. Conclusion Increased suPAR level is independently associated with elevated risk of suffering CI-AKI, and suPAR is a strong predictor for CI-AKI in patients undergoing PCI. SuPAR might act as a novel biomarker for CI-AKI in clinical practice.
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Affiliation(s)
- Yuhan Qin
- Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Yong Qiao
- Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu, People's Republic of China
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179
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Urinary proteomics investigations into contrast-induced acute kidney injury. PLoS One 2021; 16:e0258736. [PMID: 34669736 PMCID: PMC8528309 DOI: 10.1371/journal.pone.0258736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
Some patients have a decline in renal function after contrast medium injection, and this phenomenon is called contrast-induced acute kidney injury (CI-AKI); a small number of people even suffer severe renal failure. To date, the mechanism of CI-AKI remains unclear. We aimed to identify novel potential biomarkers in the urine of patients with CI-AKI through LC-MS/MS and bioinformatics analysis. We enrolled patients who underwent coronary angiography (contrast agent: iohexol). The CI-AKI group included 4 cases, and the non-CI-AKI group included 20 cases. We mixed the 4 CI-AKI samples and 20 non-CI-AKI samples. Then, a 0.6 ml urine sample was used for proteome analysis with LC-MS/MS approach. Metascape, ExPASy, and the Human Protein Atlas were utilized for bioinformatics analysis. We obtained 724 and 830 urine proteins from the CI-AKI and non-CI-AKI groups, respectively. The distribution of the pI values and molecular weights (MWs) of postoperative urine proteins showed no significant difference between the CI-AKI group and the non-CI-AKI group. A total of 99differentially expressed proteins (DEPs) were detected, among which 18 proteins were detected only in tubule cells, and 19 proteins were detected in both tubule cells and glomeruli. With GO analysis, the GEPs were mainly associated with immune response and inflammation. Although biomarkers cannot be asserted from this single pilot study, our results may help advance the understanding of the mechanisms of CI-AKI and identify potential novel biomarkers for further investigation.
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180
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Butt T, Lehti L, Apelqvist J, Gottsäter A, Acosta S. Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia. Vasc Endovascular Surg 2021; 56:151-157. [PMID: 34670450 PMCID: PMC8796150 DOI: 10.1177/15385744211051503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PurposeRepetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference (P = .30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without DM (20.6%; n = 170). Among patients with CA-AKI, patients with DM had a lower (P < .001) estimated glomerular filtration rate (eGFR) at discharge (55 ml/min/1.73 m2) than at admission (70 ml/min/1.73 m2), while no such difference was found in the group without DM (P = .20). The gram-iodine dose/eGFR ratio was higher (P < .001) in patients with CA-AKI (median 1.49, [IQR 1.34-1.81]) than in those who did not develop CA-AKI (median 1.05 [IQR 1.00-1.13]). There was a trend that gram-iodine dose/eGFR ratio (OR 1.42/standard deviation increment, 95% CI 1.00-2.02; P = .050) was associated with an increased risk of CA-AKI, after adjusting for DM, age, and gender. Conclusions: The frequency of CA-AKI was high after CTA and local continuous thrombolysis for ALI without shown increased frequency for the DM group. Among patients with CA-AKI, however, patients with DM had worse renal function at discharge than those without DM. The gram-iodine dose/eGFR ratio in these patients needs to be lower to improve renal outcomes, particularly in patients with DM.
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Affiliation(s)
- Talha Butt
- Department of Clinical Sciences, 174435Lund University, Malmo, Sweden.,Vascular Center, Department of Cardio-Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmo, Sweden
| | - Leena Lehti
- Department of Clinical Sciences, 174435Lund University, Malmo, Sweden.,Vascular Center, Department of Cardio-Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmo, Sweden
| | - Jan Apelqvist
- Department of Clinical Sciences, 174435Lund University, Malmo, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmo, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, 174435Lund University, Malmo, Sweden.,Vascular Center, Department of Cardio-Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmo, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, 174435Lund University, Malmo, Sweden.,Vascular Center, Department of Cardio-Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmo, Sweden
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181
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Song L, Yao S, Zheng D, Xuan Y, Li W. Astaxanthin attenuates contrast-induced acute kidney injury in rats via ROS/NLRP3 inflammasome. Int Urol Nephrol 2021; 54:1355-1364. [PMID: 34652584 DOI: 10.1007/s11255-021-03015-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/04/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the protective effect and mechanism of astaxanthin on the kidney of rats with contrast-induced acute kidney injury. METHODS Forty SD rats were randomly divided into five groups: Control group (CON); Astaxanthin control group (AST); Contrast media group (CM); Astaxanthin pre-treatment group (AST + CM); N-acetylcysteine pre-treatment group (NAC + CM), each group with eight rats. The rats were killed 72 h after the modeling, the blood supernatant and kidneys were collected, and then the serum creatinine and blood urea nitrogen levels were measured; HE staining was used to observe the pathological changes in kidney tissue; TUNEL was used to detect apoptosis level in renal tubular epithelial cells; frozen section was used to observe the expression of ROS in renal tissue by reactive oxygen staining; the expression of NLRP3, ASC, caspase-1, IL-1β, IL-18 were detected by immunohistochemistry and western blot. RESULTS The CI-AKI rat model was induced by iohexol. Then the elevated level of ROS activated the inflammatory response mediated by NLRP3 inflammasome (NLRP3, ASC, caspase-1). Subsequently, the increase in renal tubular epithelial cell apoptosis caused the destruction of the pathological structure of the kidney and finally led to renal impairment. While after the pretreatment of astaxanthin, the level of ROS was decreased. The activation level of NLRP3 inflammasome and its mediated inflammatory response were alleviated significantly. Eventually, the level of renal tubular epithelial cell apoptosis and renal damage were significantly mitigated. CONCLUSION Astaxanthin can protect the kidney in CI-AKI by inhibiting the activation of NLRP3 inflammasome-IL-1β/IL-18 through inhibition of the production of ROS.
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Affiliation(s)
- Liang Song
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China
| | - Shun Yao
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China
| | - Di Zheng
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, 221002, Jiangsu, China
| | - Yongli Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, 221002, Jiangsu, China
| | - Wenhua Li
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China.
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, 221002, Jiangsu, China.
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The feasibility of deep learning-based synthetic contrast-enhanced CT from nonenhanced CT in emergency department patients with acute abdominal pain. Sci Rep 2021; 11:20390. [PMID: 34650183 PMCID: PMC8516935 DOI: 10.1038/s41598-021-99896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Our objective was to investigate the feasibility of deep learning-based synthetic contrast-enhanced CT (DL-SCE-CT) from nonenhanced CT (NECT) in patients who visited the emergency department (ED) with acute abdominal pain (AAP). We trained an algorithm generating DL-SCE-CT using NECT with paired precontrast/postcontrast images. For clinical application, 353 patients from three institutions who visited the ED with AAP were included. Six reviewers (experienced radiologists, ER1-3; training radiologists, TR1-3) made diagnostic and disposition decisions using NECT alone and then with NECT and DL-SCE-CT together. The radiologists’ confidence in decisions was graded using a 5-point scale. The diagnostic accuracy using DL-SCE-CT improved in three radiologists (50%, P = 0.023, 0.012, < 0.001, especially in 2/3 of TRs). The confidence of diagnosis and disposition improved significantly in five radiologists (83.3%, P < 0.001). Particularly, in subgroups with underlying malignancy and miscellaneous medical conditions (MMCs) and in CT-negative cases, more radiologists reported increased confidence in diagnosis (83.3% [5/6], 100.0% [6/6], and 83.3% [5/6], respectively) and disposition (66.7% [4/6], 83.3% [5/6] and 100% [6/6], respectively). In conclusion, DL-SCE-CT enhances the accuracy and confidence of diagnosis and disposition regarding patients with AAP in the ED, especially for less experienced radiologists, in CT-negative cases, and in certain disease subgroups with underlying malignancy and MMCs.
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183
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Su TH, Hsieh CH, Chan YL, Wong YC, Kuo CF, Li CH, Lee CC, Chen HY. Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department-based Study. Radiology 2021; 301:571-581. [PMID: 34636631 DOI: 10.1148/radiol.2021204446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Although the historical risk of acute kidney injury (AKI) after intravenous administration of contrast media might be overstated, the risk in patients with impaired kidney function remains a concern. Purpose To investigate whether intravenous contrast media administration during CT is associated with a higher risk of AKI and further hemodialysis compared with the risk in patients undergoing unenhanced CT. Materials and Methods This retrospective study evaluated patients who underwent contrast-enhanced or unenhanced CT in five Taiwanese emergency departments between 2009 and 2016. The outcomes were AKI within 48-72 hours after CT, AKI within 48 hours to 1 week after CT, or further hemodialysis within 1 month after CT. The associations between contrast media exposure and outcome were estimated by using an overlap propensity score weighted generalized regression model. Subgroup analyses were performed according to the estimated glomerular filtration rate (eGFR). Results The study included 68 687 patients (median age, 68 years; interquartile range, 53-74 years; 39 995 men) with (n = 31 103) or without (n = 37 584) exposure to contrast media. After propensity score weighting, contrast media exposure was associated with higher risk of AKI within 48-72 hours after CT (odds ratio [OR], 1.16; 95% CI: 1.04, 1.29; P = .007) but no significant risk at 48 hours to 1 week after CT (OR, 1.00; 95% CI: 0.93, 1.08; P = .90). Among patients with eGFR less than 30 mL/min/1.73 m2, exposure to contrast media was associated with a higher AKI risk (48-72 hours after CT: OR, 1.36; 95% CI: 1.09, 1.70; P = .007) (48 hours-1 week after CT: OR, 1.49; 95% CI: 1.27, 1.74; P < .001) and a higher risk of hemodialysis (OR, 1.36; 95% CI: 1.09, 1.70; P = .008). For patients with eGFR greater than 45 mL/min/1.73.m2, contrast media exposure was not associated with higher AKI risk (P > .05). Conclusion Contrast-enhanced CT was associated with higher risk of acute kidney injury and further hemodialysis among Taiwanese patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m2 but not those with an eGFR of more than 45 mL/min/1.73 m2. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Tse-Hsuan Su
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Chih-Huang Hsieh
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ling Chan
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Yon-Cheong Wong
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Chih-Huang Li
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
| | - Hsien-Yi Chen
- From the Department of Emergency Medicine (T.H.S., C.H.H., Y.L.C., C.H.L., H.Y.C.), Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention (Y.C.W.), Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine (C.F.K.), and Kidney Research Center, Department of Nephrology (C.C.L.), Linkou Chang Gung Memorial Hospital, Linkou Main Branch, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan; College of Medicine (T.H.S., Y.L.C., C.H.L., H.Y.C.), Department of Medical Imaging and Radiological Sciences, College of Medicine (Y.C.W.), and Graduate Institute of Clinical Medical Science, College of Medicine (C.C.L.), Chang Gung University, Taoyuan, Taiwan
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Augène E, Lareyre F, Chikande J, Guidi L, Mutambayi G, Lê CD, Jean-Baptiste E, Katsiki N, Mikhailidis DP, Raffort J. Incidence of contrast-induced acute kidney injury in patients with acute mesenteric ischemia and identification of potential predictive factors. Vascular 2021; 30:1097-1106. [PMID: 34645315 DOI: 10.1177/17085381211050766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Contrast-enhanced computed tomography angiography (CTA) is commonly used to investigate acute abdominal conditions, but the risk of contrast-induced acute kidney injury (CI-AKI) has been poorly investigated in patients with acute mesenteric ischemia. The aim of the present study was to evaluate the incidence of CI-AKI in these patients and identify potential predictive factors. METHODS Patients admitted for acute mesenteric ischemia who had a diagnostic CTA with contrast medium and a follow-up of creatinine concentration were retrospectively included. RESULTS Among 53 patients included, 9 (16.9%) developed CI-AKI. The prevalence of chronic kidney disease did not differ significantly between those who developed CI-AKI and those who did not (33.3 vs 18.2%, p=.372). Plasma total bilirubin and conjugated bilirubin levels were significantly higher in patients who developed CI-AKI (17.5 vs 8.0 μmol/L, p=.013 and 8.0 vs 3.0 μmol/L, p=.031, respectively). The proportion of patients who had revascularization was similar between patients who developed CI-AKI and those who did not (11.1 vs 20.5%, p>.999). No significant difference was observed for 30-day mortality and all-cause mortality for a median follow-up of 168 days (22.2 vs 13.6%, p=.611; and 33.3 vs 61.4%, p=.153, respectively). CONCLUSION This study reports the incidence of CI-AKI in patients with acute mesenteric ischemia after diagnostic CTA with contrast medium. Plasma bilirubin levels were a predictive factor of CI-AKI in these patients. The administration of contrast media during revascularization was not associated with an increased risk of CI-AKI.
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Affiliation(s)
- Emmanuel Augène
- Department of Visceral Surgery, 37045University Hospital of Nice, France
| | - Fabien Lareyre
- Department of Vascular Surgery, 70607Hospital of Antibes Juan-les-Pins, France.,Université Côte d'Azur, 37045CHU, Inserm U1065, C3M, Nice, France
| | - Julien Chikande
- Department of Vascular Surgery, 37045University Hospital of Nice, France
| | - Lucas Guidi
- Department of Vascular Surgery, 37045University Hospital of Nice, France
| | | | - Cong Duy Lê
- Department of Vascular Surgery, 70607Hospital of Antibes Juan-les-Pins, France
| | - Elixène Jean-Baptiste
- Université Côte d'Azur, 37045CHU, Inserm U1065, C3M, Nice, France.,Department of Vascular Surgery, 37045University Hospital of Nice, France
| | - Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, 571848AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Juliette Raffort
- Université Côte d'Azur, 37045CHU, Inserm U1065, C3M, Nice, France.,Clinical Chemistry Laboratory, 37045University Hospital of Nice, France
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185
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Tao J, Dai W, Ye C, Yao Q, Zhou M, Li Y. Preprocedural Lp(a) level and ApoB/ApoA-Ι ratio and the risk for contrast-induced acute kidney injury in patients undergoing emergency PCI. Lipids Health Dis 2021; 20:130. [PMID: 34627286 PMCID: PMC8502341 DOI: 10.1186/s12944-021-01535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High serum Lipoprotein(a) (Lp(a)) level and Apolipoprotein B/Apolipoprotein AΙ (ApoB/ApoA-Ι) ratio are risk factors for cardiovascular disease and kidney disease and have been found to be correlated with the prevalence and prognosis of various kidney diseases. However, it is not clear whether the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI are correlated with the prevalence of contrast-induced acute kidney injury (CI-AKI). METHODS A total of 931 participants undergoing emergency PCI from July 2018 to July 2020 were included. According to whether the serum creatinine concentration was higher than the baseline concentration (by ≥25% or ≥ 0.5 mg/dL) 48-72 h after contrast exposure, these participants were divided into a CI-AKI group (n = 174) and a non-CI-AKI group (n = 757). Serum Lp(a), ApoA-Ι and ApoB concentration were detected in the patients when they were admitted to hospital, and the ApoB/ApoA-Ι ratio was calculated. Logistic regression and restricted cubic spline analyses were used to explore the correlation between the Lp(a) concentration or the ApoB/ApoA-Ι ratio and the risk of CI-AKI. RESULTS Among the 931 participants undergoing emergency PCI, 174 (18.69%) participants developed CI-AKI. Compared with the non-CI-AKI group, the Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in the CI-AKI group were significantly higher (P < 0.05). The incidence of CI-AKI was positively associated with the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the Lp(a) level and the ApoB/ApoA-Ι ratio before PCI, within certain ranges, were positively associated with the prevalence of CI-AKI. CONCLUSION High Lp(a) levels and high ApoB/ApoA-Ι ratios before PCI are potential risk factors for CI-AKI.
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Affiliation(s)
- Jun Tao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Wen Dai
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Chenglin Ye
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Yao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Man Zhou
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China.
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186
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Bonnefoy PB, Prevot N, Mehdipoor G, Sanchez A, Lima J, Font L, Gil-Díaz A, Llamas P, Aibar J, Bikdeli B, Bertoletti L, Monreal M. Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study. J Thromb Thrombolysis 2021; 53:829-840. [PMID: 34611738 DOI: 10.1007/s11239-021-02579-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/12/2022]
Abstract
Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis. Limited contemporary data exist about the utilization of each modality, including the predictors of using V/Q versus CTPA. We used the data from patients diagnosed with PE using V/Q or CTPA from 2007 to 2019 in Registro Informatizado Enfermedad ThromboEmbolica, an international prospective registry of patients with venous thromboembolism. Outcomes was to determine the trends in utilization of V/Q vs. CTPA and, in a contemporary subgroup fitting with current practices, to evaluate predictors of V/Q use with multivariable logistic regression. Among 26,540 patients with PE, 89.2% were diagnosed with CTPA, 7.1% with V/Q and 3.7% with > 1 thoracic imaging modality. Over time, the proportional use of V/Q scanning declined (13.9 to 3.3%, P < 0.001). In multivariable analysis, heart failure history (odds ratio [OR]:1.5; 95% confidence interval [CI] 1.14-1.98), diabetes ([OR 1.71; 95% CI 1.39-2.10]), moderate and severe renal failure (respectively [OR 1.87; 95% CI 1.47-2.38] and [OR 9.36; 95% CI 6.98-12.55]) were the patient-level predictors of V/Q utilization. We also observed an influence of geographical and institutional factors, partly explained by time-limited V/Q availability (less use over weekends) and regional practices. Use of V/Q for the diagnosis of PE decreased over time, but it still has an important role in specific situations with an influence of patient-related, institution-related and logistical factors. Local and regional resources should be evaluated to improve V/Q accessibility than could benefit for this population.
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Affiliation(s)
| | - Nathalie Prevot
- Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France.,INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France
| | - Ghazaleh Mehdipoor
- Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA.,Cardiovascular Research Foundation (CRF), New York, NY, USA
| | - Alicia Sanchez
- Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France
| | - Jorge Lima
- Department of Pneumonology, Hospital Universitario de Valme, Sevilla, Spain
| | - Llorenç Font
- Department of Haematology, Hospital de Tortosa Verge de La Cinta, Tarragona, Spain
| | - Aída Gil-Díaz
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | - Pilar Llamas
- Department of Haematology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Aibar
- Department of Internal Medicine, Hospital Clínic, Barcelona, Barcelona, Spain
| | - Behnood Bikdeli
- Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA.,Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, USA
| | - Laurent Bertoletti
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France.,Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France.,INSERM, CIC-1408, CHU Saint-Etienne, 42055, Saint-Etienne, France.,F-CRIN INNOVTE Network, Saint-Etienne, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias I PujolBadalona, Barcelona, Universidad Católica de Murcia, Barcelona, Spain
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Yun D, Cho S, Kim YC, Kim DK, Oh KH, Joo KW, Kim YS, Han SS. Use of Deep Learning to Predict Acute Kidney Injury After Intravenous Contrast Media Administration: Prediction Model Development Study. JMIR Med Inform 2021; 9:e27177. [PMID: 34596574 PMCID: PMC8520134 DOI: 10.2196/27177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/05/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022] Open
Abstract
Background Precise prediction of contrast media–induced acute kidney injury (CIAKI) is an important issue because of its relationship with poor outcomes. Objective Herein, we examined whether a deep learning algorithm could predict the risk of intravenous CIAKI better than other machine learning and logistic regression models in patients undergoing computed tomography (CT). Methods A total of 14,185 patients who were administered intravenous contrast media for CT at the preventive and monitoring facility in Seoul National University Hospital were reviewed. CIAKI was defined as an increase in serum creatinine of ≥0.3 mg/dL within 2 days or ≥50% within 7 days. Using both time-varying and time-invariant features, machine learning models, such as the recurrent neural network (RNN), light gradient boosting machine (LGM), extreme gradient boosting machine (XGB), random forest (RF), decision tree (DT), support vector machine (SVM), κ-nearest neighbors, and logistic regression, were developed using a training set, and their performance was compared using the area under the receiver operating characteristic curve (AUROC) in a test set. Results CIAKI developed in 261 cases (1.8%). The RNN model had the highest AUROC of 0.755 (0.708-0.802) for predicting CIAKI, which was superior to that obtained from other machine learning models. Although CIAKI was defined as an increase in serum creatinine of ≥0.5 mg/dL or ≥25% within 3 days, the highest performance was achieved in the RNN model with an AUROC of 0.716 (95% confidence interval [CI] 0.664-0.768). In feature ranking analysis, the albumin level was the most highly contributing factor to RNN performance, followed by time-varying kidney function. Conclusions Application of a deep learning algorithm improves the predictability of intravenous CIAKI after CT, representing a basis for future clinical alarming and preventive systems.
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Affiliation(s)
- Donghwan Yun
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Semin Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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188
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Thiel TA, Schweitzer J, Xia T, Bechler E, Valentin B, Steuwe A, Boege F, Westenfeld R, Wittsack HJ, Ljimani A. Evaluation of Radiographic Contrast-Induced Nephropathy by Functional Diffusion Weighted Imaging. J Clin Med 2021; 10:4573. [PMID: 34640591 PMCID: PMC8509538 DOI: 10.3390/jcm10194573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 01/07/2023] Open
Abstract
Contrast-induced nephropathy (CIN) resembles an important complication of radiographic contrast medium (XCM) displayed by a rise in creatinine levels 48-72 h after XCM administration. The purpose of the current study was to evaluate microstructural renal changes due to CIN in high-risk patients by diffusion weighted (DWI) and diffusion tensor imaging (DTI). Fifteen patients (five CIN and ten non-CIN) scheduled for cardiological intervention were included in the study. All patients were investigated pre- and post-intervention on a clinical 3T scanner. After anatomical imaging, renal DWI was performed by a paracoronal echo-planar-imaging sequence. Renal clinical routine serum parameters and advanced urinary injury markers were determined to monitor renal function. We observed a drop in cortical and medullar apparent diffusion coefficient (ADC) and fractional anisotropy (FA) before and after XCM administration in the CIN group. In contrast, the non-CIN group differed only in medullary ADC. The decrease of ADC and FA was apparent even before serum parameters of the kidney changed. In conclusion, DWI/DTI may be a useful tool for monitoring high-risk CIN patients as part of multi-modality based clinical protocol. Further studies, including advanced analysis of the diffusion signal, may improve the identification of patients at risk for CIN.
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Affiliation(s)
- Thomas Andreas Thiel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Julian Schweitzer
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (J.S.); (R.W.)
| | - Taogetu Xia
- Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (T.X.); (F.B.)
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Friedrich Boege
- Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (T.X.); (F.B.)
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (J.S.); (R.W.)
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
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189
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Development and Evaluation of an Audit and Feedback Process for Prevention of Acute Kidney Injury During Coronary Angiography and Intervention. CJC Open 2021; 4:271-281. [PMID: 35386131 PMCID: PMC8978052 DOI: 10.1016/j.cjco.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication of coronary angiography and intervention. Relatively little research has been done to determine how knowledge on CA-AKI prevention can be translated into clinical practice. Methods We developed, implemented, and surveyed end-users about the usability, acceptability, and utility of an audit and feedback process for CA-AKI prevention in Alberta, Canada. The audit and feedback reported on amount of radiocontrast dye used, hemodynamic optimization of intravenous fluids, and CA-AKI incidence for each cardiologist practicing coronary angiography or percutaneous coronary intervention, compared with peers at their site and across the province. Reports were developed through an iterative process involving interventional cardiologists throughout the design process and usability testing. Results Cardiologists participating in usability testing indicated a preference for the visual displays of data and summarizing indicators on the front page, and endorsed the value of peer-to-peer comparisons of performance measures. Of 31 eligible cardiologists from across Alberta, 17 responded to a survey evaluating the audit and feedback process. Fifteen respondents (88.2%) agreed that the data presented in the audit and feedback report were understandable; 17 respondents (100%) agreed or strongly agreed that the presentation of the report helped them better understand their performance compared with that of their peers; and 14 (82.4%) agreed that the audit and feedback process helped them identify ways to reduce the risk of AKI for their patients. Conclusions Conducting an audit and providing feedback was an understandable and acceptable intervention to help cardiologists identify ways to improve prevention of CA-AKI during coronary angiography or intervention.
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190
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Clinically Distinct Subtypes of Acute Kidney Injury on Hospital Admission Identified by Machine Learning Consensus Clustering. Med Sci (Basel) 2021; 9:medsci9040060. [PMID: 34698185 PMCID: PMC8544570 DOI: 10.3390/medsci9040060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022] Open
Abstract
Background: We aimed to cluster patients with acute kidney injury at hospital admission into clinically distinct subtypes using an unsupervised machine learning approach and assess the mortality risk among the distinct clusters. Methods: We performed consensus clustering analysis based on demographic information, principal diagnoses, comorbidities, and laboratory data among 4289 hospitalized adult patients with acute kidney injury at admission. The standardized difference of each variable was calculated to identify each cluster’s key features. We assessed the association of each acute kidney injury cluster with hospital and one-year mortality. Results: Consensus clustering analysis identified four distinct clusters. There were 1201 (28%) patients in cluster 1, 1396 (33%) patients in cluster 2, 1191 (28%) patients in cluster 3, and 501 (12%) patients in cluster 4. Cluster 1 patients were the youngest and had the least comorbidities. Cluster 2 and cluster 3 patients were older and had lower baseline kidney function. Cluster 2 patients had lower serum bicarbonate, strong ion difference, and hemoglobin, but higher serum chloride, whereas cluster 3 patients had lower serum chloride but higher serum bicarbonate and strong ion difference. Cluster 4 patients were younger and more likely to be admitted for genitourinary disease and infectious disease but less likely to be admitted for cardiovascular disease. Cluster 4 patients also had more severe acute kidney injury, lower serum sodium, serum chloride, and serum bicarbonate, but higher serum potassium and anion gap. Cluster 2, 3, and 4 patients had significantly higher hospital and one-year mortality than cluster 1 patients (p < 0.001). Conclusion: Our study demonstrated using machine learning consensus clustering analysis to characterize a heterogeneous cohort of patients with acute kidney injury on hospital admission into four clinically distinct clusters with different associated mortality risks.
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191
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Rachoin JS, Wolfe Y, Patel S, Cerceo E. Contrast associated nephropathy after intravenous administration: what is the magnitude of the problem? Ren Fail 2021; 43:1311-1321. [PMID: 34547972 PMCID: PMC8462873 DOI: 10.1080/0886022x.2021.1978490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Intravenous contrast media (CM) is often used in clinical practice to enhance CT scan imaging. For many years, contrast-induced nephropathy (CIN) was thought to be a common occurrence and to result in dire consequences. When treating patients with abnormal renal function, it is not unusual that clinicians postpone, cancel, or replace contrast-enhanced imaging with other, perhaps less informative tests. New studies however have challenged this paradigm and the true risk attributable to intravenous CM for the occurrence of CIN has become debatable. In this article, we review the latest relevant medical literature and aim to provide an evidence-based answer to questions surrounding the risk, outcomes, and potential mitigation strategies of CIN after intravenous CM administration.
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Affiliation(s)
- Jean-Sebastien Rachoin
- Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA.,Division of Hospital Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Yanika Wolfe
- Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Sharad Patel
- Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Elizabeth Cerceo
- Division of Hospital Medicine, Cooper University Health Care, Camden, NJ, USA
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192
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Sudarski D, Naami R, Shehadeh F, Elias A, Kerner A, Aronson D. Risk of Worsening Renal Function Following Repeated Exposures to Contrast Media During Percutaneous Coronary Interventions. J Am Heart Assoc 2021; 10:e021473. [PMID: 34533055 PMCID: PMC8649525 DOI: 10.1161/jaha.121.021473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Multiple contrast media exposures are common, but their cumulative effect on renal function is unknown. We aimed to investigate the renal consequences of repeated exposures to contrast media with coronary interventions. Methods and Results We studied 2942 patients who underwent between 1 and 9 procedures. The primary end point was a persistent creatinine increase of ≥50% above baseline at ≥90 days after the last procedure. The effect of cumulative contrast media dose was assessed using Cox models, with cumulative exposure as a time‐dependent variable, and propensity score matching. The primary end point occurred in 190 patients (6.5%), with 6.1%, 6.8%, and 6.2% of patients with 1, 2 or 3, and ≥4 procedures, respectively (P=0.75). In the multivariable Cox model, baseline renal function, diabetes, anemia, acute coronary syndrome, and heart failure were independent predictors of the primary end point (all P≤0.01), whereas cumulative contrast dose was not (hazard ratio [HR], 1.29 [95% CI, 0.89–1.88] for the fourth contrast quartile [>509 mL] versus first contrast quartile [<233 mL]). Propensity score matching yielded 384 patient pairs with similar characteristics and either 1 or 2 to 9 contrast exposures (median cumulative dose, 160 and 480 mL, respectively). Despite large differences in the cumulative contrast exposure, there were similar rates of the primary end points (7.3% versus 6.3%, respectively; HR, 0.76 [95% CI, 0.44–1.32]). Conclusions In patients with multiple exposures to contrast media, worsening of renal function over time is associated with known risk factors for the progression of kidney disease but not with cumulative contrast volume.
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Affiliation(s)
- Doron Sudarski
- Department of Cardiology Rambam Medical Center, and B. Rappaport Faculty of MedicineTechnion Medical School Haifa Israel
| | - Robert Naami
- Department of Cardiology Rambam Medical Center, and B. Rappaport Faculty of MedicineTechnion Medical School Haifa Israel
| | - Faheem Shehadeh
- Department of Cardiology Rambam Medical Center, and B. Rappaport Faculty of MedicineTechnion Medical School Haifa Israel
| | - Adi Elias
- Department of Cardiology Rambam Medical Center, and B. Rappaport Faculty of MedicineTechnion Medical School Haifa Israel
| | - Arthur Kerner
- Department of Cardiology Rambam Medical Center, and B. Rappaport Faculty of MedicineTechnion Medical School Haifa Israel
| | - Doron Aronson
- Department of Cardiology Rambam Medical Center, and B. Rappaport Faculty of MedicineTechnion Medical School Haifa Israel
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193
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Liu Y, Tan N, Huo Y, Chen S, Liu J, Chen YD, Wu K, Wu G, Chen K, Ye J, Liang Y, Feng X, Dong S, Wu Q, Ye X, Zeng H, Zhang M, Dai M, Duan CY, Sun G, He Y, Song F, Guo Z, Chen PY, Ge J, Xian Y, Chen J. Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial. Heart 2021; 108:948-955. [PMID: 34509996 DOI: 10.1136/heartjnl-2021-319716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/17/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). METHODS The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety end point is acute heart failure. RESULTS From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants. CONCLUSIONS Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.
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Affiliation(s)
- Yong Liu
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Ning Tan
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Yong Huo
- Cardiology, Peking University First Hospital, Beijing, China
| | - Shiqun Chen
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Jin Liu
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Yun-Dai Chen
- Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Keng Wu
- Cardiology, The Affiliated Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Guifu Wu
- Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Kaihong Chen
- Cardiology, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, Fujian, China
| | - Jianfeng Ye
- Cardiology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yan Liang
- Cardiology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Xinwu Feng
- Cardiology, The First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, China
| | - Shaohong Dong
- Cardiology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Qiming Wu
- Cardiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xianhua Ye
- Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Hesong Zeng
- Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Minzhou Zhang
- Cardiology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Min Dai
- Cardiology, Mianyang Central Hospital, Changjia Alley 12, Fucheng District, Mianyang, Sichuan, China
| | - Chong-Yang Duan
- Biostatistics, The State Key Laboratory of Organ Failure Research, The Key Laboratory of Tropical Disease Research, School of Public HealthMedical University, Guangzhou, Guangdong, China
| | - Guoli Sun
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Yibo He
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Feier Song
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Zhaodong Guo
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Ping-Yan Chen
- Biostatistics, The State Key Laboratory of Organ Failure Research, The Key Laboratory of Tropical Disease Research, School of Public HealthMedical University, Guangzhou, Guangdong, China
| | - Junbo Ge
- Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Ying Xian
- Neurology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jiyan Chen
- Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China
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Lun Z, Mai Z, Liu L, Chen G, Li H, Ying M, Wang B, Chen S, Yang Y, Liu J, Chen J, Ye J, Liu Y. Hypertension as a Risk Factor for Contrast-Associated Acute Kidney Injury: A Meta-Analysis Including 2,830,338 Patients. Kidney Blood Press Res 2021; 46:670-692. [PMID: 34492656 DOI: 10.1159/000517560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Previous studies have shown that the relationship between hypertension (HT) and contrast-associated acute kidney injury (CA-AKI) is not clear. We apply a systematic review and meta-analysis to assess the association between HT and CA-AKI. METHODS We searched for articles on the study of risk factors for CA-AKI in the Embase, Medline, and Cochrane Database of Systematic Reviews (by March 25, 2021). Two authors independently performed quality assessment and extracted data such as the studies' clinical setting, the definition of CA-AKI, and the number of patients. The CA-AKI was defined as a serum creatinine (SCr) increase ≥25% or ≥0.5 mg/dL from baseline within 72 h. We used fixed or random models to pool adjusted OR (aOR) by STATA. RESULTS A total of 45 studies (2,830,338 patients) were identified, and the average incidence of CA-AKI was 6.48%. There was an increased risk of CA-AKI associated with HT (aOR: 1.378, 95% CI: 1.211-1.567, I2 = 67.9%). In CA-AKI with a SCr increase ≥50% or ≥0.3 mg/dL from baseline within 72 h, an increased risk of CA-AKI was associated with HT (aOR: 1.414, 95% CI: 1.152-1.736, I2 = 0%). In CA-AKI with a Scr increase ≥50% or ≥0.3 mg/dL from baseline within 7 days, HT increases the risk of CA-AKI (aOR: 1.317, 95% CI: 1.049-1.654, I2 = 51.5%). CONCLUSION Our meta-analysis confirmed that HT is an independent risk factor for CA-AKI and can be used to identify risk stratification. Physicians should pay more attention toward prevention and treatment of patients with HT in clinical practice.
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Affiliation(s)
- Zhubin Lun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Ziling Mai
- Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | - Huanqiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Ying
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongquan Yang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jianfeng Ye
- The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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195
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Kistner A, Tamm C, Svensson AM, Beckman MO, Strand F, Sköld M, Nyrén S. Negative effects of iodine-based contrast agent on renal function in patients with moderate reduced renal function hospitalized for COVID-19. BMC Nephrol 2021; 22:297. [PMID: 34465289 PMCID: PMC8407403 DOI: 10.1186/s12882-021-02469-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Kidney disease and renal failure are associated with hospital deaths in patients with COVID - 19. We aimed to test if contrast enhancement affects short-term renal function in hospitalized COVID - 19 patients. METHODS Plasma creatinine (P-creatinine) was measured on the day of computed tomography (CT) and 24 h, 48 h, and 4-10 days after CT. Contrast-enhanced (n = 142) and unenhanced (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≤ 60 ml/min/1.73 m2. Contrast-induced acute renal failure (CI-AKI) was defined as ≥27 μmol/L increase or a > 50% rise in P-creatinine from CT or initiation of renal replacement therapy during follow-up. Patients with renal replacement therapy were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine at 48 h and at 4-10 days after contrast-enhanced CT. RESULTS Median P-creatinine at 24-48 h and days 4-10 post-CT in patients with eGFR> 60 and eGFR≥30-60 in contrast-enhanced and unenhanced groups did not differ from basal values. CI-AKI was observed at 48 h and at 4-10 days post contrast administration in 24 and 36% (n = 5/14) of patients with eGFR≥30-60. Corresponding figures in the eGFR> 60 contrast-enhanced CT group were 5 and 5% respectively, (p < 0.037 and p < 0.001, Pearson χ2 test). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that an eGFR≥30-60 and 30-day mortality were associated with CK-AKI both at 48 h and 4-10 days after contrast-enhanced CT. CONCLUSION Patients with COVID - 19 and eGFR≥30-60 had a high frequency of CK-AKI at 48 h and at 4-10 days after contrast administration, which was associated with increased 30-day mortality. For patients with eGFR≥30-60, we recommend strict indications are practiced for contrast-enhanced CT. Contrast-enhanced CT had a modest effect in patients with eGFR> 60.
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Affiliation(s)
- Anna Kistner
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Solna, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Chen Tamm
- Department of Radiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Ann Mari Svensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Mats O Beckman
- Department of Radiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Fredrik Strand
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Magnus Sköld
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Nyrén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Solna, Stockholm, Sweden
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196
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Ngo L, Ali A, Ganesan A, Woodman RJ, Adams R, Ranasinghe I. Utilisation and safety of catheter ablation of atrial fibrillation in public and private sector hospitals. BMC Health Serv Res 2021; 21:883. [PMID: 34454482 PMCID: PMC8400841 DOI: 10.1186/s12913-021-06874-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background Little is known about the utilisation and safety of catheter ablation of atrial fibrillation (AF) among public and private sector hospitals. Aims To examine the uptake of AF ablations and compare procedural safety between the sectors. Method: Hospitalisation data from all public and private hospitals in four large Australian states (NSW, QLD, VIC and WA) were used to identify patients undergoing AF ablation from 2012 to 17. The primary endpoint was any procedure-related complications up to 30-days post-discharge. Logistic regression was used to evaluate the association between treatment at a public hospital and risk of complications adjusting for covariates. Results Private hospitals performed most of the 21,654 AF ablations identified (n = 16,992, 78.5 %), on patients who were older (63.5 vs. 59.9y) but had lower rates of heart failure (7.9 % vs. 10.4 %), diabetes (10.2 % vs. 14.1 %), and chronic kidney diseases (2.4 % vs. 5.2 %) (all p < 0.001) than those treated in public hospitals. When compared with private hospitals, public hospitals had a higher crude rate of complications (7.25 % vs. 4.70 %, p < 0.001). This difference remained significant after adjustment (OR 1.74 [95 % CI 1.54–2.04]) and it occurred with both in-hospital (OR 1.83 [1.57–2.14]) and post-discharge (OR 1.39 [1.06–1.83]) complications, with certain complications including acute kidney injury (OR 5.31 [3.02–9.36]), cardiac surgery (OR 5.18 [2.19–12.27]), and pericardial effusion (OR 2.18 [1.50–3.16]). Conclusions Private hospitals performed most of AF ablations in Australia with a lower rate of complications when compared with public hospitals. Further investigations are needed to identify the precise mechanisms of this observed difference. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06874-7.
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Affiliation(s)
- Linh Ngo
- School of Clinical Medicine, The University of Queensland, Northside Clinical Unit, The Prince Charles Hospital, 627 Rode Road, Queensland, 4032, Chermside, Australia. .,Department of Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia. .,Cardiovascular Centre, E Hospital, Hanoi, Vietnam.
| | - Anna Ali
- Discipline of Medicine, The University of Adelaide, South Australia, Adelaide, Australia
| | - Anand Ganesan
- Department of Cardiovascular Medicine, Flinders Medical Centre, South Australia, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, South Australia, Adelaide, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, South Australia, Adelaide, Australia
| | - Robert Adams
- Discipline of Medicine, The University of Adelaide, South Australia, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, South Australia, Adelaide, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, South Australia, Adelaide, Australia
| | - Isuru Ranasinghe
- School of Clinical Medicine, The University of Queensland, Northside Clinical Unit, The Prince Charles Hospital, 627 Rode Road, Queensland, 4032, Chermside, Australia.,Department of Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
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197
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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] [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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198
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Cao D, Dangas GD. Sodium Bicarbonate, Contrast-Associated Acute Kidney Injury, and Long-Term Outcomes: The End of an Era? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 31:69-70. [PMID: 34364806 DOI: 10.1016/j.carrev.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States of America.
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199
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Parco C, Brockmeyer M, Kosejian L, Quade J, Tröstler J, Bader S, Lin Y, Sokolowski A, Hoss A, Heinen Y, Schulze V, Icks A, Jung C, Kelm M, Wolff G. National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort. J Nephrol 2021; 34:1491-1500. [PMID: 34363595 PMCID: PMC8494719 DOI: 10.1007/s40620-021-01124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study. METHODS AND RESULTS Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72-0.78; vs. Mehran c-index 0.69, 95% CI 0.66-0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12-0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79-0.91; vs. Mehran c-index 0.75, 95% CI 0.66-0.84; pNCDRvsMehran < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk. CONCLUSION In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the GRACE model while showing less accurate calibration. Results for the outcome 'need for dialysis' were equivocal.
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Affiliation(s)
- Claudio Parco
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Lucin Kosejian
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Julia Quade
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jennifer Tröstler
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Selina Bader
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yingfeng Lin
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Sokolowski
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Hoss
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yvonne Heinen
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Volker Schulze
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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200
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Yan P, Zhang NY, Luo XQ, Wang M, Deng YH, Wu T, Wu X, Liu Q, Wang HS, Wang L, Kang YX, Duan SB. Is intravenous iodinated contrast medium administration really harmful in hospitalized acute kidney injury patients: a propensity score-matched study. Eur Radiol 2021; 32:1163-1172. [PMID: 34342692 DOI: 10.1007/s00330-021-08192-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the effects of intravenous iodinated contrast medium (ICM) administration on the deterioration of renal function (DRF), new renal replacement therapy (RRT) induction and mortality of hospitalized acute kidney injury (AKI) patients. METHODS Adult hospitalized patients undergoing a contrast-enhanced or unenhanced CT scan within 7 days after AKI diagnosis from January 2015 to December 2019 were identified in this retrospective study. Propensity score matching was performed. Outcomes in 7 and 30 days after CT scan were compared between the contrast and non-contrast groups. Additional analyses were also performed in patients stratified by SCr levels at AKI diagnosis, times and time of CT scan, and in patients without chronic kidney disease or RRT requirement prior to CT scan. RESULTS In total, 1172 pairs were generated after 1:1 propensity score matching from 1336 cases exposed to ICM and 2724 unexposed. No significant differences were found in the outcomes between the two groups: DRF, 7.8% vs 9.0% (odds ratio (OR) 0.83, 95% confidence interval (CI) 0.62-1.11) in 7 days, 5.1% vs 5.4% (OR 0.93, 95%CI 0.64-1.34) in 30 days; new RRT induction, 2.3% vs 3.3% (OR 0.72,95%CI 0.43-1.18) in 7 days, 4.2% vs 4.5% (OR 0.95,95%CI 0.64-1.41) in 30 days; and mortality, 3.9% vs 4.8% (OR 0.83,95%CI 0.56-1.22) in 7 days, 9.0% vs 10.2% (OR 0.88,95%CI 0.68-1.15) in 30 days. Subset analyses showed similar results. CONCLUSION Intravenous ICM administration during AKI duration did not increase the risks of DRF, new RRT induction, and mortality in 7 and 30 days after CT scan. KEY POINTS • Intravenous ICM administration in hospitalized AKI patients does not increase the risks of deterioration of renal function, RRT induction, and mortality in 7 and 30 days after CT scan. • The effects of intravenous ICM on adverse outcomes are minimal even in AKI patients with high level of SCr values or multiple CT scans.
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Affiliation(s)
- Ping Yan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiao-Qin Luo
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Mei Wang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Ying-Hao Deng
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Ting Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Xi Wu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Qian Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Hong-Shen Wang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Lin Wang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Yi-Xin Kang
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China.
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