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Vasin AA, Mironova OI, Fomin VV. [The atorvastatin effects on the prevention of contrast-induced acute kidney injury during computed tomography with contrast media]. TERAPEVT ARKH 2022; 94:1057-1061. [PMID: 36286755 DOI: 10.26442/0403660.2022.09.201845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
AIM To assess the role of atorvastatin to the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media. MATERIALS AND METHODS One hundred patients with CVD undergoing CT with with intravenous contrast media administration were included in prospective observational study (ClinicalTrials.gov ID NCT04666389). Patients were divided into 3 groups 16 (15.8%) patients receiving atorvastatin at a dose of 80 mg 24 hours and 40 mg before the CT and 40 mg after; 33 (32.7%) patients 40 mg before the CT and 40 mg after; 52 (51.5%) people not receiving statin therapy. The primary endpoint was CI-AKI according to KDIGO criteria: the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 4872 hours after administration of contrast media. There were 51% of men. The average age was 59.7714.4. The most frequent cardiovascular disease was hypertension 86%. RESULTS CI-AKI was diagnosed in 4 (3.96%) patients. At the same time, it was not possible to establish statistically significant relationships (p0.05) between risk factors and the development of CI-AKI. Statins can be a successful way to prevent this complication. CONCLUSION Cardiovascular diseases may increase the risk of CI-AKI after computed tomography with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.
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Affiliation(s)
- A A Vasin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O I Mironova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
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2
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Yan SX, Gao M, Yang TH, Tian C, Jin S. The preventive effects of different doses of atorvastatin on contrast-induced acute kidney injury after CT perfusion. J Clin Lab Anal 2022; 36:e24386. [PMID: 35582743 PMCID: PMC9279945 DOI: 10.1002/jcla.24386] [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: 10/26/2020] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Contrast‐induced acute kidney injury (CI‐AKI) is a severe complication among patients receiving intravascular contrast media. The purpose of this study was to investigate the preventive effects of pretreatment of atorvastatin at intensive doses on CI‐AKI after computed tomography (CT) perfusion. Methods The levels of serum creatinine (SCR), blood urea nitrogen (BUN), Cystatin C (CysC), estimated glomerular filtration rate (eGFR), high‐sensitivity C‐reactive protein (hs‐CRP), and interleukin‐6 (IL‐6) in patients were compared between the observation group receiving 40 mg/kg atorvastatin and the control group receiving 20 mg/kg atorvastatin before and 72 h after CT examination. In addition, the incidence of CI‐AKI was recorded. Results Compared with the control group, the incidence of renal injury in the observation group was significantly reduced, from 8% to 2% (χ2 = 6.62, p = 0.010). In addition, there was no notable difference in the levels of Scr, BUN, CysC, hs‐CRP, and IL‐6 before CT examination between two groups (p > 0.05). The levels of SCR, BUN, CysC, hs‐CRP, and IL‐6 were increased, while the levels of eGFR were decreased in the control group at 72 h after CT examination (p < 0.05). At 72 h after CT enhancement, the levels of BUN, CysC, and hs‐CRP were prominently increased in the observation group (p < 0.05), while SCR, eGFR, and IL‐6 did not change (p > 0.05). Compared with the control group, the levels of SCR, BUN, CysC, eGFR, hs‐CRP, and IL‐6 in the observation group were significantly decreased at 72 h after CT examination (p < 0.05). Conclusion Intensive dose of atorvastatin pretreatment can prevent CI‐AKI undergoing CT perfusion through lowering inflammation as well as renal function indexes SCR, CysC, BUN, and eGFR.
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Affiliation(s)
- Shi-Xin Yan
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Man Gao
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Tian-Hao Yang
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Chao Tian
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Song Jin
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
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Chen PY, Liu YH, Duan CY, Fan HL, Zeng LH, Guo W, Jiang L, Wei XB, He WF, Tao S, Guo ZQ, Chen JY, Tan N, He PC. Association of in-hospital intensive statins dosage and death in arteriosclerotic cardiovascular disease with percutaneous coronary intervention: insights of multicentre cohort from China. Eur J Clin Pharmacol 2020; 76:1755-1763. [PMID: 32700000 DOI: 10.1007/s00228-020-02966-1] [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: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE In-hospital statin dosage-related effect remains unknown for patients with arteriosclerotic cardiovascular disease (ASCVD). This study aimed to determine the associations of different in-hospital intensive statins dosages with the prognosis for patients in the era of percutaneous coronary intervention (PCI). METHODS From January 2010 to December 2014, consecutive ASCVD patients receiving PCI were enrolled from five centres in China. All the enrolled patients were classified into high-dose (40 mg atorvastatin or 20 mg rosuvastatin) or low-dose (20 mg atorvastatin or 10 mg rosuvastatin) intensive statin group. In-hospital all-cause death was the primary outcome. RESULTS Of the 7008 patients included in this study, 5248 received low-dose intensive statins (mean age, 64.28 ± 10.39; female, 25.2%), whereas 1760 received high-dose intensive statins (mean age, 63.68 ± 10.59; female, 23.1%). There was no significant difference in the in-hospital all-cause death between the two groups (adjusted OR, 1.27; 95% CI, 0.43-3.72; P = 0.665). All-cause death was similar between the two groups during the 30-day follow-up period (adjusted HR, 1.28; 95% CI, 0.55-2.97; P = 0.571). However, the high-dose intensive statins were tightly associated with the reduction in in-hospital dialysis (adjusted OR, 0.11; 95% CI, 0.01-0.81; P = 0.030). Besides, primary analyses were confirmed by subgroup analyses. CONCLUSIONS The in-hospital high-dose intensive statins are not associated with the lower risk of in-hospital or 30-day all-cause death among ASCVD patients undergoing PCI. Given the robust beneficial effect of high-dose intensive statins with in-hospital dialysis, an individualized high-dose intensive statin therapy can be rational in specified populations.
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Affiliation(s)
- Peng-Yuan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, 528000, China
| | - Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,School of Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510100, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hua-Lin Fan
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, 510100, China
| | - Li-Huan Zeng
- School of Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510100, China
| | - Wei Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, 510100, China
| | - Xue-Biao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Wen-Fei He
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, 528000, China
| | - Sha Tao
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, 528000, China
| | - Zhi-Qiang Guo
- Department of Cardiology, Guangdong Provincial People's Hospital's Nanhai Hospital, the Second Hospital of Nanhai District Foshan City, Foshan, 528000, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,School of Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510100, China.,School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, 510100, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,School of Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510100, China.,School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, 510100, China
| | - Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China. .,School of Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510100, China. .,School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, 510100, China.
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Toso A, Leoncini M, Maioli M, Bellandi F. Pharmacologic Prophylaxis of Contrast-Induced Nephropathy. Interv Cardiol Clin 2020; 9:369-383. [PMID: 32471677 DOI: 10.1016/j.iccl.2020.02.006] [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: 10/24/2022]
Abstract
Different pharmacologic agents have been tested in the effort to prevent contrast-induced acute kidney injury (AKI) in the last two decades. To date, however, no individual drug has received unanimous approval for this aim. Since 2014 statins have been included as preventive treatment in the European guidelines for revascularization procedures in cardiac patients. The present update presents the latest findings in this field focusing on the changing paradigms in the definition and consequently the approach to nephroprotection that considers clinical prognosis as the major issue. We note the current shift from attention to contrast-induced AKI to contrast-associated AKI.
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Affiliation(s)
- Anna Toso
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy.
| | - Mario Leoncini
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| | - Mauro Maioli
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| | - Francesco Bellandi
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
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Faucon AL, Bobrie G, Clément O. Nephrotoxicity of iodinated contrast media: From pathophysiology to prevention strategies. Eur J Radiol 2019; 116:231-241. [DOI: 10.1016/j.ejrad.2019.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
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Healy E, Wasfy JH. Translating Experimental Evidence Into Clinical Decision Making. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:9-10. [PMID: 30744829 DOI: 10.1016/j.carrev.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Emma Healy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Zhao WB, Fu H, Chang F, Liu J, Wang J, Li F, Zhao J. Effects of various doses of atorvastatin on vascular endothelial cell apoptosis and autophagy in vitro. Mol Med Rep 2019; 19:1919-1925. [PMID: 30628690 DOI: 10.3892/mmr.2019.9828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/26/2018] [Indexed: 11/06/2022] Open
Abstract
Atorvastatin (Lipitor™) is a lipid‑lowering agent that is widely used in the treatment of cardiovascular diseases. Previous research has largely focused on its cholesterol‑lowering effects; however, a limited number of studies have investigated the actions of atorvastatin on vascular endothelial cells. In the present study, the effects of various doses of atorvastatin were investigated on human umbilical vein endothelial cells (HUVECs). HUVECs were treated with various concentrations of atorvastatin in serum‑free or serum‑containing medium, and alterations in HUVEC morphology were observed. Cell survival and necrosis rates were evaluated using sulforhodamine B and lactate dehydrogenase assays, respectively. In addition, the protein expression levels of cellular apoptosis and autophagy markers were detected using western blot analysis. The results revealed that HUVEC morphology was altered following treatment with various concentrations of atorvastatin. In addition, autophagy was demonstrated to be induced by atorvastatin treatment at all concentrations, whereas high concentrations appeared to induce apoptosis and suppress the survival of HUVECs. In conclusion, the results of the present study suggested that various doses of atorvastatin may exert differential effects on HUVECs, and high doses may suppress angiogenesis. Therefore, atorvastatin may present a novel potential anti‑tumor therapeutic strategy. However, further studies are required to fully elucidate the association between the dose of atorvastatin and its clinical outcome.
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Affiliation(s)
- Wen-Bo Zhao
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hui Fu
- Shandong Provincial Key Laboratory of Animal Cells and Developmental Biology, School of Life Science, Shandong University, Jinan, Shandong 250100, P.R. China
| | - Fen Chang
- Shandong Provincial Key Laboratory of Animal Cells and Developmental Biology, School of Life Science, Shandong University, Jinan, Shandong 250100, P.R. China
| | - Jing Liu
- Shandong Provincial Key Laboratory of Animal Cells and Developmental Biology, School of Life Science, Shandong University, Jinan, Shandong 250100, P.R. China
| | - Jinlan Wang
- Shandong Provincial Key Laboratory of Animal Cells and Developmental Biology, School of Life Science, Shandong University, Jinan, Shandong 250100, P.R. China
| | - Fang Li
- Shandong Provincial Key Laboratory of Animal Cells and Developmental Biology, School of Life Science, Shandong University, Jinan, Shandong 250100, P.R. China
| | - Jing Zhao
- Shandong Provincial Key Laboratory of Animal Cells and Developmental Biology, School of Life Science, Shandong University, Jinan, Shandong 250100, P.R. China
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8
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van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, Clement O, Heinz-Peer G, Stacul F, Webb JAW, Thomsen HS. Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28:2856-2869. [PMID: 29417249 PMCID: PMC5986837 DOI: 10.1007/s00330-017-5247-4] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. AREAS COVERED IN PART 2: Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium. KEY POINTS • In CKD, hydration reduces the PC-AKI risk • Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis • No drugs have been consistently shown to reduce the risk of PC-AKI • Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m 2 • Dialysis schedules need not change when intravascular contrast medium is given.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
| | - Peter Reimer
- Institute for Diagnostic and Interventional Radiology Klinikum Karlsruhe, Moltkestraße 90, D-76133, Karlsruhe, Germany
| | - Ilona A Dekkers
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
| | - Georg Bongartz
- Department of Diagnostic Radiology, University Hospitals of Basel, Petersgaben 4, CH-4033, Basel, Switzerland
| | - Marie-France Bellin
- Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807, Villejuif, France
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Olivier Clement
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris Cedex 15, F-71015, Paris, France
| | - Gertraud Heinz-Peer
- Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straße 4, AT-3100, St. Pölten, Austria
| | - Fulvio Stacul
- S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, I-34129, Trieste, Italy
| | - Judith A W Webb
- Department of Radiology, St. Bartholomew's Hospital, University of London, West Smithfield, EC1A 7BE, London, UK
| | - Henrik S Thomsen
- Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
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Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention. J Vasc Interv Radiol 2017; 28:1687-1692. [PMID: 28947366 DOI: 10.1016/j.jvir.2017.07.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine incidence, predictors, and clinical outcomes of postcontrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis. MATERIALS AND METHODS This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis; 437 patients with follow-up data were included. Mean age was 73.6 years ± 8.3. PC-AKI was defined as absolute serum creatinine increase ≥ 0.3 mg/dL or percentage increase in serum creatinine ≥ 50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis. RESULTS Mean follow-up was 71.1 months ± 68.4. PC-AKI developed in 26 patients (5.9%). Patients with PC-AKI had significantly higher levels of baseline proteinuria compared with patients without PC-AKI (odds ratio = 1.38; 95% confidence interval, 1.11-1.72; P = .004). Hydration before intervention, chronic kidney disease stage, baseline glomerular filtration rate, statin medications, contrast volume, and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P = .50 and P = .17, respectively). CONCLUSIONS Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death.
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11
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Guo XS, Lin KY, Li HL, Chen JY, Zhou YL, Liu Y, Tan N, Atkins ER, Ran P, Yang JQ, Wu DX, Chen SQ, Duan CY, Chen PY. Preprocedural High-Sensitivity C-Reactive Protein Predicts Contrast-Induced Nephropathy and Long-Term Outcome After Coronary Angiography. Angiology 2016; 68:614-620. [PMID: 27814269 DOI: 10.1177/0003319716674623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We investigated whether high-sensitivity C-reactive protein (hsCRP) levels were associated with contrast-induced nephropathy (CIN) and long-term mortality after coronary angiography (CAG). Patients (N = 2133) undergoing CAG with preprocedural hsCRP were consecutively enrolled. High-sensitivity C-reactive protein was measured before angiography. Median follow-up was 2.3 years. The overall incidence of CIN was 2.77% (59 of 2133). There was a positive trend of hsCRP quartiles (Q) with rates of CIN: 0.9% for Q1 (<1.6 mg/L), 0.9% for Q2 (1.6-3.9 mg/L), 2.4% for Q3 (4.0-11.3mg/L), and 6.8% for Q4 (>11.3 mg/L; P < .05). The receiver operating characteristic (ROC) analysis showed that the cutoff point of hsCRP was 7.3 mg/L for predicting CIN with a 72.7% sensitivity and a 67.0% specificity (area under the curve [AUC] = 0.742, 95% confidence interval [CI] 0.672-0.810; P < .05). The predictive value of hsCRP was similar to the Mehran score for CIN (AUChsCRP = 0.742 vs AUCMehran = 0.801; P = .228). After adjustment for other potential risk factors, hsCRP >7.3 mg/L still was an independent predictor of CIN (odds ratio [OR] = 2.83, 95% CI: 1.44-5.58; P = .003). Furthermore, hsCRP >7.3 mg/L was associated with higher mortality (OR = 2.04, 95% CI: 1.30-3.19; P = .002).
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Affiliation(s)
- Xiao-Sheng Guo
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kai-Yang Lin
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,2 Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Hua-Long Li
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ji-Yan Chen
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Ling Zhou
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Tan
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Emily R Atkins
- 3 The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peng Ran
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun-Qing Yang
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Deng-Xuan Wu
- 4 Department of Cardiology, Panzhihua Central Hospital, Panzhihua, China
| | - Shi-Qun Chen
- 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chong-Yang Duan
- 5 State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ping-Yan Chen
- 5 State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
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12
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Whayne TF. Renal Iodine Dye Risk, Age, and the Acute Coronary Syndrome. Angiology 2016; 67:107-12. [DOI: 10.1177/0003319715581750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas F. Whayne
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
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Peng PA, Wang L, Ma Q, Xin Y, Zhang O, Han HY, Liu XL, Ji QW, Zhou YJ, Zhao YX. Valsartan protects HK-2 cells from contrast media-induced apoptosis by inhibiting endoplasmic reticulum stress. Cell Biol Int 2015; 39:1408-17. [PMID: 26248489 DOI: 10.1002/cbin.10521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/01/2015] [Indexed: 01/16/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is associated with increasing in-hospital and long-term adverse clinical outcomes in high-risk patients undergoing percutaneous coronary intervention (PCI). Contrast media (CM)-induced renal tubular cell apoptosis is reported to participate in this process by activating endoplasmic reticulum (ER) stress. An angiotensin II type 1 receptor (AT1R) antagonist can alleviate ER stress-induced renal apoptosis in streptozotocin (STZ)-induced diabetic mice and can reduce CM-induced renal apoptosis by reducing oxidative stress and reversing the enhancement of bax mRNA and the reduction of bcl-2 mRNA, but the effect of the AT1R blocker on ER stress in the pathogenesis of CI-AKI is still unknown. In this study, we explored the effect of valsartan on meglumine diatrizoate-induced human renal tubular cell apoptosis by measuring changes in ER stress-related biomarkers. The results showed that meglumine diatrizoate caused significant cell apoptosis by up-regulating the expression of ER stress markers, including glucose-regulated protein 78 (GRP78), activating transcription factor 4 (ATF4), CCAAT/enhancer-binding protein-homologous protein (CHOP) and caspase 12, in a time- and dose-dependent manner, which could be alleviated by preincubation with valsartan. In conclusion, valsartan had a potential nephroprotective effect on meglumine diatrizoate-induced renal cell apoptosis by inhibiting ER stress.
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Affiliation(s)
- Ping-An Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Le Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yi Xin
- Experimental Center, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ou Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hong-Ya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiao-Li Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Qing-Wei Ji
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ying-Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
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Athyros VG, Katsiki N, Karagiannis A, Mikhailidis DP. Statins can improve proteinuria and glomerular filtration rate loss in chronic kidney disease patients, further reducing cardiovascular risk. Fact or fiction? Expert Opin Pharmacother 2015; 16:1449-61. [PMID: 26037614 DOI: 10.1517/14656566.2015.1053464] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD), a risk factor for cardiovascular disease (CVD), is increasing worldwide. Statin treatment, the cornerstone of prevention or treatment of CVD, might have beneficial effects on urine protein excretion and renal function as determined by the glomerular filtration rate, whereas it might protect from acute kidney injury (AKI), mainly due to contrast-induced AKI. These beneficial effects on CKD may not be drug class effects; specific statins at specific doses may help prevent CKD deterioration and reduce CVD risk. We analysed all statin studies that had renal and CVD endpoints as main outcome measures. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched up to February 2015. AREAS COVERED We consider the effects of statins on microalbuminuria, proteinuria, glomerular filtration rate, AKI associated with angiography or percutaneous coronary intervention and on CVD event rates in patients with CKD. EXPERT OPINION Current evidence points towards the need to prescribe high-potency statins in patients with CKD, before a major decline in kidney function occurs. This may reduce CVD risk and delay the progress of CKD. Administration of either atorvastatin or rosuvastatin can prevent contrast-induced AKI before angiography or percutaneous coronary intervention. The combination of simvastatin + ezetimibe may decrease vascular events in patients with advanced CKD.
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Affiliation(s)
- Vasilios G Athyros
- Aristotle University of Thessaloniki, Hippocration Hospital, Medical School, Second Propedeutic Department of Internal Medicine , Thessaloniki , Greece +30 2310 892606 ; +30 2310 835955 ;
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15
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Peng P, Ma Q, Wang L, Zhang O, Han H, Liu X, Zhou Y, Zhao Y. Preconditioning With Tauroursodeoxycholic Acid Protects Against Contrast-Induced HK-2 Cell Apoptosis by Inhibiting Endoplasmic Reticulum Stress. Angiology 2015; 66:941-9. [DOI: 10.1177/0003319715575965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To investigate whether tauroursodeoxycholic acid (TUDCA) could attenuate contrast media (CM)-induced renal tubular cell apoptosis by inhibiting endoplasmic reticulum stress (ERS), we exposed HK-2 cells to increasing doses of meglumine diatrizoate (20, 40, and 80 mg I/mL) for 2 to 16 hours, with/without TUDCA preconditioning for 24 hours. Cell viability test, Hoechst 33258 staining, and flow cytometry were used to detect meglumine diatrizoate-induced cell apoptosis, while real-time polymerase chain reaction and Western blot analysis were used to measure the expressions of ERS markers of glucose-regulated protein 78 (GRP78), activating transcription factor 4 (ATF4), and the apoptosis-related marker of caspase 12. Cell apoptosis and messenger RNA (mRNA) expression of GRP78 ( P = .005), ATF4 ( P = .01), and caspase 12 ( P = .001) were significantly higher in the CM 4 hours group than the control as well as the protein expressions. The TUDCA preconditioning reduced the mRNA expression of GRP78, ATF4, and caspase 12 in the CM 4 hours groups ( P = .009, .019, and .003, respectively) as well as the protein expression. In conclusion, TUDCA could protect renal tubular cells from meglumine diatrizoate-induced apoptosis by inhibiting ERS.
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Affiliation(s)
- Pingan Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Le Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Ou Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
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McCulloch MI. Acute Kidney Injury (AKI): Current Thoughts and Controversies in Pediatrics. CURRENT PEDIATRICS REPORTS 2015. [DOI: 10.1007/s40124-014-0073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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