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Šečić D, Turohan A, Begić E, Rebić D, Pepić E, Begić Z, Iglica A, Begić N, Metović A, Mušanović J. Serum creatinine versus corrected cockcroft-gault equation according to poggio reference values in patients with arterial hypertension. Int J Appl Basic Med Res 2022; 12:9-13. [PMID: 35265474 PMCID: PMC8848562 DOI: 10.4103/ijabmr.ijabmr_301_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/27/2021] [Accepted: 10/16/2021] [Indexed: 11/04/2022] Open
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Abstract
Contrast-induced nephropathy (CIN) is common. Risk factors include preexisting renal impairment, diabetes, elderly age, and dehydration. In a single-centre prospective study, we investigated which factors are implicated for CIN in patients with peripheral arterial disease due for angiography. Serum creatinine was measured before, 1, 2, and 7 days post-angiography. We also considered the chronic kidney disease stage of the patients at admission and 48 hours post-contrast. All patients received 500 mL normal saline pre- and post-angiography and a low-osmolality contrast medium. 6 of 94 patients developed CIN: 1 required dialysis and 1 died partly due to renal failure. Only 2 factors were associated with CIN: body mass index (BMI; P = .019) and kidney function (P = .001); 4 of 6 patients with CIN were obese (BMI ≥30) and only 2 were nonobese (P = .0092). Diabetes, contrast volume, and age were not significant risk factors. Our results confirm renal impairment raises the risk of CIN. To our knowledge, we report for the first time that obesity may be a risk factor for CIN. Pending confirmatory studies and given the rising prevalence of obesity, this finding could help identify at-risk patients and hence reduce the burden of CIN.
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Affiliation(s)
- Muhammad Asif Kabeer
- Department of Vascular Surgery, University Hospitals of North Midlands
NHS Trust, UK
| | - Jennifer Cross
- Department of Renal Medicine, Royal Free & University College
Medical School and Royal Free Hospital, London, UK
| | - George Hamilton
- Department of Vascular Surgery, Royal Free & University College
Medical School and Royal Free Hospital, London, UK
| | - Sheikh Tawqeer Rashid
- Department of Vascular Surgery, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust & University of Manchester, UK
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Lv M, Hu B, Ge W, Li Z, Wang Q, Han C, Liu B, Zhang Y. Impact of Preoperative Occult Renal Dysfunction on Early and Late Outcomes After Off-Pump Coronary Artery Bypass. Heart Lung Circ 2020; 30:288-295. [PMID: 32690359 DOI: 10.1016/j.hlc.2020.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/29/2019] [Accepted: 05/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal dysfunction is independently associated with increased early and late mortality after coronary artery bypass graft (CABG) surgery. Off-pump CABG (OPCABG) avoids postoperative complications from the cardiopulmonary bypass, but it is unclear how it is impacted by occult renal dysfunction (ORD). This study aimed to investigate the effects of ORD on early and late outcomes after OPCABG. METHODS This retrospective and observational cohort study reviewed data on 1,188 patients who underwent first isolated OPCABG with normal serum creatinine (SCr) levels. According to preoperative estimated creatinine clearance (eCrCl) by the Cockcroft-Gault formula, the patients were divided into an ORD group (n=260, eCrCl <60 mL/min/1.73 m2) and a control group (n=928, eCrCl ≥60 mL/min/1.73 m2). RESULTS The ORD patients presented with older age, higher incidence of small body surface area, hypertension, low preoperative eCrCl, cerebrovascular accident, peripheral vascular disease, New York Heart Association (NYHA) Ⅲ, and high risk score. The prevalence of hospital mortality, postoperative acute kidney injury (AKI), peak postoperative SCr, and prolonged hospital stay were greater in the ORD patients than the control patients. Multivariable logistic regression analysis showed that the ORD patients were at significantly higher risk of postoperative AKI (OR, 2.702; 95% CI, 1.994-3.662) and in-hospital mortality (OR, 2.884; 95% CI, 1.293-6.432). Multivariate Cox proportional hazard models confirmed that ORD was significantly associated with high later mortality (HR, 2.847; 95% CI, 1.262-6.425). CONCLUSIONS Occult renal dysfunction is an independent risk factor for postoperative AKI in-hospital and later mortality in patients undergoing OPCABG with normal SCr levels.
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Affiliation(s)
- Mengwei Lv
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, P. R. China; The Shanghai East Clinical Medical College of Nanjing Medical University, Shanghai, P. R. China
| | - Bo Hu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Qi Wang
- The Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, P. R. China
| | - Chunyan Han
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Tongji University School of Medicine, Shanghai, P. R. China.
| | - Yangyang Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, P. R. China; The Shanghai East Clinical Medical College of Nanjing Medical University, Shanghai, P. R. China; Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, P. R. China.
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Walsh SR, Tang T, Sadat U, Varty K, Boyle JR, Gaunt ME. Preoperative Glomerular Filtration Rate and Outcome Following Open Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2019; 41:225-9. [PMID: 17595389 DOI: 10.1177/1538574407299614] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Estimated glomerular filtration rate (eGFR) can be readily calculated from serum creatinine values. It is a more sensitive prognostic indicator than serum creatinine alone in patients undergoing thoracoabdominal or endovascular abdominal aortic aneurysm repair. The value of eGFR in patients undergoing open abdominal aortic aneurysm repair remains unclear. The preoperative eGFR was calculated for patients undergoing elective open infrarenal aortic aneurysm repair. Postoperative complications, perioperative mortality, and long-term survival were compared across eGFR and serum creatinine quartiles. The eGFR identified preoperative renal dysfunction in 33% of patients, whereas serum creatinine identified renal impairment in only 11%. The eGFR correlated with perioperative morbidity and long-term survival. Serum creatinine did not correlate with perioperative mortality or long-term survival. However, it did correlate with postoperative morbidity. The eGFR is a more sensitive index of preoperative renal function than serum creatinine and correlates with survival. It should replace serum creatinine as the standard index of renal function before open abdominal aortic aneurysm repair.
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Affiliation(s)
- Stewart R Walsh
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
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Lawal OM, Balogun MO, Akintomide AO, Ayoola OO, Mene-Afejuku TO, Ogunlade O, Okunola OO, Lawal AO, Akinsola A. Carotid Intima-Media Thickness: A Surrogate Marker for Cardiovascular Disease in Chronic Kidney Disease Patients. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819852941. [PMID: 31258338 PMCID: PMC6589967 DOI: 10.1177/1179546819852941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 05/03/2019] [Indexed: 12/18/2022]
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Carotid intima-media thickness (CIMT) is a measure of atherosclerotic vascular disease and considered a comprehensive picture of all alterations caused by multiple cardiovascular risk factors over time on the arterial walls. We therefore sought to determine the CIMT of the common carotid artery in patients with CKD and to evaluate the clinical pattern and prevalence of CVD in CKD patients. Methods: A case-control study involving 100 subjects made of 50 patients with CKD stages 2 to 4 and 50 age and sex matched apparently normal individuals. Carotid intima-media thickness of the common carotid artery was considered thickened if it measured greater than 0.8 mm. All subjects had laboratory investigations, 12-lead electrocardiogram, transthoracic echocardiography, and ankle-brachial index. Results: The mean CIMT was higher in CKD population compared with controls (P < .001). Eighty-four percent of the study population was found to have thickened CIMT compared with 18% of controls (P < .001). Patients with CKD had significantly higher blood pressure and heart rate than controls. Cardiovascular disease was also more prevalent among patients with CKD as compared with controls. Carotid intima-media thickness positively correlated with age, blood pressure, and random blood sugar. Conclusions: As CIMT was well correlated with many cardiovascular risk factors among CKD patients, it may serve as a surrogate marker for CVD and its early assessment may target patients who may need more aggressive therapy to retard the progression of kidney disease and improve outcome.
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Affiliation(s)
| | - Michael Olabode Balogun
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | - Anthony Olubunmi Akintomide
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | | | | | - Oluwadare Ogunlade
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | - Oluyomi Oluseun Okunola
- Nephrology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
| | | | - Adewale Akinsola
- Nephrology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Nigeria
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Sajja LR, Singh S, Mannam G, Guttikonda J, Pusapati VRR, Saikiran KVSS. Impact of occult renal disease on the outcomes of off-pump and on-pump coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2018; 35:150-157. [PMID: 33060999 DOI: 10.1007/s12055-018-0767-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022] Open
Abstract
Purpose Occult renal disease (ORD) is a clinical condition in which glomerular filtration rate (GFR) is less than 60 ml/min/1.73 m2, while serum creatinine is ≤ 1.3 mg/dl. The aim of the study was to compare the incidence of postoperative stage I acute kidney injury (AKI) according to Acute Kidney Injury Network (AKIN) classification in patients with ORD undergoing either off-pump or on-pump coronary artery bypass grafting. Methods A single center prospective randomized study was conducted from March 2011 through January 2014. A total of 120 coronary artery disease (CAD) patients with ORD undergoing coronary artery bypass grafting (CABG) were randomized to either off-pump (group1, n = 62) or on-pump (group2, n = 58) CABG in 1:1 ratio by computer-generated random number table. The GFR and serum creatinine levels were measured preoperatively and postoperatively on day 1 and day 5. The primary outcome (postoperative AKI (stage I)) and secondary outcomes (AKI (stage III) requiring renal replacement therapy (RRT) death, myocardial infarction (MI), cerebrovascular accident, atrial fibrillation (AF), and re-exploration for bleeding) at 30 days were analyzed between the groups. Results There is no significant difference in baseline characteristics of patients between off-pump and on-pump group. The incidence of postoperative AKI (stage I) was similar between on-pump (20.69%) and off-pump (16.13%) groups (p = 0.51). There was no significant difference in mortality (p = 0.33), postoperative MI (p = 0.34), cerebrovascular accident (p = 1.00), re-exploration (p = 0.96), and AF (p = 0.50). The number of patients of stage III AKI requiring RRT was higher in the off-pump group (3 patients, 4.8%) and none in the on-pump group (p = 0.08). Conclusions This study demonstrated that on-pump CABG is associated with significantly lower GFR and significantly higher serum creatinine on postoperative day 1 which return to baseline by postoperative day 5. In patients with ORD undergoing CABG, the incidence of postoperative AKI and major adverse cardiac and cerebrovascular events were similar between off-pump or on-pump CABG patients.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, Telangana 500 034 India.,Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500 073 India
| | - Sudhanshu Singh
- Division of Cardiothoracic Surgery, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, Telangana 500 034 India
| | - Gopichand Mannam
- Division of Cardiothoracic Surgery, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, Telangana 500 034 India
| | - Jyothsna Guttikonda
- Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500 073 India.,Division of Nephrology, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, 500 034 India
| | - Venkata Ramachandra Raju Pusapati
- Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500 073 India.,Division of Cardiology, Star Hospitals, Road no. 10, Banjara Hills, Hyderabad, 500 034 India
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Scalise F. Commentary: Carbon Dioxide Automated Angiography in Patients With a High Risk of Contrast-Induced Nephropathy Who Undergo Percutaneous Interventions for Critical Limb Ischemia. J Endovasc Ther 2016; 23:49-51. [PMID: 26763257 DOI: 10.1177/1526602815620870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Filippo Scalise
- Interventional Cardiology Department, Policlinico di Monza, Italy
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Stanišić MG, Majewska N, Romanowski M, Kulesza J, Juszkat R, Makałowski M, Majewski W. Endovascular treatment of renal artery occlusion caused by aortic stentgraft migration. POLISH JOURNAL OF SURGERY 2015; 87:181-4. [PMID: 26146117 DOI: 10.1515/pjs-2015-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 11/15/2022]
Abstract
Renal function impairment during interventional procedures became a real clinical problem. Contrast related nephropathy is the most common cause of renal failure, however, the procedure-related technical troubles may cause unexpected renal dysfunction.Technical failure of EVAR resulting in acute renal dysfunction is presented. The postprocedural occlusion of the right renal artery was treated in chimney technique. Early reintervention allowed the kidney preservation and renal function restoration. It is impossible to avoid all the complications following treatment of aortic aneurysm, but they can be anticipated and comprehensively treated in collaboration with other specialists.
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Marui A, Okabayashi H, Komiya T, Tanaka S, Furukawa Y, Kita T, Kimura T, Sakata R. Impact of occult renal impairment on early and late outcomes following coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2013; 17:638-43. [PMID: 23793709 DOI: 10.1093/icvts/ivt254] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES High serum creatinine is considered an independent risk factor for poor outcomes following coronary artery bypass grafting (CABG). However, the impact of occult renal impairment (ORI), defined as an impaired glomerular filtration rate (GFR) with a normal serum creatinine (SCr) level, remains unclear. Thus, we sought to investigate the impact of ORI on outcomes after CABG. METHODS Among patients undergoing their first percutaneous coronary intervention (PCI) or CABG enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI and CABG patients in Japan), 1842 patients with normal SCr levels undergoing CABG were enrolled in the study. Patients were divided into two groups based on preoperative estimated GFR calculated by the Cockcroft-Gault equation: 1339 patients with estimated GFR of ≥ 60 ml/min/1.73 m(2) (normal group) and 503 with estimated GFR of <60 ml/min/1.73 m(2) (ORI group). RESULTS Preoperative estimated GFR differed between the groups (51.3 ± 6.6 vs 85.8 ± 23.0 ml/min/1.73 m(2), P < 0.01). ORI was associated with high in-hospital mortality (3.2 vs 1.0%, P < 0.01) and need for dialysis (2.0 vs 0.2%, P < 0.01). In terms of long-term outcomes, ORI was associated with high mortality compared with the normal (hazard ratio [95% confidence interval]: 1.72 [1.16-2.54], P < 0.01) and high incidence of composite cardiovascular events (death, stroke or myocardial infarction: 1.53 [1.16-2.02], P < 0.01). CONCLUSIONS ORI was an independent risk factor for early and late death as well as cardiovascular events in patients undergoing CABG with normal SCr levels. A more accurate evaluation of renal function through a combination of SCr and estimated GFR is needed in patients with normal SCr levels.
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Affiliation(s)
- Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. Renal Function Impairment in Peripheral Arterial Disease: An Important Parameter that Should not Be Neglected. Ann Vasc Surg 2009; 23:690-9. [DOI: 10.1016/j.avsg.2009.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 02/15/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
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Efficacy of Estimated Glomerular Filtration Rate in Prediction of the Early Complication After Peripheral Artery Reconstruction. POLISH JOURNAL OF SURGERY 2009. [DOI: 10.2478/v10035-009-0083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Walsh SR, Tang TY, Boyle JR. Renal Consequences of Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2008; 15:73-82. [PMID: 18254679 DOI: 10.1583/07-2299.1] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fatourou EM, Paraskevas KI, Seifalian AM, Hamilton G, Mikhailidis DP. The role of established and emerging risk factors in peripheral vascular graft occlusion. Expert Opin Pharmacother 2007; 8:901-11. [PMID: 17472536 DOI: 10.1517/14656566.8.7.901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several studies have evaluated the association between established as well as emerging vascular risk factors with peripheral graft occlusion. There is evidence for a link between the risk for graft occlusion and total serum cholesterol, low-density lipoprotein cholesterol and triglyceride levels. The overall effect of smoking shows a 2.35-fold increase in risk of graft failure. Studies involving diabetic patients undergoing peripheral bypass may have failed to detect higher occlusion rates, possibly due to increased morbidity and mortality as well as higher amputation rates even if the graft is patent. Both antiplatelet agents and anticoagulation seem to be effective in the prevention of graft occlusion. Unconvincing data have been published with regards to the effect of hypertension on graft patency. Emerging factors such as fibrinogen, lipoprotein (a), C-reactive protein and homocysteine levels should also be considered when assessing the risk of graft occlusion. More research is needed to prevent graft occlusion due to the obvious clinical relevance, quality of life and cost issues.
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Affiliation(s)
- E M Fatourou
- Department of Clinical Biochemistry, Royal Free Hospital and Royal Free University College Medical School, London, UK
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