1
|
Wang W, Yu R, Wu C, Li Q, Chen J, Xiao Y, Chen H, Song J, Ji M, Zuo Z. Berberine alleviates contrast-induced nephropathy by activating Akt/Foxo3a/Nrf2 signalling pathway. J Cell Mol Med 2024; 28:e18016. [PMID: 37909687 PMCID: PMC10805492 DOI: 10.1111/jcmm.18016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
Contrast-induced nephropathy (CIN) is a condition that causes kidney damage in patients receiving angiography with iodine-based contrast agents. This study investigated the potential protective effects of berberine (BBR) against CIN and its underlying mechanisms. The researchers conducted both in vivo and in vitro experiments to explore BBR's renal protective effects. In the in vivo experiments, SD rats were used to create a CIN model, and different groups were established. The results showed that CIN model group exhibited impaired renal function, severe damage to renal tubular cells and increased apoptosis and ferroptosis. However, BBR treatment group demonstrated improved renal function, decreased apoptosis and ferroptosis. Similar results were observed in the in vitro experiments using HK-2 cells. BBR reduced ioversol-induced apoptosis and ferroptosis, and exerted its protective effects through Akt/Foxo3a/Nrf2 signalling pathway. BBR administration increased the expression of Foxo3a and Nrf2 while decreasing the levels of p-Akt and p-Foxo3a. In conclusion, this study revealed that BBR effectively inhibited ioversol-induced apoptosis and ferroptosis in vivo and in vitro. The protective effects of BBR were mediated through the modulation of Akt/Foxo3a/Nrf2 signalling pathway, leading to the alleviation of CIN. These findings suggest that BBR may have therapeutic potential for protecting against CIN in patients undergoing angiography with iodine-based contrast agents.
Collapse
Affiliation(s)
- Wanpeng Wang
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
- School of Clinical Medicine, Medical College of Yangzhou University, Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, Jiangsu, China
- Jiangsu College of Nursing, Huai'an, Jiangsu, China
| | - Ran Yu
- School of Clinical Medicine, Medical College of Yangzhou University, Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, Jiangsu, China
- Jiangsu College of Nursing, Huai'an, Jiangsu, China
- Department of Cardiology, Lianshui People's Hospital, Affiliated Kangda college of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Caixia Wu
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Qingju Li
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
- School of Clinical Medicine, Medical College of Yangzhou University, Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, Jiangsu, China
- Jiangsu College of Nursing, Huai'an, Jiangsu, China
| | - Jiajia Chen
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
- Jiangsu College of Nursing, Huai'an, Jiangsu, China
| | - Yao Xiao
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
- Jiangsu College of Nursing, Huai'an, Jiangsu, China
| | - Haoyu Chen
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Jian Song
- Department of Nephrology, Lianshui People's Hospital, Affiliated Kangda College of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Mingyue Ji
- Department of Cardiology, Lianshui People's Hospital, Affiliated Kangda college of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Zhi Zuo
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital, Nanjing, Jiangsu, China
| |
Collapse
|
2
|
Kanai D, Fujii H, Nakai K, Kono K, Watanabe K, Goto S, Nishi S. Statin Use Influence on the Occurrence of Acute Kidney Injury in Patients with Peripheral Arterial Disease. J Atheroscler Thromb 2022; 29:1646-1654. [PMID: 35013022 PMCID: PMC9623082 DOI: 10.5551/jat.63265] [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: 09/20/2021] [Accepted: 12/03/2021] [Indexed: 11/11/2022] Open
Abstract
AIM Acute kidney injury (AKI) is an important clinical issue in the diagnosis and treatment of cardiovascular diseases. The association between pretreatment by statins and the occurrence of AKI in patients with peripheral arterial diseases (PAD) remains unclear. Therefore, we examined the association between statin therapy and the occurrence of AKI in patients with PAD. METHODS We retrospectively analyzed data from the endovascular treatment (EVT) database in our hospital. A total of 295 patients who underwent angiography and/or intervention for PAD between October 2011 and March 2016 were enrolled and divided into two groups: those without statins (control group; N=157) and those with statins (statin group; N=138) for at least 1 month before admission. We examined the occurrence of AKI and its related factors in these patients. RESULTS The serum creatinine levels, dose of contrast medium, use of a renin-angiotensin system inhibitor, smoking habit, and blood pressure were similar in both groups. The statin group had more diabetes patients, had patients who were significantly younger, had patients with a higher body mass index (BMI), and had patients with lower low-density lipoprotein cholesterol than the control group. With regard to the occurrence of AKI, there was a significantly lower incidence in the statin group compared with the control group (5% vs. 16%, p<0.05). The result of the multivariate analysis indicated that statin therapy was significantly correlated with lower occurrence rates of AKI (p<0.05). CONCLUSIONS Our study suggests that statin therapy might prevent the occurrence of AKI after angiography and/or intervention for PAD.
Collapse
Affiliation(s)
- Daisuke Kanai
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Nephrology and Kidney Center, Kakogawa Central City Hospital, Hyogo, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Nakai
- Department of Nephrology and Kidney Center, Kakogawa Central City Hospital, Hyogo, Japan
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Watanabe
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Goto
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
3
|
Yu X, Feng Z. Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies. Front Med (Lausanne) 2022; 8:751793. [PMID: 35004722 PMCID: PMC8738090 DOI: 10.3389/fmed.2021.751793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/09/2021] [Indexed: 12/18/2022] Open
Abstract
Acute kidney injury (AKI) is a serious clinical syndrome, and one of the common comorbidities in the perioperative period. AKI can lead to complications in surgical patients and is receiving increasing attention in clinical workup. In recent years, the analysis of perioperative risk factors has become more in-depth and detailed. In this review, the definition, diagnosis, and pathophysiological characteristics of perioperative AKI are reviewed, and the main risk factors for perioperative AKI are analyzed, including advanced age, gender, certain underlying diseases, impaired clinical status such as preoperative creatinine levels, and drugs that may impair renal function such as non-steroidal anti-inflammatory drugs (NASIDs), ACEI/ARB, and some antibiotics. Injectable contrast agents, some anesthetic drugs, specific surgical interventions, anemia, blood transfusions, hyperglycemia, and malnutrition are also highlighted. We also propose potential preventive and curative measures, including the inclusion of renal risk confirmation in the preoperative assessment, minimization of intraoperative renal toxin exposure, intraoperative management and hemodynamic optimization, remote ischemic preadaptation, glycemic control, and nutritional support. Among the management measures, we emphasize the need for careful perioperative clinical examination, timely detection and management of AKI complications, administration of dexmedetomidine for renal protection, and renal replacement therapy. We aim that this review can further increase clinicians' attention to perioperative AKI, early assessment and intervention to try to reduce the risk of AKI.
Collapse
Affiliation(s)
- Xiang Yu
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center of Kidney Diseases, Chinese PLA Institute of Nephrology, Chinese PLA General Hospital, Beijing, China
| | - Zhe Feng
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center of Kidney Diseases, Chinese PLA Institute of Nephrology, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
4
|
Lin M, Xu T, Zhang W, Li D, Li Y, Hong X, Luan Y, Zhang W, Wang M. Effect of statins on post-contrast acute kidney injury: a multicenter retrospective observational study. Lipids Health Dis 2021; 20:63. [PMID: 34225750 PMCID: PMC8258930 DOI: 10.1186/s12944-021-01489-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/13/2021] [Indexed: 02/08/2023] Open
Abstract
Background Post-contrast acute kidney injury (PC-AKI) is a severe complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Currently, the effect of statins on PC-AKI and its mechanism remains unclear. Methods This multicenter retrospective observational study included 4386 patients who underwent CAG or PCI from December 2006 to December 2019 in Sir Run Run Shaw Hospital and its medical consortium hospitals. Serum creatinine pre- or post-procedure within 72 h after PCI was recorded. Multivariate logical regression was used to explore whether preoperative use of statins was protective from PC-AKI. The path analysis model was then utilized to look for the mediation factors of statins. Results Four thousand three hundred eighty-six patients were enrolled totally. The median age of the study population was 68 years old, 17.9% with PC-AKI, and 83.3% on preoperative statins therapy. The incidence of PC-AKI was significantly lower in group of patients on statins therapy. Multivariate regression indicated that preoperative statins therapy was significantly associated with lower percentage of elevated creatinine (β: -0.118, P < 0.001) and less PC-AKI (OR: 0.575, P < 0.001). In the preoperative statins therapy group, no statistically significant difference was detected between the atorvastatin and rosuvastatin groups (OR: 1.052, P = 0.558). Pathway model analysis indicated a direct protective effect of preoperative statins therapy on PC-AKI (P < 0.001), but not through its lipid-lowering effect (P = 0.277) nor anti-inflammatory effect (P = 0.596). Furthermore, it was found that “low-density lipoprotein cholesterol (LDL-C)→C-reactive protein (CRP)” mediated the relationship between preoperative statins therapy and PC-AKI (P = 0.007). However, this only explained less than 1% of the preoperative protective effects of statins on PC-AKI. Conclusion Preoperative statins therapy is an independent protective factor of PC-AKI, regardless of its type. This protective effect is not achieved by lipid-lowering effect or anti-inflammatory effect. These findings underscore the potential use of statins in preventing PC-AKI among those at risk.
Collapse
Affiliation(s)
- Maoning Lin
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Tian Xu
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Wenjuan Zhang
- Department of Information Technology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qingchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China
| | - Duannbin Li
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Ya Li
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Xulin Hong
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Yi Luan
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China. .,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China.
| | - Wenbin Zhang
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China. .,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China.
| | - Min Wang
- Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, People's Republic of China. .,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, People's Republic of China.
| |
Collapse
|
5
|
Toso A, Leoncini M, Maioli M, Bellandi F. Pharmacologic Prophylaxis of Contrast-Induced Nephropathy. Interv Cardiol Clin 2020; 9:369-383. [PMID: 32471677 DOI: 10.1016/j.iccl.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Different pharmacologic agents have been tested in the effort to prevent contrast-induced acute kidney injury (AKI) in the last two decades. To date, however, no individual drug has received unanimous approval for this aim. Since 2014 statins have been included as preventive treatment in the European guidelines for revascularization procedures in cardiac patients. The present update presents the latest findings in this field focusing on the changing paradigms in the definition and consequently the approach to nephroprotection that considers clinical prognosis as the major issue. We note the current shift from attention to contrast-induced AKI to contrast-associated AKI.
Collapse
Affiliation(s)
- Anna Toso
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy.
| | - Mario Leoncini
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| | - Mauro Maioli
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| | - Francesco Bellandi
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| |
Collapse
|
6
|
Radak D, Neskovic M, Otasevic P, Isenovic ER. Renal Dysfunction Following Elective Endovascular Aortic Aneurysm Repair. Curr Vasc Pharmacol 2020; 17:133-140. [PMID: 29149818 DOI: 10.2174/1570161115666171116163203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 02/01/2023]
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative disease of the aortic wall with potentially fatal complications. Open repair (OR) was considered the gold standard, until the emergence of endovascular aneurysm repair (EVAR), which is less invasive and equally (if not more) effective. As the popularity of endovascular procedures grows, related complications become more evident, with kidney damage being one of them. Although acute kidney injury (AKI) following EVAR is relatively common, its true incidence is still uncertain. Also, there is insufficient data concerning long-term renal outcomes after EVAR, especially with repeated contrast agent exposure. Despite the lack of firm evidence on the effectiveness of individual strategies, it is evident that prevention of AKI following EVAR requires a multifactorial approach. This review focuses on recent findings based on human studies regarding the current evidence of renal impairment after EVAR, its quantification and strategies for its prevention.
Collapse
Affiliation(s)
- Djodje Radak
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade 11040, Serbia
| | - Mihailo Neskovic
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade 11040, Serbia
| | - Petar Otasevic
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade 11040, Serbia
| | - Esma R Isenovic
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Sciences Vinca, University of Belgrade, Mike Petrovica Alasa 12-14, Belgrade 11000, Serbia
| |
Collapse
|
7
|
Faucon AL, Bobrie G, Clément O. Nephrotoxicity of iodinated contrast media: From pathophysiology to prevention strategies. Eur J Radiol 2019; 116:231-241. [DOI: 10.1016/j.ejrad.2019.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
|
8
|
Non-coding RNA-Associated ceRNA Networks in a New Contrast-Induced Acute Kidney Injury Rat Model. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 17:102-112. [PMID: 31234008 PMCID: PMC6595412 DOI: 10.1016/j.omtn.2019.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a severe complication of intravascular applied radial contrast media, and recent progress in interventional therapy and angiography has revived interest in explaining detailed mechanisms and developing effective treatment. Recent studies have indicated a potential link between CI-AKI and microRNA (miRNA). However, the potential non-coding RNA-associated-competing endogenous RNA (ceRNA) pairs involved in CI-AKI still remain unclear. In this study, we systematically explored the circRNA or lncRNA-associated-ceRNA mechanism in a new rat model of CI-AKI through deep RNA sequencing. The results revealed that the expression of 38 circRNAs, 12 lncRNAs, 13 miRNAs and 127 mRNAs were significantly dysregulated. We performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses for mRNAs with significantly different expression and then constructed comprehensive circRNA or lncRNA-associated ceRNA networks in kidney of CI-AKI rats. Thereafter, two constructed ceRNA regulatory pathways in this CI-AKI rat model—novel_circ_0004153/rno-miR-144-3p/Gpnmb or Naglu and LNC_000343/rno-miR-1956-5p/KCP—were validated by real-time qPCR. This study is the first one to provide a systematic dissection of non-coding RNA-associated ceRNA profiling in kidney of CI-AKI rats. The selected non-coding RNA-associated ceRNA networks provide new insight for the underlying mechanism and may profoundly affect the diagnosis and therapy of CI-AKI.
Collapse
|
9
|
Brosnahan GM, Abebe KZ, Rahbari-Oskoui FF, Patterson CG, Bae KT, Schrier RW, Braun WE, Chapman AB, Flessner MF, Harris PC, Perrone RD, Steinman TI, Torres VE. Effect of Statin Therapy on the Progression of Autosomal Dominant Polycystic Kidney Disease. A Secondary Analysis of the HALT PKD Trials. Curr Hypertens Rev 2019; 13:109-120. [PMID: 28460625 DOI: 10.2174/1573402113666170427142815] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) commonly results in end-stage renal disease (ESRD), yet a long-term treatment that is well tolerated is still lacking. In a small randomized trial in children and adolescents pravastatin administration for 3 years was associated with reduced renal cyst growth, but no large trial has tested the effect of statins in adults. METHODS We performed a post-hoc analysis of the HALT PKD trials to compare outcomes of participants who never used statins with those who used statin for at least 3 years. Because statins were not randomly allocated, we used propensity score models with inverse probability of treatment weighting to account for imbalances between the groups. For subjects in Study A (preserved renal function, n=438) relevant outcomes were percent change in total kidney and liver volume and the rate of decline in estimated glomerular filtration rate (eGFR); for those in Study B (reduced renal function, n=352) we compared time to the composite endpoint of death, ESRD or 50% decline in eGFR. Follow-up was 5-8 years. RESULTS There was no difference in any outcome between the 2 groups. However, limitations of this analysis are the small number of statin users in Study A, different statin drugs and doses used, non-randomized allocation and advanced disease stage in Study B. CONCLUSION Although this post-hoc analysis of the HALT PKD trials does not demonstrate a benefit of statin therapy, conclusions remain preliminary. A larger randomized trial in young people with ADPKD is necessary to answer the question whether statins can slow renal cyst growth and preserve kidney function.
Collapse
Affiliation(s)
| | - Kaleab Z Abebe
- University of Pittsburgh, Pittsburgh, Pennsylvania PA. United States
| | | | | | - Kyongtae T Bae
- University of Pittsburgh, Pittsburgh, Pennsylvania PA. United States
| | | | | | | | | | | | | | - Theodore I Steinman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts MA. United States
| | | | | |
Collapse
|
10
|
Ni Z, Liang Y, Xie N, Liu J, Sun G, Chen S, Ye J, He Y, Guo W, Tan N, Chen J, Liu Y, Chen Z, Wang S. Simple pre-procedure risk stratification tool for contrast-induced nephropathy. J Thorac Dis 2019; 11:1597-1610. [PMID: 31179104 DOI: 10.21037/jtd.2019.04.69] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A few simple and pre-procedural risk models have been developed for predicting contrast-induced nephropathy (CIN), which allow for early administration of preventative strategies before coronary angiography (CAG). The study aims to develop and validate simple pre-procedure tools for predicting risk of CIN following CAG. Methods We retrospectively analyzed the data from 3,469 consecutive patients undergoing CAG, who were randomly assigned to a development dataset (n=2,313) and a validation dataset (n=1,156). CIN was defined as an increase in serum creatinine (SCr) ≥0.5 mg/dL from baseline within 72 hours after CAG. Multivariate logistic regression was applied to identify independent predictors of CIN to develop risk models. The possible predictors included age >75 years, hypotension, acute myocardial infarction (AMI), SCr ≥1.5 mg/dL, and congestive heart failure (CHF). Results The incidences of CIN were 3.20% and 3.55% in the training and validation dataset respectively. Compared to classical Mehran' and ACEF CIN risk score, the new score across the validation dataset exhibited similar discrimination and predictive ability on CIN (c-statistic: 0.829, 0.832, 0.812 respectively) and in-hospital mortality (c-statistic: 0.909, 0.937, 0.866 respectively) (all P>0.05). Conclusions The easy-to-use pre-procedural prediction model only containing 5 factors had similar predictive ability on CIN and mortality.
Collapse
Affiliation(s)
- Zhonghan Ni
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Nianjin Xie
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan People's Hospital, Dongguan 523059, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Guo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhujun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| |
Collapse
|
11
|
Association between statin use and perioperative mortality after aortobifemoral bypass in patients with aortoiliac occlusive disease. J Vasc Surg 2019; 70:509-515. [PMID: 30837182 DOI: 10.1016/j.jvs.2018.10.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 10/23/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The benefit of statins in reducing perioperative cardiovascular events in patients undergoing suprainguinal bypass is still controversial. The purpose of this study was to evaluate the association between statin use and perioperative mortality in patients undergoing aortobifemoral bypass (ABFB) for aortoiliac occlusive disease. METHODS We retrospectively analyzed all patients who had ABFB in the American College of Surgeons National Surgical Quality Improvement Program data set from 2011 to 2016. Univariable (t-test, χ2 test, or Fisher exact test) and multivariable logistic regression analyses were used to compare patients' characteristics and the primary outcome (30-day mortality) between statin users and nonstatin users. Propensity score matching between statin users and nonusers was also performed on the basis of variables that were different between the two groups. RESULTS A total of 4445 patients underwent ABFB. Of those, 3032 (68.2%) were taking statins. Compared with nonstatin users, statins users were older (median [interquartile range], 67 years [59-74 years] vs 63 years [56-72 years]; P < .01) and more likely to be diabetic (31% vs 16%) and hypertensive (84% vs 63%) and to have a history of chronic obstructive pulmonary disease (20% vs 17%; all P < .05). Statin users had lower rates of 30-day mortality (3.4% vs 4.7%; P = .03) and renal complications (2.5% vs 3.7%; P = .04) compared with nonstatin users. After adjustment for patients' demographics (age, sex, race), comorbidities (diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, dialysis, bleeding disorder), smoking, clinical presentation (claudication vs critical limb ischemia), and elective surgery status, statin use was associated with 32% reduction in 30-day mortality (odds ratio, 0.68; 95% confidence interval, 0.47-0.96; P = .03). Propensity score matching showed similar results (odds ratio, 0.63; 95% confidence interval, 0.41-0.95; P = .03). CONCLUSIONS This is the largest study to date demonstrating an association between preoperative statin use and lower 30-day mortality after ABFB for aortoiliac occlusive disease. This study highlights an area of potential quality improvement as one-third of the patients undergoing this procedure are not receiving statins.
Collapse
|
12
|
Sreenivasan J, Khan MS, Li H, Zhuo M, Patel A, Fugar S, Tarbutton M, Siddamsetti S, Yadav N. Statins and Incidence of Contrast-Induced Acute Kidney Injury Following Coronary Angiography - Five Year Experience at a Tertiary Care Center. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:654-658. [PMID: 30318173 DOI: 10.1016/j.carrev.2018.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/25/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Role of statins in prevention of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography remains controversial. We studied the use of statins in decreasing CI-AKI following coronary angiography. METHODS We reviewed all patients who underwent coronary angiography with or without PCI and had a follow-up creatinine from January 2012 to December 2016 at a single tertiary care center in the United States. CI-AKI was defined as 0.3 mg/dL absolute rise in creatinine. Patients who were on moderate to high-intensity statins or received moderate to high-intensity statins prior to coronary angiography were included in the statin group. Crude and adjusted odds ratios (AOR) were calculated using univariate multiple logistic regression analysis. RESULTS Out of 2055 patients (females = 30.7%, mean age 58.0 ± 12.5 years, statin group = 886, non-statin group = 1169), 293 (14.3%) developed CI-AKI. Mean estimated glomerular filtration rate (eGFR) was not significantly different between the statin and the non-statin group (86.5 mL/min/1.73 m2 vs 87.1 mL/min/1.73 m2, p = 0.65). There was no significant difference in the incidence of CI-AKI between statin and non-statin group (14.4% vs 14.1%, p = 0.83). When adjusted for other risk factors, statin use was not significantly associated with decreased risk of CI-AKI (AOR) = 0.8, [95% confidence interval (CI) = 0.6-1.1, p = 0.19]. Results remained statistically non-significant on subgroup analysis of patients with acute coronary syndrome (ACS) (OR = 0.8, 95% CI = 0.6-1.2, p = 0.27), patients who had percutaneous coronary intervention (PCI) (OR = 1.1, 95% CI = 0.6-1.7, p = 0.81) and patients with eGFR < 60 mL/min/1.73 m2 (OR = 0.9, 95% CI = 0.6-1.5, p = 0.9). CONCLUSION Statin use prior to coronary angiography is not associated with decreased incidence of CI-AKI.
Collapse
Affiliation(s)
- Jayakumar Sreenivasan
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America.
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America
| | - Heyi Li
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America
| | - Min Zhuo
- Division of Nephrology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States of America
| | - Axi Patel
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America
| | - Setri Fugar
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America
| | - Morgan Tarbutton
- Department of Internal Medicine, RUSH University Medical Center, Chicago, IL, United States of America
| | - Sisir Siddamsetti
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America
| | - Neha Yadav
- Division of Cardiology, Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States of America
| |
Collapse
|
13
|
van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, Clement O, Heinz-Peer G, Stacul F, Webb JAW, Thomsen HS. Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28:2856-2869. [PMID: 29417249 PMCID: PMC5986837 DOI: 10.1007/s00330-017-5247-4] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. AREAS COVERED IN PART 2: Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium. KEY POINTS • In CKD, hydration reduces the PC-AKI risk • Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis • No drugs have been consistently shown to reduce the risk of PC-AKI • Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m 2 • Dialysis schedules need not change when intravascular contrast medium is given.
Collapse
Affiliation(s)
- Aart J van der Molen
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
| | - Peter Reimer
- Institute for Diagnostic and Interventional Radiology Klinikum Karlsruhe, Moltkestraße 90, D-76133, Karlsruhe, Germany
| | - Ilona A Dekkers
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
| | - Georg Bongartz
- Department of Diagnostic Radiology, University Hospitals of Basel, Petersgaben 4, CH-4033, Basel, Switzerland
| | - Marie-France Bellin
- Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807, Villejuif, France
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Olivier Clement
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris Cedex 15, F-71015, Paris, France
| | - Gertraud Heinz-Peer
- Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straße 4, AT-3100, St. Pölten, Austria
| | - Fulvio Stacul
- S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, I-34129, Trieste, Italy
| | - Judith A W Webb
- Department of Radiology, St. Bartholomew's Hospital, University of London, West Smithfield, EC1A 7BE, London, UK
| | - Henrik S Thomsen
- Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730, Herlev, Denmark.
| |
Collapse
|
14
|
Comparison of iohexol and iodixanol induced nephrotoxicity, mitochondrial damage and mitophagy in a new contrast-induced acute kidney injury rat model. Arch Toxicol 2018; 92:2245-2257. [DOI: 10.1007/s00204-018-2225-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
|
15
|
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]
|
16
|
Katsiki N, Giannoukas AD, Athyros VG, Mikhailidis DP. Lipid-lowering treatment in peripheral artery disease. Curr Opin Pharmacol 2018; 39:19-26. [DOI: 10.1016/j.coph.2018.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/14/2018] [Accepted: 01/19/2018] [Indexed: 12/19/2022]
|
17
|
Prevention of Contrast and Radiation Injury During Coronary Angiography and Percutaneous Coronary Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:32. [DOI: 10.1007/s11936-018-0621-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
18
|
The acute impact of high-dose lipid-lowering treatment on endothelial progenitor cells in patients with coronary artery disease-The REMEDY-EPC early substudy. PLoS One 2017; 12:e0172800. [PMID: 28394933 PMCID: PMC5386268 DOI: 10.1371/journal.pone.0172800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/09/2017] [Indexed: 01/11/2023] Open
Abstract
RATIONALE AND OBJECTIVE Endothelial progenitor cells (EPCs) play a role in vascular repair, while circulating endothelial cells (CECs) are biomarkers of vascular damage and regeneration. Statins may promote EPC/CEC mobilization in the peripheral blood. We evaluated whether pre-procedural exposure to different lipid-lowering drugs (statins±ezetimibe) can acutely increase levels/activity of EPCs/CECs in patients with stable coronary artery disease (CAD). METHODS In a planned sub-analysis of the Rosuvastatin For REduction Of Myocardial DamagE During Coronary AngioplastY (REMEDY) trial, 38 patients with stable CAD on chronic low-dose statin therapy were randomized, in a double-blind, placebo-controlled design, into 4 groups before PCI: i. placebo (n = 11); ii. atorvastatin (80 mg+40 mg, n = 9); iii. rosuvastatin (40 mg twice, n = 9); and iv. rosuvastatin (5 mg) and ezetimibe (10 mg) twice, (n = 9). At baseline and 24 h after treatment-before PCI-, patients underwent blinded analyses of EPCs [colony forming units-endothelial cells (CFU-ECs), endothelial colony-forming cells (ECFCs) and tubulization activity] and CECs in peripheral blood. RESULTS We found no significant treatment effects on parameters investigated such as number of CECs [Median (IQR): i. 0(0), ii. 4.5(27), iii. 1.9(2.3), iv. 1.9(2.3)], CFU-ECs [Median (IQR): i. 27(11), ii. 19(31), iii. 47(36), iv. 30(98)], and ECFCs [Median (IQR): i. 86(84), ii. 7(84), iii. 8/(42.5), iv. 5(2)], as well as tubulization activity [total tubuli (well), Median (IQR): i. 19(7), ii. 5(4), iii. 25(13), iv. 15(24)]. CONCLUSIONS In this study, we found no evidence of acute changes in levels or activity of EPCs and CECs after high-dose lipid-lowering therapy in stable CAD patients.
Collapse
|
19
|
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
|
20
|
Comparison of Effects of Different Statins on Contrast-Induced Acute Kidney Injury in Rats: Histopathological and Biochemical Findings. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:6282486. [PMID: 28243357 PMCID: PMC5294380 DOI: 10.1155/2017/6282486] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/12/2016] [Indexed: 12/01/2022]
Abstract
Statins are a promising new strategy to prevent contrast-induced acute kidney injury (CI-AKI). In this study we compared the ameliorative effect of different statins in a rat model of CI-AKI. Sprague-Dawley rats were divided into five groups: control group; CI-AKI group; CI-AKI + rosuvastatin group (10 mg/kg/day); CI-AKI + simvastatin group (80 mg/kg/day); and CI-AKI + atorvastatin group (20 mg/kg/day). CI-AKI was induced by dehydration for 72 hours, followed by furosemide intramuscular injection 20 minutes before low-osmolar contrast media (CM) intravenous injection. Statins were administered by oral gavage once daily for 3 consecutive days before CM injection and once 4 hours after CM injection. Rats were sacrificed 24 hours after CM injection, and renal function, kidney histopathology, nitric oxide (NO) metabolites, and markers of oxidative stress, inflammation, and apoptosis were evaluated. The results showed that atorvastatin and rosuvastatin but not simvastatin ameliorated CM-induced serum creatinine elevation and histopathological alterations. Atorvastatin and rosuvastatin showed similar effectiveness against CM-induced oxidative stress, but simvastatin was less effective. Atorvastatin was most effective against NO system dysfunction and cell apoptosis, whereas rosuvastatin was most effective against inflammation. Our findings indicate that statins exhibit differential effects in preventing CI-AKI when given at equivalent lipid-lowering doses.
Collapse
|
21
|
|
22
|
Schetz M, Oudemans-Van Straaten H. Statins do not prevent cardiac surgery-associated AKI: is ubiquinone the missing link? Intensive Care Med 2016; 42:1464-6. [PMID: 27324240 DOI: 10.1007/s00134-016-4424-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Miet Schetz
- Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Herestraat 49, 3000, Louvain, Belgium.
| | - Heleen Oudemans-Van Straaten
- Department of Adult Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| |
Collapse
|