1
|
Maksimczuk J, Galas A, Krzesiński P. What Promotes Acute Kidney Injury in Patients with Myocardial Infarction and Multivessel Coronary Artery Disease-Contrast Media, Hydration Status or Something Else? Nutrients 2022; 15:nu15010021. [PMID: 36615678 PMCID: PMC9824824 DOI: 10.3390/nu15010021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Multivessel coronary artery disease (MVCAD) is found in approximately 50% of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Although we have data showing the benefits of revascularization of significant non-culprit coronary lesions in patients with AMI, the optimal timing of angioplasty remains unclear. The most common reason for postponing subsequent percutaneous treatment is the fear of contrast-induced acute kidney injury (CI-AKI). Acute kidney injury (AKI) is common in patients with AMI undergoing PCI, and its etiology appears to be complex and incompletely understood. In this review, we discuss the definition, pathophysiology and risk factors of AKI in patients with AMI undergoing PCI. We present the impact of AKI on the course of hospitalization and distant prognosis of patients with AMI. Special attention was paid to the phenomenon of AKI in patients undergoing multivessel revascularization. We analyze the correlation between increased exposure to contrast medium (CM) and the risk of AKI in patients with AMI to provide information useful in the decision-making process about the optimal timing of revascularization of non-culprit lesions. In addition, we present diagnostic tools in the form of new biomarkers of AKI and discuss ways to prevent and mitigate the course of AKI.
Collapse
|
2
|
Abstract
AKI is a potential complication of intravascular iodinated contrast exposure. Contrast-associated AKI, which typically manifests as small and transient decrements in kidney function that develop within several days of contrast administration, is associated with serious adverse outcomes, including progressive kidney dysfunction and death. However, a causal link between the small increases in serum creatinine that characteristically occur with contrast-associated AKI and serious adverse outcomes remains unproven. This is important given mounting evidence that clinically indicated, potentially lifesaving radiographic procedures are underutilized in patients with CKD. This has been hypothesized to be related to provider concern about precipitating contrast-associated AKI. Intravascular gadolinium-based contrast, an alternative to iodinated contrast that is administered with magnetic resonance imaging, has also been linked with potential serious adverse events, notably the development of nephrogenic systemic fibrosis in patients with severe impairment in kidney function. Patients hospitalized in the intensive care unit frequently have clinical indications for diagnostic and therapeutic procedures that involve the intravascular administration of contrast media. Accordingly, critical care providers and others treating critically ill patients should possess a sound understanding of the risk factors for and incidence of such outcomes, the ability to perform evidence-based risk-benefit assessments regarding intravascular contrast administration, and knowledge of empirical data on the prevention of these iatrogenic complications.
Collapse
Affiliation(s)
- Winn Cashion
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven D Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania .,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| |
Collapse
|
3
|
Caracciolo A, Scalise RFM, Ceresa F, Bagnato G, Versace AG, Licordari R, Perfetti S, Lofrumento F, Irrera N, Santoro D, Patanè F, Di Bella G, Costa F, Micari A. Optimizing the Outcomes of Percutaneous Coronary Intervention in Patients with Chronic Kidney Disease. J Clin Med 2022; 11:2380. [PMID: 35566504 PMCID: PMC9100167 DOI: 10.3390/jcm11092380] [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: 03/12/2022] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is one of the most common procedures performed in medicine. However, its net benefit among patients with chronic kidney disease (CKD) is less well established than in the general population. The prevalence of patients suffering from both CAD and CKD is high, and is likely to increase in the coming years. Planning the adequate management of this group of patients is crucial to improve their outcome after PCI. This starts with proper preparation before the procedure, the use of all available means to reduce contrast during the procedure, and the implementation of modern strategies such as radial access and drug-eluting stents. At the end of the procedure, personalized antithrombotic therapy for the patient's specific characteristics is advisable to account for the elevated ischemic and bleeding risk of these patients.
Collapse
Affiliation(s)
- Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Renato Francesco Maria Scalise
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Fabrizio Ceresa
- Department of Cardio-Thoraco-Vascular Surgery, Division of Cardiac Surgery, Papardo Hospital, 98158 Messina, Italy; (F.C.); (F.P.)
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Silvia Perfetti
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Francesca Lofrumento
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Francesco Patanè
- Department of Cardio-Thoraco-Vascular Surgery, Division of Cardiac Surgery, Papardo Hospital, 98158 Messina, Italy; (F.C.); (F.P.)
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “Gaetano Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (R.F.M.S.); (G.B.); (A.G.V.); (R.L.); (S.P.); (F.L.); (N.I.); (D.S.); (G.D.B.)
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Bağcı A, Aksoy F, Baş HA. Systemic Immune-Inflammation Index May Predict the Development of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2021; 73:218-224. [PMID: 34247536 DOI: 10.1177/00033197211030053] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The aim of this study was to investigate the predictive capacity of a systemic immune-inflammation index (SII) in the detection of contrast-induced nephropathy (CIN) following ST-segment elevation myocardial infarction (STEMI). A total of 477 STEMI patients were enrolled in the study. The patients were divided into 2 groups according to CIN development. A cutoff point of 5.91 for logarithm-transformed SII was identified with 73.0% sensitivity and 57.5% specificity to predict CIN following STEMI. According to a pairwise analysis of receiver operating characteristic curve analysis, the predictive power of SII in detecting CIN following STEMI was similar to that of high-sensitivity C-reactive protein and better than the neutrophil/lymphocyte ratio or platelet/lymphocyte ratio. As a result, SII can be used as one of the independent predictors of CIN after STEMI.
Collapse
Affiliation(s)
- Ali Bağcı
- Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Fatih Aksoy
- Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Hasan Aydin Baş
- Department of Cardiology, Isparta City Hospital, Isparta, Turkey
| |
Collapse
|
6
|
Huyut MA. Kidney Injury Molecule-1 Is Associated with Contrast-Induced Nephropathy in Elderly Patients with Non-STEMI. Arq Bras Cardiol 2021; 116:1048-1056. [PMID: 33787767 PMCID: PMC8288528 DOI: 10.36660/abc.20200172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/21/2020] [Accepted: 06/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is associated with an increased risk of major adverse cardiovascular events (MACE), and the association between CIN and oxidative mechanisms is well documented. OBJECTIVE This study aimed to evaluate the relationship between serum levels of kidney injury molecule-1 (KIM-1) and CIN in elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS This study included a total of 758 patients with NSTEMI, who underwent percutaneous coronary intervention (PCI); 15 developed CIN after PCI, and another 104 were the control group, matched for age > 65 years. Baseline to 48-to-72-hour laboratory values and clinical outcomes were recorded. Patients were followed during one year. P values of < 0.05 were considered significant. RESULTS CIN was observed in 12.60% of the patients. Serum KIM-1 was significantly higher in the CIN group than in the non-CIN group (14.02 [9.53 - 19.90] vs. 5.41 [3.41 - 9.03], p < 0.001). The Mehran score was significantly higher in the CIN group than in the non-CIN group (14 [5 - 22] vs. 5 [2 - 7], p = 0.001). MACE were significantly higher in the CIN group than in the non-CIN group (7 [46.70%] vs. 12 [11.50%], p = 0.001). Multivariate logistic regression analysis showed that baseline KIM-1 level (OR = 1.652, 95% CI: 1.20 - 2.27, p = 0.002) and Mehran score (OR = 1.457, 95% CI: 1.01 - 2.08, p = 0.039) were independent predictors of CIN in elderly patients with NSTEMI. CONCLUSION Baseline serum KIM-1 concentration and Mehran score are independent predictors of CIN in elderly patients with NSTEMI. Additionally, all-cause mortality, cardiovascular death, myocardial reinfarction, stroke, and MACE were significantly higher in the CIN group at one-year follow-up. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).
Collapse
Affiliation(s)
- Mustafa Ahmet Huyut
- Yeni Yuzyil UniversityFaculdade de MedicinaDepartamento de CardiologiaIstambulTurquiaYeni Yuzyil University, Faculdade de Medicina, Departamento de Cardiologia, Istambul - Turquia
| |
Collapse
|
7
|
Shroff GR, Bangalore S, Bhave NM, Chang TI, Garcia S, Mathew RO, Rangaswami J, Ternacle J, Thourani VH, Pibarot P. Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e1088-e1114. [PMID: 33980041 DOI: 10.1161/cir.0000000000000979] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.
Collapse
|
8
|
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 4038] [Impact Index Per Article: 1009.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
9
|
Bugani G, Ponticelli F, Giannini F, Gallo F, Gaudenzi E, Laricchia A, Fisicaro A, Cimaglia P, Mangieri A, Gardi I, Colombo A. Practical guide to prevention of contrast-induced acute kidney injury after percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 97:443-450. [PMID: 31967390 DOI: 10.1002/ccd.28740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/12/2019] [Accepted: 01/11/2020] [Indexed: 11/06/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) represents a common but serious complication of percutaneous coronary interventions (PCI)-and in general of all those examinations requiring iodinated contrast injection-which affects not only renal function but also long-term prognosis. While several prophylactic approaches were designed in order to prevent CI-AKI, most failed to demonstrate clear benefits in randomized trials, and their implementation is therefore discouraged in clinical practice. The most notorious examples include pre-procedural bicarbonate or N-acetylcysteine, and preprocedural withdrawal of ACE inhibitors/Angiotensin receptor blockers. Those strategies that were instead demonstrated effective include the appropriate use of preprocedural hydration, reduction in contrast volume utilization, adoption of techniques for zero- or ultra-low-contrast procedures, and pharmacological treatments with statins. In this brief review, we summarize the main preventive strategies into brief and pragmatic recommendations designed to improve everyday clinical practice.
Collapse
Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Gallo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.,Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Eleonora Gaudenzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Fisicaro
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Paolo Cimaglia
- Cardiology Department, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Ilja Gardi
- Cardiology Department, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.,Emo GVM Centro Cuore Columbus, Interventional Cardiology Unit, Milan, Italy
| |
Collapse
|
10
|
Bağcı A, Aksoy F, Baş HA. Akut koroner sendromda kontrast nefropati gelişimi ile Syntax Skoru arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.512112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
11
|
Oyamada N, Hamanaka I, Fujioka A, Iwasaku T, Minami T, Fujie H, Ueda K. Effectiveness of high flow‐volume intermittent hemodiafiltration during and after intervention to prevent contrast‐induced nephropathy in patients with advanced chronic kidney disease: A pilot study. Catheter Cardiovasc Interv 2019; 96:1174-1181. [DOI: 10.1002/ccd.28640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 10/09/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Naofumi Oyamada
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| | - Ichiro Hamanaka
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| | - Ayumu Fujioka
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| | - Toshihiro Iwasaku
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| | - Takeya Minami
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| | - Hiroaki Fujie
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| | - Kinzo Ueda
- Rakuwakai Kyoto Cardiovascular Intervention Center Rakuwakai Marutamachi Hospital Kyoto Japan
| |
Collapse
|
12
|
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
14
|
Karadeniz M, Kandemir H, Sarak T, Alp Ç. The prevalence of contrast nephropathy in patients undergoing percutaneous coronary intervention in acute coronary syndrome. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2018. [DOI: 10.32322/jhsm.410522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
15
|
Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures. Int J Nephrol 2018; 2018:5727309. [PMID: 29854458 PMCID: PMC5954945 DOI: 10.1155/2018/5727309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/21/2018] [Accepted: 03/14/2018] [Indexed: 01/04/2023] Open
Abstract
Contrast-induced nephropathy (CIN) is a frequent and severe complication in subjects receiving iodinated contrast media for diagnostic or therapeutic purposes. Several preventive strategies were evaluated in the past. Recent clinical studies and meta-analyses delivered some new aspects on preventive measures used in the past and present. We will discuss all pharmacological and nonpharmacological procedures. Finally, we will suggest individualized recommendations for CIN prevention.
Collapse
|
16
|
Sessa M, Rossi C, Mascolo A, Scavone C, di Mauro G, Grassi R, Sportiello L, Cappabianca S, Rafaniello C. Contrast media-induced nephropathy: how has Italy contributed in the past 30 years? A systematic review. Ther Clin Risk Manag 2017; 13:1463-1478. [PMID: 29123405 PMCID: PMC5661489 DOI: 10.2147/tcrm.s144418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objective The use of contrast media in Italy has exponentially increased in the past 3 decades. However, it is unknown whether there has been an increase in clinical research evaluating the risks associated with contrast media usage, especially regarding contrast-induced nephropathy. To fill this gap in knowledge, we performed a systematic review. Study eligibility criteria Meta-analyses, observational studies, and clinical trials assessing contrast media-induced nephropathy as the safety outcome, in which at least one author was affiliated with an Italian university/health care structure, were eligble. Data sources Ovid MEDLINE, Ovid Embase, Cochrane Methodology Register, and Web of Science were screened. Participants Men and women exposed to contrast media. Results In total, 60 original articles were retrieved with an incremental trend between 1990 and 2017. Cohort studies were the most common study design represented. In total, 45 of 60 (75.0%) studies were monocenter studies and 41 of 60 (68.3%) received no funding. In all, 91.7% of studies disclosed no conflicts of interest and 81.7% had no external collaboration. Most of the studies provided a level of evidence of III-2 (32/60; 53.3%) and II (23/60; 38.3%). In total, 50 of 60 studies (83.3%) were published in a scientific journal ranked in the first quartile of their subject area. Conclusion There was an increased number of studies evaluating contrast-induced nephropathy in Italy during the last three decades. These studies covered procedures to prevent contrast-induced nephropathy or aimed to identify risk factors, biomarkers, and scores, and their related prognosis.
Collapse
Affiliation(s)
- Maurizio Sessa
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Claudia Rossi
- Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", University of Campania "L Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Cristina Scavone
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Gabriella di Mauro
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", University of Campania "L Vanvitelli", Naples, Italy
| | - Liberata Sportiello
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", University of Campania "L Vanvitelli", Naples, Italy
| | - Concetta Rafaniello
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| |
Collapse
|
17
|
Opina AD, Qureshi AM, Brewer E, Elenberg E, Swartz S, Michael M, Justino H. Intra-procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure. Catheter Cardiovasc Interv 2017; 90:784-789. [DOI: 10.1002/ccd.27188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/18/2017] [Accepted: 06/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Angeline D. Opina
- Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| | - Athar M. Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| | - Eileen Brewer
- Renal Section; Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| | - Ewa Elenberg
- Renal Section; Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| | - Sarah Swartz
- Renal Section; Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| | - Mini Michael
- Renal Section; Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| | - Henri Justino
- Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, and Texas Children's Hospital; Houston Texas
| |
Collapse
|
18
|
Bahrainwala JZ, Leonberg-Yoo AK, Rudnick MR. Use of Radiocontrast Agents in CKD and ESRD. Semin Dial 2017; 30:290-304. [DOI: 10.1111/sdi.12593] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jehan Z Bahrainwala
- Renal-Electrolyte and Hypertension Division; Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Amanda K Leonberg-Yoo
- Renal-Electrolyte and Hypertension Division; Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Michael R Rudnick
- Renal-Electrolyte and Hypertension Division; Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| |
Collapse
|
19
|
Donahue M, Briguori C. Renal Insufficiency and the Impact of Contrast Agents. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael Donahue
- Laboratory of Interventional Cardiology and Department of Cardiology; Clinica Mediterranea; Naples Italy
| | - Carlo Briguori
- Laboratory of Interventional Cardiology and Department of Cardiology; Clinica Mediterranea; Naples Italy
| |
Collapse
|
20
|
Rear R, Bell RM, Hausenloy DJ. Contrast-induced nephropathy following angiography and cardiac interventions. Heart 2016; 102:638-48. [PMID: 26857214 PMCID: PMC4819627 DOI: 10.1136/heartjnl-2014-306962] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 12/29/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- Roger Rear
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Robert M Bell
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, London, UK The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
| |
Collapse
|
21
|
Wong G, Lee E, Irwin M. Contrast induced nephropathy in vascular surgery. Br J Anaesth 2016; 117:ii63-ii73. [DOI: 10.1093/bja/aew213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
22
|
|
23
|
Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Gouveia R, Bravo P, Santos C, Ramos A. Contrast-induced acute kidney injury – A review focusing on prophylactic strategies. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
25
|
Marenzi G, Mazzotta G, Londrino F, Gistri R, Moltrasio M, Cabiati A, Assanelli E, Veglia F, Rombolà G. Post-procedural hemodiafiltration in acute coronary syndrome patients with associated renal and cardiac dysfunction undergoing urgent and emergency coronary angiography. Catheter Cardiovasc Interv 2014; 85:345-51. [DOI: 10.1002/ccd.25694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/12/2014] [Accepted: 10/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Giancarlo Marenzi
- Intensive Cardiac Care Unit, Centro CardiologicoMonzino, I.R.C.C.S.; Milan Italy
| | | | | | | | - Marco Moltrasio
- Intensive Cardiac Care Unit, Centro CardiologicoMonzino, I.R.C.C.S.; Milan Italy
| | - Angelo Cabiati
- Intensive Cardiac Care Unit, Centro CardiologicoMonzino, I.R.C.C.S.; Milan Italy
| | - Emilio Assanelli
- Intensive Cardiac Care Unit, Centro CardiologicoMonzino, I.R.C.C.S.; Milan Italy
| | - Fabrizio Veglia
- Intensive Cardiac Care Unit, Centro CardiologicoMonzino, I.R.C.C.S.; Milan Italy
| | | |
Collapse
|
26
|
Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3326] [Impact Index Per Article: 332.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
27
|
Choi MJ, Yoon JW, Han SJ, Choi HH, Song YR, Kim SG, Oh JE, Lee YK, Seo JW, Kim HJ, Noh JW, Koo JR. The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: a comparison with periprocedural hemofiltration. Int J Cardiol 2014; 176:941-5. [PMID: 25200848 DOI: 10.1016/j.ijcard.2014.08.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Periprocedural (6 h pre- and 24 h post-angiography) hemofiltration appears to effectively prevent contrast-induced nephropathy (CIN) in chronic kidney disease (CKD) patients undergoing coronary angiography. However, this procedure over-uses medical resources, and the cessation of hemofiltration during coronary angiography results in persistent renal injury. In comparison, simultaneous hemofiltration performed only during coronary angiography requires fewer medical resources and can provide instantaneous protection against CIN. METHODS Sixty-eight CKD patients (serum creatinine, 2.51±1.15 mg/dL) undergoing coronary angiography were randomized in a 1:2 ratio to receive either periprocedural (n=23) or simultaneous (n=45) hemofiltration. The expected CIN rate was similar for the two groups (41.3% versus 40.0%, p=0.769). RESULTS On day 3 after contrast exposure, four and seven patients in the periprocedural and simultaneous groups, respectively experienced CIN (17.4% versus 15.6%, p=0.846). On days 5-30, seven and three patients in the periprocedural and simultaneous groups, respectively experienced CIN (30.4% versus 6.7%, p=0.009). The serum creatinine levels of patients in the periprocedural group transiently decreased on day 1 and persistently increased during days 5-30 compared with the simultaneous group. This difference between the two groups in terms of creatinine levels over time was statistically significant (F statistic=6.830; p=0.001, by ANCOVA). The cost of hemofiltration was doubled in the periprocedural group ($1066±83 versus $504±40, p<0.001). CONCLUSIONS Simultaneous hemofiltration provide equal early (day 3) and better late-stage (days 5-30) renal protection against CIN at a significantly lower cost compared with periprocedural hemofiltration.
Collapse
Affiliation(s)
- Myung-Jin Choi
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Sang-Jin Han
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea
| | - Hyun-Hee Choi
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea
| | - Young-Rim Song
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Sung-Gyun Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Ji-Eun Oh
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Jang-Won Seo
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea; Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Republic of Korea
| | - Hyung-Jik Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea; Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Republic of Korea.
| |
Collapse
|
28
|
Abaci O, Harmankaya O, Kocas B, Kocas C, Bostan C, Coskun U, Yildiz A, Ersanli M. Long-Term Follow-Up of Patients at High Risk for Nephropathy After Contrast Exposure. Angiology 2014; 66:514-8. [PMID: 25115554 DOI: 10.1177/0003319714546527] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, but the long-term outcomes of patients who do not develop CI-AKI remain unknown. We assessed clinical end points during long-term follow-up in patients at high risk for nephropathy who did not develop CI-AKI. Patients (n = 135) with impaired renal function (estimated glomerular filtration rate: 30-60 mL/min/1.73 m(2)) were divided into 2 groups according to contrast media (CM) exposure. The primary end point of this study was a composite outcome measure of death or renal failure requiring dialysis. Multivariate analyses identified CM exposure to be independently associated with major adverse long-term outcomes (hazard ratio: 2.3; 95% confidence interval, 1.34-6.52; P = .018). Even when CM exposure does not cause CI-AKI in patients with impaired renal function, in the long term, primary end points occur more frequently in patients exposed to CM than in those with no CM exposure.
Collapse
Affiliation(s)
- Okay Abaci
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Ozlem Harmankaya
- Department of Nephrology, Bakırkoy Sadi Konuk Educational and Research Hospital, Istanbul, Turkey
| | - Betul Kocas
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Cuneyt Kocas
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Cem Bostan
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Ugur Coskun
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Ahmet Yildiz
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Murat Ersanli
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| |
Collapse
|
29
|
Stub D, Duffy SJ, Kaye DM. Device-Based Therapy in the Prevention of Contrast-Induced Nephropathy. Interv Cardiol Clin 2014; 3:421-428. [PMID: 28582226 DOI: 10.1016/j.iccl.2014.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-induced nephropathy (CIN) is a common condition that is associated with short- and, likely, long-term adverse outcomes. Although periprocedural intravenous hydration is the simplest and most widely used technique to prevent CIN, the limited ability of this approach to mitigate the CIN risk in high-risk populations has provided an impetus to develop new preventive strategies. A range of potentially useful device-based approaches offers new preventive techniques. Well-designed and adequately powered randomized studies of these device-based therapies are urgently needed to determine the expanding role they will play in future clinical practice.
Collapse
Affiliation(s)
- Dion Stub
- Cardiovascular Medicine, Baker IDI Heart and Diabetes Institute, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
| | - Stephen J Duffy
- Cardiovascular Medicine, Baker IDI Heart and Diabetes Institute, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
| | - David M Kaye
- Cardiovascular Medicine, Baker IDI Heart and Diabetes Institute, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
| |
Collapse
|
30
|
Abstract
Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures resulting from the administration of contrast media (CM). It is the third most common cause of hospital acquired acute renal injury and represents about 12% of the cases. CIN is defined as an elevation of serum creatinine (Scr) of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 h. More sensitive markers of renal injury are desired, therefore, several biomarkers of tubular injury are under evaluation. Multiple risk factors may contribute to the development of CIN; these factors are divided into patient- and procedure-related factors. Treatment of CIN is mainly supportive, consisting mainly of careful fluid and electrolyte management, although dialysis may be required in some cases. The available treatment option makes prevention the corner stone of management. This article will review the recent evidence concerning CIN incidence, diagnosis, and prevention strategies as well as its treatment and prognostic implications.
Collapse
Affiliation(s)
- Nazar M A Mohammed
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Katafan Achkar
- Department of Nephrology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ihsan M Rafie
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rachel Hajar
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
31
|
Walther CP, Podoll AS, Finkel KW. Summary of clinical practice guidelines for acute kidney injury. Hosp Pract (1995) 2014; 42:7-14. [PMID: 24566591 DOI: 10.3810/hp.2014.02.1086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Clinical practice guidelines are intended to standardize the diagnosis and treatment of diseases in order to improve both patient outcomes and resource utilization, using evidence-based criteria. As recently as a decade ago, there was no agreed upon definition of acute kidney injury (AKI), making it difficult to conduct proper clinical studies on the epidemiology and treatment of the disorder. Following the advent of the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria for defining AKI, several guidelines for the diagnosis and management of AKI have been developed. In our review, we present a narrative description and comparison of the major published guidelines. Overall, there has been significant agreement among the various guidelines, and each seems well-reasoned and clinically useful. Perhaps the most striking conclusion upon review of the various guidelines is the limited scope of knowledge about optimal management of patients with AKI.
Collapse
Affiliation(s)
- Carl P Walther
- University of Texas Health Science Center at Houston, Department of Medicine, Division of Renal Diseases and Hypertension, Houston, TX
| | | | | |
Collapse
|
32
|
Prophylaxis of contrast-induced nephrotoxicity. BIOMED RESEARCH INTERNATIONAL 2014; 2014:308316. [PMID: 24812612 PMCID: PMC4000949 DOI: 10.1155/2014/308316] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/18/2014] [Accepted: 03/05/2014] [Indexed: 01/29/2023]
Abstract
Contrast-induced nephrotoxicity (CIN) is a form of acute kidney injury that follows intravascular contrast media exposure. CIN may be preventable because its risk factors are well established and the timing of renal insult is commonly known in advance. However, contrast-induced nephrotoxicity is still the third leading cause of iatrogenic renal failure. This important complication accounts up to 10% of acute renal failure cases in hospitalized patients and it is associated with increased short- and long-term morbidity and mortality. Prolonged hospitalization follows and overall increases healthcare resource utilization. This paper will discuss the various prophylactic procedures tested in clinical trials.
Collapse
|
33
|
Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version. JSN, JRS, and JCS Joint Working Group. Jpn J Radiol 2014; 31:546-84. [PMID: 23884513 DOI: 10.1007/s11604-013-0226-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
34
|
Nonpharmacological strategies to prevent contrast-induced acute kidney injury. BIOMED RESEARCH INTERNATIONAL 2014; 2014:463608. [PMID: 24795882 PMCID: PMC3984770 DOI: 10.1155/2014/463608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/17/2022]
Abstract
Contrast-induced AKI (CI-AKI) has been one of the leading causes for hospital-acquired AKI and is associated with independent risk for adverse clinical outcomes including morbidity and mortality. The aim of this review is to provide a brief summary of the studies that focus on nonpharmacological strategies to prevent CI-AKI, including routine identification of at-risk patients, use of appropriate hydration regimens, withdrawal of nephrotoxic drugs, selection of low-osmolar contrast media or isoosmolar contrast media, and using the minimum volume of contrast media as possible. There is no need to schedule dialysis in relation to injection of contrast media or injection of contrast agent in relation to dialysis program. Hemodialysis cannot protect the poorly functioning kidney against CI-AKI.
Collapse
|
35
|
Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Genereux P, Nikolsky E, Brener SJ, Witzenbichler B, Guagliumi G, Clark AE, Fahy M, Xu K, Brodie BR, Stone GW. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 2014; 35:1533-40. [DOI: 10.1093/eurheartj/ehu063] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
36
|
Continuous venovenous hemofiltration after coronary procedures for the prevention of contrast-induced acute kidney injury in patients with severe chronic renal failure. Am J Cardiol 2014; 113:588-92. [PMID: 24321895 DOI: 10.1016/j.amjcard.2013.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 12/27/2022]
Abstract
Continuous venovenous hemofiltration (CVVH) is a renal replacement therapy that has been successfully used in patients with severe chronic renal failure to prevent contrast-induced acute kidney injury (CI-AKI). In this study, we present a consecutive experience using a new CVVH protocol that has also been applied to patients with acute coronary syndrome (ACS). CVVH was performed in consecutive patients with estimated glomerular filtration rate <30 ml/min/1.73 m(2) (mean ± SD, 21.1 ± 7.3 ml/min/1.73 m(2)) undergoing diagnostic or interventional coronary procedures starting after the angiographic procedures. Iopamidol was used as a contrast agent. In the first 6 patients, iopamidol removal by the CVVH hemofilter and kidney was calculated by measuring iopamidol concentrations in the blood, urine, and ultrafiltrate collected during the 6-hour CVVH session. In the second phase, the protocol was applied to 47 additional patients meeting the inclusion criteria. Six-hour CVVH resulted in iopamidol removal comparable with that of 12-hour diuresis (43 ± 12% vs 42 ± 15% of administered, p = NS). CI-AKI occurred in 7.5% of patients in the whole population and no patients had acute pulmonary edema, need for dialysis, or any major bleeding. In conclusion, in a population including patients with ACS with severe chronic renal failure undergoing coronary angiographic procedures, 6-hour CVVH performed only after contrast medium exposure was able to remove an amount of contrast medium similar to that removed by the kidneys in 12 hours and resulted in a low rate of CI-AKI.
Collapse
|
37
|
ACE-I/ARB therapy prior to contrast exposure: what should the clinician do? BIOMED RESEARCH INTERNATIONAL 2014; 2014:423848. [PMID: 24605330 PMCID: PMC3925541 DOI: 10.1155/2014/423848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/10/2013] [Indexed: 11/17/2022]
Abstract
Contrast-induced nephropathy (CIN) is now one of the three leading causes of acute kidney injury in the world. A lot is known about the risk factors of CIN, yet it remains a major cause of morbidity, end stage renal disease, prolonged hospital stay, and increased costs as well as a high mortality. Many patients undergoing contrast-based radiological investigations are treated with angiotensin converting inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) for their cardiac and renal benefits and their known mortality benefits. However, controversy exists among clinicians as to whether ACE-Is and ARBs should be continued or discontinued prior to contrast media exposure. In this paper we review the current evidence on ACE-I/ARB therapy for patients undergoing procedures involving use of contrast media and provide recommendations as to whether these drugs should be continued or held prior to contrast exposure.
Collapse
|
38
|
Lameire N. Contrast-induced nephropathy in the critically-ill patient: focus on emergency screening and prevention. Acta Clin Belg 2014; 62 Suppl 2:346-52. [PMID: 18283997 DOI: 10.1179/acb.2007.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- N Lameire
- Department of Nephrology, University Hospital Ghent, Belgium.
| |
Collapse
|
39
|
|
40
|
Ohno I, Hayashi H, Aonuma K, Horio M, Kashihara N, Okada H, Komatsu Y, Tamura S, Awai K, Yamashita Y, Kuwatsuru R, Hirayama A, Saito Y, Murohara T, Tamaki N, Sato A, Takayama T, Imai E, Yasuda Y, Koya D, Tsubakihara Y, Horie S, Korogi Y, Narumi Y, Hayakawa K, Daida H, Node K, Kubota I. Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version. Clin Exp Nephrol 2013; 17:441-79. [DOI: 10.1007/s10157-013-0843-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
41
|
Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, Van Biesen W. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012; 27:4263-72. [PMID: 23045432 PMCID: PMC3520085 DOI: 10.1093/ndt/gfs375] [Citation(s) in RCA: 386] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
-
- Department of Internal Medicine IV, Saarland University Medical Centre, Homburg/Saar, Germany
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Radiological procedures utilizing intravascular iodinated contrast media are being widely applied for both diagnostic and therapeutic purposes and represent one of the main causes of contrast-induced nephropathy (CIN) and hospital-acquired renal failure. Although the risk of CIN is low (0.6-2.3 %) in the general population, it may be very high (up to 50 %) in selected subsets, especially in patients with major risk factors such as advanced chronic kidney disease and diabetes mellitus, and in those undergoing emergency percutaneous coronary interventions (PCI). Due to the lack of any effective treatment, prevention of this iatrogenic disease, which is associated with significant in-hospital and long-term morbidity and mortality and increased costs, is the key strategy. However, prevention of CIN continues to elude clinicians and is a main concern during PCI, as patients undergoing these procedures often have multiple comorbidities. The purpose of this study is to examine the pathophysiology, risk factors and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI.
Collapse
Affiliation(s)
- Giancarlo Marenzi
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, I.R.C.C.S, University of Milan, Via Parea 4, 20138, Milan, Italy.
| | | | | | | |
Collapse
|
43
|
Ehrmann S, Pajot O, Lakhal K. Néphropathie induite par les produits de contraste iodés en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
44
|
Hung YM, Lin SL, Hung SY, Huang WC, Wang PYP. Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography. World J Cardiol 2012; 4:157-72. [PMID: 22655164 PMCID: PMC3364502 DOI: 10.4330/wjc.v4.i5.157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/16/2012] [Accepted: 03/23/2012] [Indexed: 02/06/2023] Open
Abstract
Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.
Collapse
Affiliation(s)
- Yao-Min Hung
- Yao-Min Hung, Division of Nephrology, Jiannren Hospital, Kaohsiung 813, Taiwan, China
| | | | | | | | | |
Collapse
|
45
|
Maioli M, Toso A, Leoncini M, Gallopin M, Musilli N, Bellandi F. Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation 2012; 125:3099-107. [PMID: 22592896 DOI: 10.1161/circulationaha.111.085290] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The temporal evolution of renal function in patients with acute kidney injury after contrast medium (CI-AKI) is not well known. The aim of this observational study was to evaluate the incidence, risk factors, and prognostic implications of persistent renal damage (RD) in patients with preexistent moderate-to-severe renal dysfunction. METHODS AND RESULTS From June 2003 to March 2008, 3986 patients underwent coronary angiography at our institution; 1490 of 3986 had an estimated creatinine clearance of <60 mL/min and were enrolled. CI-AKI was defined as an absolute increase ≥ 0.5 mg/dL over baseline serum creatinine within 3 days after the administration of contrast medium (iodixanol). In patients who developed CI-AKI, persistent RD was defined as a relative decrease of creatinine clearance ≥ 25% over baseline at 3 months. Patients whose creatinine clearance returned to baseline (or nearly) were classified as transient RD. The overall incidence of CI-AKI was 12.1%, and persistent RD occurred in 18.6% of CI-AKI patients. At Cox regression analysis, nephropathy risk score ≥ 17, left ventricular ejection fraction ≤ 30%, and increased value of serum creatinine ≥ 1.5-fold from baseline within 5 days were found to be significant risk factors for persistent RD. At 5 years, the incidence of death was significantly higher in patients with persistent RD than in both patients with transient RD (P=0.015) and those without CI-AKI (P=0.0001). A similar trend was observed for the combined end point of death, dialysis and cardiovascular events. CONCLUSIONS These results suggest that CI-AKI is not always a transient, benign creatininopathy, but rather a direct cause of worsening renal function. The occurrence of CI-AKI can identify patients at increased risk of cardiovascular events.
Collapse
Affiliation(s)
- Mauro Maioli
- Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy.
| | | | | | | | | | | |
Collapse
|
46
|
|
47
|
|
48
|
Renal replacement therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Med 2012; 125:66-78.e3. [PMID: 22195531 DOI: 10.1016/j.amjmed.2011.06.029] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 05/31/2011] [Accepted: 06/05/2011] [Indexed: 01/03/2023]
Abstract
BACKGROUND Radiocontrast-induced nephropathy (RCIN) is an important cause of acute kidney injury, increasing in-hospital and long-term mortality. It is controversial whether prophylactic renal replacement therapy (RRT) may reduce a patient's risk of RCIN when compared with standard medical therapy (SMT). METHODS We searched through PubMed and bibliographies of retrieved articles. Published studies of RRT for RCIN prevention in patients receiving radiocontrast were included. The primary endpoint was RCIN incidence, defined as an increase in serum creatinine ≥0.5 mg/dL. Results were combined on the risk ratio (RR) scale. Random-effects models were used. Sensitivity analyses were defined a priori to evaluate the effects of RRT modality, study design, and sample size. RESULTS Nine randomized controlled and 2 nonrandomized trials were included (n = 1010 patients); 8 studies used hemodialysis (HD) and 3 used hemofiltration or hemodiafiltration. Nine studies had data for primary endpoint; RCIN incidence was 23.3% in the RRT group and 21.2% in SMT. RRT did not decrease RCIN incidence compared with SMT (risk ratio [RR] 1.02; 95% confidence interval [CI], 0.54-1.93); however, intertrial heterogeneity was high. In sensitivity analyses, limiting to only HD studies significantly reduced heterogeneity. HD appeared to increase RCIN risk (RR 1.61; 95% CI, 1.13-2.28) and had no effect on need for permanent RRT or progression to end-stage renal disease (RR 1.47; 95% CI, 0.56-3.89). CONCLUSION In this updated meta-analysis, periprocedural RRT did not decrease the incidence of RCIN compared with SMT. HD appears to actually increase RCIN risk.
Collapse
|
49
|
Rey JR, Iglesias D, López De Sá E, Armada E, Moreno R, Salvador O, Monedero MDC, Blas SG, Iniesta AM, López-Sendon JL. Prevention of contrast-induced nephropathy with haemofiltration in high-risk patients after percutaneous coronary intervention. ACUTE CARDIAC CARE 2011; 13:164-169. [PMID: 21877876 DOI: 10.3109/17482941.2011.606476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) is increasing. The aim of the study is to assess the benefits of prophylactic haemofiltration (PHF) in patients with high risk of developing CIN after PCI. METHODS 20 patients who underwent PHF after PCI in the context of acute coronary syndrome were selected retrospectively and compared with 20 matched controls with similar risk characteristics. The main variable analysed was the appearance of CIN and the secondary variables were the development of acute clinical kidney failure, heart failure, therapeutic HF and mortality. RESULTS The baseline characteristics were similar in both groups, with reference creatinine of 2.4 ± 1.3 mg/dl, contrast used 392 ± 213 cc and Mehran score of 21.9 ± 5.2 in the PHF group, as opposed to values of 2.0 ± 0.6 mg/dl, 368 ± 126 cc and 20.2 ± 6.9 respectively in controls. The incidence of CIN was of 6 patients (30%) in the PHF group and 13 patients (65%) in the control group (P=0.03). There were no significant differences in the rest of the variables studied. CONCLUSION Haemofiltration after PCI may be an effective strategy for the prevention of CIN in patients at high risk of developing it.
Collapse
Affiliation(s)
- J R Rey
- La Paz University Hospital, Cardiology, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011; 21:2527-41. [PMID: 21866433 DOI: 10.1007/s00330-011-2225-0] [Citation(s) in RCA: 631] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 06/15/2011] [Accepted: 06/30/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN). AREAS COVERED Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points • Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed. • CIN risk is lower with intravenous than intra-arterial iodinated contrast medium. • eGFR of 45 ml/min/1.73 m (2) is CIN risk threshold for intravenous contrast medium. • Hydration with either saline or sodium bicarbonate reduces CIN incidence. • Patients with eGFR ≥ 60 ml/min/1.73 m (2) receiving contrast medium can continue metformin normally.
Collapse
|