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Naraiah Mukkala A, Petrut R, Goldfarb R, Leigh Beroncal E, Ho Leung C, Khan Z, Ailenberg M, Jerkic M, Andreazza AC, Rhind SG, Jeschke MG, Kapus A, Rotstein OD. Augmented Parkin-dependent mitophagy underlies the hepatoprotective effect of remote ischemic conditioning used prior to hemorrhagic shock. Mitochondrion 2023; 70:20-30. [PMID: 36906251 DOI: 10.1016/j.mito.2023.03.002] [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: 10/23/2022] [Revised: 02/04/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND AIMS Hemorrhagic shock-resuscitation (HSR) following trauma contributes to organ dysfunction by causing ischemia-reperfusion injury (IRI). We previously showed that 'remote ischemic preconditioning' (RIPC) exerted multi-organ protection from IRI. Maintenance of mitochondrial quality by clearance of dysfunctional mitochondria via mitophagy is vital in restoring organ integrity. We hypothesized that parkin-dependent mitophagy played a role in RIPC-induced hepatoprotection following HSR. METHODS The hepatoprotective effect of RIPC in a murine model of HSR-IRI was investigated in wild type and parkin-/- animals. Mice were subjected to HSR ± RIPC and blood and organs were collected, followed by cytokine ELISAs, histology, qPCR, Western blots, and transmission electron microscopy. RESULTS HSR increased hepatocellular injury, as measured by plasma ALT and liver necrosis, while antecedent RIPC prevented this injury; in parkin-/- mice, RIPC failed to exert hepatoprotection. The ability of RIPC to lessen HSR-induced rises in plasma IL-6 and TNFα, was lost in parkin-/- mice. While RIPC alone did not induce mitophagy, the application of RIPC prior to HSR caused a synergistic increase in mitophagy, this increase was not observed in parkin-/- mice. RIPC induced shifts in mitochondrial morphology favoring mitophagy in WT but not in parkin-/- animals. CONCLUSIONS RIPC was hepatoprotective in WT mice following HSR but not in parkin-/- mice. Loss of protection in parkin-/- mice corresponded with the failure of RIPC plus HSR to upregulate the mitophagic process. Improving mitochondrial quality by modulating mitophagy, may prove to be an attractive therapeutic target in disease processes caused by IRI.
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Affiliation(s)
- Avinash Naraiah Mukkala
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Raluca Petrut
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Rachel Goldfarb
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | | | - Chung Ho Leung
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Zahra Khan
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Menachem Ailenberg
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Mirjana Jerkic
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Department of National Defense, Government of Canada, Toronto, Canada
| | - Marc G Jeschke
- Hamilton Health Sciences Centre and McMaster University, Hamilton, Canada
| | - Andras Kapus
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Department of Biochemistry, University of Toronto, Toronto, Canada
| | - Ori D Rotstein
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
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Effect of Remote Ischemic Preconditioning on the Incidence of Contrast Induced Nephropathy in Patients Undergoing Evar (Ripc-Evar Study). Ann Vasc Surg 2022; 86:338-348. [PMID: 35717008 DOI: 10.1016/j.avsg.2022.05.018] [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: 09/30/2021] [Revised: 04/26/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Contrast induced nephropathy (CIN) is a major inconvenience in the use of iodinated contrast media (ICM) and it is associated with a significant increase in morbidity and mortality and cost of hospitalization. Remote ischemic preconditioning (RIPC) is a non-invasive and cost-effective tissue protection technique that has showed beneficial in decreasing renal insult in patients receiving intravascular contrast. AIM The primary outcome of this study is to evaluate the impact of RIPC on the incidence of CIN in patients undergoing endovascular aneurysm repair. MATERIAL AND METHODS Patients suffering from aortic aneurysm were recruited prior to the administration of iodinated contrast media. Randomization was used to assign patients into the control/RIPC groups. Biochemical parameters determined renal function before and after surgery in immediate (24-72 hours) and at 30 days' follow-up. RESULTS Of the 120 patients included in the study, 98,3% were male. Mean age was 73 years (range 56-87). Diabetes and chronic renal failure (considering eGFR<60) was present prior to administration of ICM in 29,16% and 38,33% respectively. RIPC was applied in 50% (n=60) of the patients. A total of 24,17% developed CIN regardless of fluid therapy, RIPC and other protective strategies. RIPC did not influence outcome in terms of incidence on CIN, serum creatinine, urea, estimated glomerular filtration (eGFR) or microalbuminuria in immediate postoperative period. However, the group of RIPC patients showed a statistically significant benefit in renal function in terms of serum creatinine (1,46 ± 0,3 vs 1,03 ± 0,5; p<0,001), urea (61,06 ± 27,5mg/dl vs 43,78 ± 12,9mg/dl; p=0,003) and an increase in eGFR (56,37 ± 23,4ml/min/1.73m2vs 72,85 ± 17,7ml/min/1.73m2; p=0,004) at 30 days follow-up. CONCLUSIONS RIPC seems to be a reasonable, effective and low-cost technique to alleviate effects of ICM on the renal parenchyma in EVAR procedures during short-term postoperative period.
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Belabbas D, Koch C, Chaudru S, Lederlin M, Laviolle B, Le Pabic E, Boulmier D, Heautot JF, Mahe G. Effects of Remote Ischemic Pre-Conditioning to Prevent Contrast-Induced Nephropathy after Intravenous Contrast Medium Injection: A Randomized Controlled Trial. Korean J Radiol 2020; 21:1230-1238. [PMID: 32729273 PMCID: PMC7462761 DOI: 10.3348/kjr.2019.0916] [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: 12/06/2019] [Revised: 02/22/2020] [Accepted: 03/31/2020] [Indexed: 11/15/2022] Open
Abstract
Objective We aimed to assess the effects of remote ischemic pre-conditioning (RIPC) on the incidence of contrast-induced nephropathy (CIN) after an intravenous (IV) or intra-arterial injection of contrast medium (CM) in patient and control groups. Materials and Methods This prospective, randomized, single-blinded, controlled trial included 26 patients who were hospitalized for the evaluation of the feasibility of transcatheter aortic valve implantation and underwent investigations including contrast-enhanced computed tomography (CT), with Mehran risk scores greater than or equal to six. All the patients underwent four cycles of five minute-blood pressure cuff inflation followed by five minutes of total deflation. In the RIPC group (n = 13), the cuff was inflated to 50 mm Hg above the patient's systolic blood pressure (SBP); in the control group (n = 13), it was inflated to 10 mm Hg below the patient's SBP. The primary endpoint was the occurrence of CIN. Additionally, variation in the serum levels of cystatin C was assessed. Results One case of CIN was observed in the control group, whereas no cases were detected in the RIPC group (p = 0.48, analysis of 25 patients). Mean creatinine values at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 88 ± 32 µmol/L, 91 ± 28 µmol/L and 82 ± 29 µmol/L, respectively (p = 0.73) in the RIPC group, whereas in the control group, they were 100 ± 36 µmol/L, 110 ± 36 µmol/L, and 105 ± 34 µmol/L, respectively (p = 0.78). Cystatin C values (median [Q1, Q3]) at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 1.10 [1.08, 1.18] mg/L, 1.17 [0.97, 1.35] mg/L, and 1.12 [0.99, 1.24] mg/L, respectively (p = 0.88) in the RIPC group, whereas they were 1.11 [0.97, 1.28] mg/L, 1.13 [1.08, 1.25] mg/L, and 1.16 [1.03, 1.31] mg/L, respectively (p = 0.93), in the control group. Conclusion The risk of CIN after an IV injection of CM is very low in patients with Mehran risk score greater than or equal to six and even in the patients who are unable to receive preventive hyperhydration. Hence, the Mehran risk score may not be an appropriate method for the estimation of the risk of CIN after IV CM injection.
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Affiliation(s)
- Dihia Belabbas
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Caroline Koch
- Department of Radiodology, Toulouse University Hospital, Toulouse, France
| | - Ségolène Chaudru
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Mathieu Lederlin
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Bruno Laviolle
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Estelle Le Pabic
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Dominique Boulmier
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Jean François Heautot
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Guillaume Mahe
- Vascular Medicine Unit, Department of Radiology, University Hospital Pontchaillou, Rennes, France.
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Chen C, Sun L, Zhang W, Tang Y, Li X, Jing R, Liu T. Limb ischemic preconditioning ameliorates renal microcirculation through activation of PI3K/Akt/eNOS signaling pathway after acute kidney injury. Eur J Med Res 2020; 25:10. [PMID: 32192513 PMCID: PMC7081586 DOI: 10.1186/s40001-020-00407-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Contrast-induced acute kidney injury (CI-AKI) resulting from administration of iodinated contrast media (CM) is the third leading cause of hospital-acquired acute kidney injury and is associated with substantial morbidity and mortality. Deteriorated renal microcirculation plays an important role in CI-AKI. Limb ischemic preconditioning (LIPC), where brief and non-injurious ischemia/reperfusion is applied to a limb prior to the administration of the contrast agent, is emerging as a promising strategy for CI-AKI prevention. However, it is not known whether the renal protection of LIPC against CI-AKI is mediated by regulation of renal microcirculation and the molecular mechanisms remain largely unknown. Methods In this study, we examined the renal cortical and medullary blood flow in a stable CI-AKI model using 5/6-nephrectomized (NE) rat. The LIPC and sham procedures were performed prior to the injection of CM. Furthermore, we analyzed renal medulla hypoxia using in vivo labeling of hypoxyprobe. Pharmacological inhibitions and western blotting were used to determine the underlying molecular mechanisms. Results In this study, we found LIPC significantly ameliorated CM-induced reduction of medullary blood flow and attenuated CM-induced hypoxia. PI3K inhibitor (wortmannin) treatment blocked the regulation of medullary blood flow and the attenuation of hypoxia of LIPC. Phosphorylation of Akt/eNOS was significantly decreased via wortmannin treatment compared with LIPC. Nitric oxide synthase-inhibitor [Nω-nitro-l-arginine methyl ester (L-NAME)] treatment abolished the above effects and decreased phosphorylation of eNOS, but not Akt. Conclusions Collectively, the results demonstrate that LIPC ameliorates CM-induced renal vasocontraction and is mediated by activation of PI3K/Akt/eNOS signaling pathway.
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Affiliation(s)
- Cheng Chen
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Li Sun
- Division of Nephrology, Xuyi People's Hospital, Huaian, 211700, Jiangsu, China
| | - Wanfen Zhang
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Yushang Tang
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Xiaoping Li
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Ran Jing
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Tongqiang Liu
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China.
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Gu G, Yuan X, Zhou Y, Liu D, Cui W. Elevated high-sensitivity C-reactive protein combined with procalcitonin predicts high risk of contrast-induced nephropathy after percutaneous coronary intervention. BMC Cardiovasc Disord 2019; 19:152. [PMID: 31234798 PMCID: PMC6591961 DOI: 10.1186/s12872-019-1137-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is common after percutaneous coronary intervention (PCI) and always leads to a poor prognosis. Compared with conventional detection methods, either high-sensitivity C-reactive protein (hs-CRP) or procalcitonin have higher sensitivity and specificity for predicting CIN, but their combination has not been explored. This prospective study investigated the value of hs-CRP combined with procalcitonin for predicting CIN after PCI. Methods All patients undergoing PCI admitted to our hospital during the year 2016 were consecutively enrolled (n = 343). The patients received adequate hydration before PCI and 20 mg furosemide after the procedure. CIN was diagnosed by a 25% elevation in serum creatinine or ≥ 44.2 μmol/L (0.5 mg/dL) serum creatinine within 48 to 72 h after intravenous injection of contrast media. Results Patients with high hs-CRP or procalcitonin had higher rates of CIN relative to those patients with low values. For predicting CIN, hs-CRP combined with procalcitonin showed an area under the receiver operating characteristic curve of 0.67, with optimal cut-off value 0.0643610, and the sensitivity and specificity were higher than hs-CRP or procalcitonin alone. The logistic regression analysis showed that high-risk factors of CIN were acute myocardial infarction and highly elevated hsCRP and procalcitonin. Conclusions Prior to PCI, an elevation of the inflammatory biomarkers hsCRP and procalcitonin are a risk factor for postoperative CIN. This study suggests that the combination of hsCRP and procalcitonin is a better predictor of CIN after PCI then either hsCRP or procalcitonin alone. Trial registration number ChiCTR-IOR-14005250. Date of registration 2014-09-24.
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Affiliation(s)
- Guoqiang Gu
- Department of Cardiology, Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, 050000, Hebei, China
| | - Xuechao Yuan
- Department of Cardiology, Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, 050000, Hebei, China
| | - Yaqing Zhou
- Department of Cardiology, Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, 050000, Hebei, China
| | - Demin Liu
- Department of Cardiology, Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, 050000, Hebei, China
| | - Wei Cui
- Department of Cardiology, Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, 050000, Hebei, China.
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Contrast medium induced acute kidney injury: a narrative review. J Nephrol 2018; 31:797-812. [DOI: 10.1007/s40620-018-0498-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/14/2018] [Indexed: 12/24/2022]
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A minimal resting time of 25 min is needed before measuring stabilized blood pressure in subjects addressed for vascular investigations. Sci Rep 2017; 7:12893. [PMID: 29018246 PMCID: PMC5635024 DOI: 10.1038/s41598-017-12775-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/15/2017] [Indexed: 02/07/2023] Open
Abstract
Blood pressure (BP) measurement is a central element in clinical practice. According to international recommendations 3 to 5 minutes of resting is needed before blood pressure measurement. Surprisingly, no study has modelled the time course of BP decrease and the minimum resting-time before BP measurement. A cross-sectional bicentric observational study was performed including outpatients addressed for vascular examination. Using two automatic BP monitors we recorded the blood pressure every minute during 11 consecutive minutes. The data was analyzed by non-linear mixed effect regression. Systolic (SBP) and diastolic BPs were studied and we tested the effect of covariates on its evolution through log-likelihood ratio tests. We included 199 patients (66+/−13years old). SBP was found to decrease exponentially. Simulations based on the final model show that only half the population reaches a stabilized SBP (defined as SBP + 5 mmHg) after 5 min of resting-time while it takes 25 min to ensure 90% of the population has a stabilized SBP. In conclusion, our results and simulations suggest that 5 minutes are not enough to achieve a stabilized SBP in most patients and at least 25 minutes are required. This questions whether the diagnosis of hypertension can be reliably made during routine visits in general practitioners’ offices.
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Zhou CC, Yao WT, Ge YZ, Xu LW, Wu R, Gao XF, Song KW, Jiang XM, Wang M, Huang WJ, Zhu YP, Li LP, Zhou LH, Xu ZL, Zhang SL, Zhu JG, Li WC, Jia RP. Remote ischemic conditioning for the prevention of contrast-induced acute kidney injury in patients undergoing intravascular contrast administration: a meta-analysis and trial sequential analysis of 16 randomized controlled trials. Oncotarget 2017; 8:79323-79336. [PMID: 29108311 PMCID: PMC5668044 DOI: 10.18632/oncotarget.18106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/12/2017] [Indexed: 12/15/2022] Open
Abstract
Objective We conducted this meta-analysis to examine the effect of remote ischemic conditioning (RIC) on contrast-induced acute kidney injury (CI-AKI) in patients undergoing intravascular contrast administrationon. Methods Pubmed, Embase, and Cochrane Library were comprehensively searched to identify all eligible studies by 15th March, 2017. Risk ratio (RR) and weighted mean difference with the corresponding 95% confidence intervals (CI) were used to examine the treatment effect. The heterogeneity and statistical significance were assessed with Q-test and Z-test, respectively. Results A total of 16 RCTs including 2175 patients were eventually analyzed. Compared with the control group, RIC could significantly decrease the incidence of CI-AKI (RR=0.58; 95% CI: 0.46, 0.74; P < 0.001), which was further confirmed by the trial sequential analysis. Subgroup analyses showed that remote ischemic preconditioning (RIPrC) and remote ischemic postconditioning (RIPoC) were both obviously effective, and perioperative hydration might enhance the efficiency of RIC. RIC also significantly reduced the major adverse cardiovascular events within six months. Conclusion RIC, whether RIPrC or RIPoC, could effectively exert renoprotective role in intravascular contrast administration and reduce the incidence of relevant adverse events.
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Affiliation(s)
- Chang-Cheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Tao Yao
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Zheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lu-Wei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ran Wu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kai-Wei Song
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Min Jiang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Juan Huang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yun-Peng Zhu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang-Peng Li
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liu-Hua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhong-Le Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.,Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Sheng-Li Zhang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jia-Geng Zhu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Cheng Li
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui-Peng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Martínez-Rico C, Martí-Mestre X, Romera-Villegas A, Espinar-Garcia E, Iborra-Ortega E, Vila-Coll R. Contrast-Induced Nephropathy: A Fact or Fiction in Lower Limb Revascularization? Ann Vasc Surg 2017; 44:277-281. [PMID: 28479456 DOI: 10.1016/j.avsg.2017.03.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Contrast-induced nephropathy (CIN) is defined as an increase >25% of serum creatinine from baseline, occurring in 24-48 hours after exposure to contrast, while alternative explanations for renal impairment have been excluded. The volume administered directly relates to risk, increasing by 12% per 100 mL of contrast. According to the series, its incidence varies between 3.3% and 8% in patients without renal damage and 12-50% in patients with chronic kidney disease (CKD) and/or diabetes mellitus (DM). The purpose of this study is to determine the incidence of CIN in endovascular revascularization of lower limbs in our center, where we apply the ALARA concept (As Low As Reasonably Achievable) to the use of contrast. MATERIAL AND METHODS 163 patients who underwent endovascular revascularization procedures in lower limbs were included in this prospective observational study between February 2013 and April 2015. They were classified according to clinical stage and presence of DM and/or CKD. Data included serum creatinine values preoperative and postoperative, type and volume of contrast used. Patients on hemodialysis and those without sufficient analytical data were excluded. Chi-squared test and Student t-test were used for data analysis. P < 0.05 was considered statistically significant. RESULTS 109 patients were enrolled, with 67% of DM and 31.5% of CKD. CIN incidence was 3.7% in patients without DM neither CKD, in DM was 6.8% and 12.5% in CKD. Mean creatinine presurgery was 97.96 and postsurgery 97.07, finding no significant differences between them (P = 0.753). Medium-contrast volume was 37.43 mL ± 22.3. The worsening variable (creatinine postsurgery minus creatinine presurgery) was evaluated according to clinical stage, DM, or CKD, being not significant in either group. CONCLUSIONS In our experience, the dose administered of contrast was not related to the existence of postprocedure CIN, due to the policy of optimizing the use of contrast.
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Affiliation(s)
- Carlos Martínez-Rico
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Xavier Martí-Mestre
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Romera-Villegas
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Emma Espinar-Garcia
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Iborra-Ortega
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Vila-Coll
- Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Chalikias G, Drosos I, Tziakas DN. Prevention of Contrast-Induced Acute Kidney Injury: an Update. Cardiovasc Drugs Ther 2016; 30:515-524. [DOI: 10.1007/s10557-016-6683-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Koch C, Chaudru S, Jaquinandi V, Mahé G, Raoult H. Re. "Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease". Eur J Vasc Endovasc Surg 2016; 51:605. [PMID: 26854210 DOI: 10.1016/j.ejvs.2015.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/25/2015] [Indexed: 11/16/2022]
Affiliation(s)
- C Koch
- CHU Rennes, Imagerie, Rennes, France
| | - S Chaudru
- INSERM, Centre d'investigation Clinique CIC 1414, Rennes, France
| | | | - G Mahé
- INSERM, Centre d'investigation Clinique CIC 1414, Rennes, France; CHU Rennes, Imagerie Cœur-Vaisseaux, Rennes, France.
| | - H Raoult
- CHU Rennes, Imagerie, Rennes, France
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