1
|
Huang X, Luo B, Peng Y, Yan F, Li S, Lin F, Lin Q, Ye Q, Chen L, Lin Y. Sex-Based Differences in the Risk of Contrast-Induced Nephropathy and Clinical Outcomes in Patients Undergoing Coronary Angiography and/or Percutaneous Coronary Intervention. J Womens Health (Larchmt) 2024. [PMID: 39234764 DOI: 10.1089/jwh.2023.0331] [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: 09/06/2024] Open
Abstract
Background: There is still controversial or limited evidence on whether sex differences exist in clinical characteristics, the risk of contrast-induced nephropathy (CIN), and other clinical outcomes of patients who received coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The aim of this study was to characterize the effect of sex on clinical characteristics and outcomes of patients undergoing CAG and/or PCI. Methods: A total of 3,340 consecutive patients undergoing CAG and/or PCI from May 2017 to December 2022 were assessed in this retrospective study. Subgroup analyses by sex were performed. Clinical characteristics, treatments, the risk of CIN, and other clinical outcomes, including in-hospital and follow-up, were compared between females and males. Results: Females undergoing CAG and/or PCI tended to have an advanced age (65.8 versus 63.3 years, p < 0.001), a higher burden of complications, and received PCI less frequently compared with males (43.2% versus 64.2%, p < 0.001). After adjustment, female sex was associated with a higher incidence of CIN [adjusted odds ratio (aOR) 1.47; 95% CI 1.08-2.01; p = 0.015] and a higher all-cause readmission rate (aOR 1.26; 95%CI 1.02-1.56; p = 0.031). Meanwhile, females undergoing CAG alone demonstrated a higher risk of severe arrhythmia compared with males after controlling for potential confounders (aOR 1.52; 95% CI 1.12-2.04; p = 0.006). Conclusion: Sex disparities exist in the clinical characteristics, treatments, the risk of CIN, and other clinical outcomes among patients undergoing CAG and/or PCI. Female sex was identified as an independent predictor of risk for CIN, all-cause readmission rate, and severe arrhythmia.
Collapse
Affiliation(s)
- Xizhen Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Baolin Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Feixin Yan
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fen Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qinghua Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qingyang Ye
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Yanjuan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
2
|
Xie J, Jiang M, Lin Y, Deng H, Li L. Effect of Alprostadil on the Prevention of Contrast-Induced Nephropathy: A Meta-Analysis of 36 Randomized Controlled Trials. Angiology 2019; 70:594-612. [PMID: 30669852 DOI: 10.1177/0003319719825597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is the third leading cause of acquired acute renal injury in hospitalized patients. Alprostadil plays a role in the maintenance and redistribution of intrarenal blood flow and the excretion of electrolytes and water. However, the effectiveness of alprostadil in preventing CIN remains controversial. Thirty-six articles with a total of 5495 patients were included in this study. Both groups (experimental group and control group) received standard hydration therapy. In the experimental group, patients received different doses of alprostadil. Serum creatinine (SCr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), cystatin C, creatinine clearance rate (CCr), and β2-microglobulin (β2-MG) were measured at 24, 48, and 72 hours after contrast media injection. The incidence of CIN in the experimental group was significantly lower than that in the control group (6.56% vs 16.74%). The level of SCr, cystatin C, BUN, and β2-MG in the experimental group was lower than those in the control group; CCr and eGFR in the experimental group were higher than those in the control group. This study demonstrated that alprostadil may reduce the incidence of CIN in patients undergoing coronary angiogram and/or percutaneous coronary intervention.
Collapse
Affiliation(s)
- Jian Xie
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | | | - Yunni Lin
- Guangxi Medical University, Nanning, Guangxi, China
| | - Huachu Deng
- Guangxi Medical University, Nanning, Guangxi, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| |
Collapse
|
3
|
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 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28:2845-2855. [PMID: 29426991 PMCID: PMC5986826 DOI: 10.1007/s00330-017-5246-5] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [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: 12/15/2022]
Abstract
Purpose 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 1 Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. Key Points • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.
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, Academic Teaching Hospital of the University of Freiburg, 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, London, EC1A 7BE UK
| | - Henrik S. Thomsen
- Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| |
Collapse
|
4
|
Ye Z, Lu H, Su Q, Xian X, Li L. Effect of trimetazidine on preventing contrast-induced nephropathy in diabetic patients with renal insufficiency. Oncotarget 2017; 8:102521-102530. [PMID: 29254267 PMCID: PMC5731977 DOI: 10.18632/oncotarget.19519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/30/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our study sought to assess the effect of trimetazidine (TMZ) on preventing contrast-induced nephropathy (CIN) in diabetic patients with renal insufficiency. MATERIALS AND METHODS 106 diabetic patients with renal insufficiency who were undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) were enrolled in this study. Standard hydration was administered to both groups (the TMZ group and the control group). In the TMZ group, patients were orally administered TMZ for 48 hours before and 24 hours after CAG and/or PCI. Serum creatinine (Scr), cystatin C and the glomerular filtration rate (eGFR) were measured before as well as 24 hours, 48 hours and 72 hours after contrast media injection. The incidence of CIN and major cardiovascular events (MACE) was also evaluated in both groups. RESULTS Scr, cystatin C and the eGRF in the TMZ group were better than those in the control group after 24 hours (OR: 0.78, 95% CI: 0.54-0.82; OR: 0.66, 95% CI: 0.62-0.73; OR: 1.2, 95% CI: 1.02-1.53, respectively), 48 hours (OR: 0.69, 95% CI: 0.52-0.73; OR: 0.76, 95% CI: 0.69-0.84; OR: 1.5, 95% CI: 1.25-1.68, respectively) and 72 hours (OR: 0.82, 95% CI: 0.77-0.91; OR: 0.85, 95% CI: 0.71-0.92; OR: 1.67, 95% CI: 1.33-1.72, respectively). The incidence of CIN (9.26% vs 16.67%) and MACE (7.41% vs 18.51%) in the TMZ group was significantly lower than that in the control group (P < 0.05). CONCLUSIONS Our study suggests that TMZ could reduce the incidence of CIN and MACE in diabetic patients with renal insufficiency who are undergoing CAG and/or PCI.
Collapse
Affiliation(s)
- Ziliang Ye
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institue, Nanning, Guangxi, China
- Guangxi Medical University, Nanning, Guangxi, China
| | - Haili Lu
- Guangxi Medical University, Nanning, Guangxi, China
| | - Qiang Su
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institue, Nanning, Guangxi, China
| | - Xinhua Xian
- Guangxi Medical University, Nanning, Guangxi, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institue, Nanning, Guangxi, China
| |
Collapse
|
5
|
Lee H, Song S, Oh YK, Kang W, Kim E. Is gender still a predisposing factor in contrast-media associated adverse drug reactions? A systematic review and meta-analysis of randomized trials and observational studies. Eur J Radiol 2017; 89:81-89. [PMID: 28267554 DOI: 10.1016/j.ejrad.2017.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the role of gender as a risk factor for developing contrast media-associated adverse drug reactions (CM-ADRs) by comparing the incidence of CM-ADR between male and female patients according to study design, ADR type, and computed tomography (CT) examination. MATERIAL AND METHODS We systematically searched three electronic databases for eligible studies. In the studies included (n=18), we assessed effect estimates of the relative incidence of CM-ADR, analysed by experimental design, ADR type and CT examination. This was calculated by using a random effects model if clinical conditions showed heterogeneity; otherwise, a fixed effects model was used. RESULTS We identified 10,776 patients administered CM. According to the designs, studies were classified into randomised controlled trials (RCTs) and observational studies. Results were as follows: risk ratio (RR)=1.07 (95% confidence interval (CI): 0.79-1.46, P=0.66) for RCTs, and RR=0.77 (95% CI: 0.58-1.04, P=0.09) for observational studies. The results of analysis according to ADR type and for undergoing CT demonstrated that the incidence of CM-ADR did not differ between males and females. CONCLUSIONS We found no significant difference in the incidence of CM-ADRs between male and female patients according to study design, ADR type, or CT examination. Future studies to determine why gender has shown different roles as a risk factor between CM-ADRs and non-CM ADRs are needed.
Collapse
Affiliation(s)
- Heeyoung Lee
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| | - Seungyeon Song
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| | - Yun-Kyoung Oh
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea; Department of Pharmacy, Konkuk University Medical Center, Seoul, South Korea.
| | - WonKu Kang
- College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| | - Eunyoung Kim
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea; College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| |
Collapse
|
6
|
Barbieri L, Verdoia M, Nardin M, Marino P, Suryapranata H, De Luca G. Gender Difference in the Risk of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention. Angiology 2016; 68:542-546. [PMID: 27662891 DOI: 10.1177/0003319716669429] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Contrast-induced nephropathy (CIN) is a common complication of coronary angiography/percutaneous coronary intervention (PCI). Identification of high-risk patients and optimal periprocedural management are key points to reduce the incidence of this iatrogenic complication. We evaluated the impact of gender on CIN after coronary angiography/PCI. We enrolled 2851 consecutive patients (730 females and 1851 males) undergoing coronary angiography/PCI. Baseline clinical and procedural characteristics were collected according to gender. CIN was defined as an absolute ≥0.5mg/dL or a relative ≥25% increase in creatinine level 24 to 48 hours after the procedure. The incidence of CIN was 12.6% and was significantly higher among females (15.6% vs 11.4%, odds ratio (OR) [95% confidence interval (CI)] = 1.42 [1.11-1.82]; P = .004), but this result was not confirmed at multivariate analysis after correction for all baseline confounders (adjusted OR [95% CI] = 1.14 [0.81-1.60]; P = 0.45). In conclusion, we showed that female gender is associated with an increased risk of CIN after coronary angiography/PCI. However, this finding was not confirmed after correction for baseline confounders. Therefore, the higher risk profile rather than female gender itself may contribute to the higher occurrence of CIN among women.
Collapse
Affiliation(s)
- Lucia Barbieri
- 1 Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy
| | - Monica Verdoia
- 1 Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy
| | - Matteo Nardin
- 1 Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy
| | - Paolo Marino
- 1 Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy
| | | | - Giuseppe De Luca
- 1 Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy
| | | |
Collapse
|
7
|
Li J, Li Y, Xu B, Jia G, Guo T, Wang D, Xu K, Deng J, Han Y. Short-term rosuvastatin therapy prevents contrast-induced acute kidney injury in female patients with diabetes and chronic kidney disease: a subgroup analysis of the TRACK-D study. J Thorac Dis 2016; 8:1000-6. [PMID: 27162677 DOI: 10.21037/jtd.2016.03.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Female patients are at higher risk of contrast-induced acute kidney injury (CIAKI) compared to males. In the multicenter, prospective, TRACK-D study, short-term rosuvastatin has proven effectively reduce CIAKI in patients with type 2 diabetes mellitus and stage 2-3 chronic kidney disease (CKD). This study aimed to explore the efficacy of rosuvastatin in the female TRACK-D population. METHODS This study was a gender-based analysis of 2,998 patients (1,044 females) enrolled in the TRACK-D study and were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard of care. The primary outcome was the incidence of CIAKI and the secondary outcome was a composite of death, dialysis/hemofiltration or worsening heart failure at 30 days. RESULTS CIAKI incidence was comparable between male and female patients in the overall study population (2.5% vs. 3.4%, P=0.165) and in the rosuvastatin group (2.4% vs. 2.1%, P=0.72), while it was higher in females than in males in the control group (3.1% vs. 5.3%, P=0.04). Female gender was an independent risk factor of CIAKI [odds ratio (OR) =1.65; 95% confidence interval (CI), 1.03-2.63; P=0.036]. Rosuvastatin treatment vs. control lowered CIAKI rate in females [2.1% vs. 5.3%; relative risk (RR) =0.39; 95% CI, 0.19-0.77; number needed to treat (NNT) =31], particularly among those with CKD stage 2 (1.2% vs. 4.1%, P=0.011). Secondary outcome incidence was similar for females in the rosuvastatin and control groups (3.7% vs. 4.9%, P=0.37). CONCLUSIONS Compared to males, untreated females with diabetes mellitus and CKD had a higher risk of CIAKI, which can be reduced by short-term rosuvastatin treatment.
Collapse
Affiliation(s)
- Jing Li
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Yi Li
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Biao Xu
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Guoliang Jia
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Tao Guo
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Dongmei Wang
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Kai Xu
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Jie Deng
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| | - Yaling Han
- 1 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China ; 2 Nanjing Drum Tower Hospital Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210029, China ; 3 Dongguan Kanghua Hospital, Dongguan 523080, China ; 4 First Affiliated Hospital of Kunming Medical University, Kunming 650031, China ; 5 Shijiazhuang Peace Hospital, Shijiazhuang 050081, China
| |
Collapse
|
8
|
Impact of sex on the risk to develop contrast-induced nephropathy after transcatheter aortic valve implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 9:87-92; discussion 92. [PMID: 24758950 DOI: 10.1097/imi.0000000000000052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure and is associated with increased morbidity and in-hospital mortality. Some recent studies identified female sex as a risk factor of CIN. The aim of this study was to determine the relative impact of female sex on the development and clinical outcome of CIN in patients with preexisting renal impairment after transapical transcatheter aortic valve implantation (TAVI). METHODS From February 2008 to February 2011, a total of 55 TAVI patients [82.4 (6.5) years] with preprocedural serum creatinine level of greater than 1.1 mg/dL were retrospectively investigated. The incidence of postprocedural CIN, lengths of intensive care unit and hospital stay, and short-term mortality among men and women were compared. Contrast-induced nephropathy was defined as a creatinine increase of greater than 0.5 mg/dL or greater than 25% from baseline within 3 days after contrast medium (CM) exposure. RESULTS The women had significantly lower body surface area [1.8 (0.18) vs 1.95 (0.17) m2; P = 0.002), lower hemoglobin levels [11.5 (1.3) vs 12.7 (1.6) g/dL, P < 0.001], and lower estimated glomerular filtration rate [34.2 (9.7) vs 49.4 (12.3) mL/min per 1.73 m2, P = 0.002]. The amount of CM given was significantly higher in the women relative to body surface area [67.3 (42.5) vs 48.3 (16.6) mL/m2, P = 0.043]. The women received a higher number of blood cell transfusion units [4.4 (3.4) vs 2.1 (2.7) U, P = 0.006]. The frequency of CIN within 72 hours after CM exposure was significantly higher in the women (62.1% vs 26.9%, P = 0.009). A total of 31% of the women (n = 9) versus 7.7% of the men (n = 2) needed hemodialysis (P = 0.031). Analysis of the postoperative morbidity in terms of length of intensive care unit and hospital stay revealed no significant difference between the two groups. Mortality results reached a significant difference at 60 days, with 31% (n = 9) mortality in the women compared with 7.7% (n = 2) in the men (P = 0.031). CONCLUSIONS Women with preexisting renal impairment are at higher risk than men for CIN, with resultant higher early mortality after transapical TAVI.
Collapse
|
9
|
Abstract
Contrast-induced nephropathy (CIN) represents an important adverse effect of contrast media (CM) administration. Contrast-induced nephropathy is associated with prolonged hospitalization as well as increased cardiovascular morbidity, renal morbidity, and all-cause mortality. Several risk factors may predict CIN incidence, and various scores and ratios have been proposed to identify high-risk patients. Novel biomarkers may provide an earlier diagnosis of CIN. A multifactorial approach is required for CIN prevention including hydration, administration of low- or iso-osmolar CM, minimizing CM volume, and statin administration. Renal function may deteriorate after CM administration, even in the absence of CIN. Therefore, this deterioration may not be an “all or none” phenomenon; it may well occur in many patients receiving CM, with/without CIN, and may prove to be an underestimated risk factor. Patients should be followed up for longer periods as outpatients after CM exposure to assess kidney function and predict subsequent increased morbidity and mortality.
Collapse
Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, United Kingdom
| |
Collapse
|
10
|
Victor SM, Gnanaraj A, S V, Deshmukh R, Kandasamy M, Janakiraman E, Pandurangi UM, Latchumanadhas K, Abraham G, Mullasari AS. Risk scoring system to predict contrast induced nephropathy following percutaneous coronary intervention. Indian Heart J 2014; 66:517-24. [PMID: 25443605 PMCID: PMC4223201 DOI: 10.1016/j.ihj.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/27/2014] [Accepted: 05/18/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Contrast induced nephropathy (CIN) is associated with significant morbidity and mortality after percutaneous coronary intervention (PCI). The aim of this study is to evaluate the collective probability of CIN in Indian population by developing a scoring system of several identified risk factors in patients undergoing PCI. METHODS This is a prospective single center study of 1200 consecutive patients who underwent PCI from 2008 to 2011. Patients were randomized in 3:1 ratio into development (n = 900) and validation (n = 300) groups. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 hours after PCI when compared to baseline value. Seven independent predictors of CIN were identified using logistic regression analysis - amount of contrast, diabetes with microangiopathy, hypotension, peripheral vascular disease, albuminuria, glomerular filtration rate (GFR) and anemia. A formula was then developed to identify the probability of CIN using the logistic regression equation. RESULTS The mean (±SD) age was 57.3 (±10.2) years. 83.6% were males. The total incidence of CIN was 9.7% in the development group. The total risk of renal replacement therapy in the study group is 1.1%. Mortality is 0.5%. The risk scoring model correlated well in the validation group (incidence of CIN was 8.7%, sensitivity 92.3%, specificity 82.1%, c statistic 0.95). CONCLUSION A simple risk scoring equation can be employed to predict the probability of CIN following PCI, applying it to each individual. More vigilant preventive measures can be applied to the high risk candidates.
Collapse
Affiliation(s)
- Suma M Victor
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
| | - Anand Gnanaraj
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - VijayaKumar S
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Rajendra Deshmukh
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Ezhilan Janakiraman
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ulhas M Pandurangi
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - K Latchumanadhas
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Georgi Abraham
- Institute of Kidney Diseases, Urology and Organ Transplantation, Madras Medical Mission, India
| | - Ajit S Mullasari
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| |
Collapse
|
11
|
Madershahian N, Scherner M, Rudolph T, Slottosch I, Grundmann F, Kuhn E, Michels G, Wahlers T. Impact of Sex on the Risk to Develop Contrast-Induced Nephropathy after Transcatheter Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Navid Madershahian
- Departments of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Maximilian Scherner
- Departments of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Tanja Rudolph
- Internal Medicine III (Cardiology), Cologne University Heart Centre, Cologne, Germany
| | - Ingo Slottosch
- Departments of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Franziska Grundmann
- Internal Medicine III (Cardiology), Cologne University Heart Centre, Cologne, Germany
| | - Elmar Kuhn
- Departments of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Guido Michels
- Internal Medicine III (Cardiology), Cologne University Heart Centre, Cologne, Germany
| | - Thorsten Wahlers
- Departments of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| |
Collapse
|
12
|
Neyra JA, Shah S, Mooney R, Jacobsen G, Yee J, Novak JE. Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease. Nephrol Dial Transplant 2013; 28:1463-71. [PMID: 23585585 DOI: 10.1093/ndt/gft082] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Contrast-induced acute kidney injury (CIAKI) has been linked to unfavorable consequences. In routine clinical practice, small increases in serum creatinine (SCr) following coronary angiography tend to be underestimated, especially in patients without chronic kidney disease (CKD). METHODS We conducted a retrospective observational cohort study to analyze in-hospital and long-term outcomes of CIAKI following coronary angiography in patients with or without CKD (eGFR ≥ 60 mL/min/1.73 m(2)) from January 2008 through December 2009. CIAKI was defined as SCr either ≥ 25% or ≥ 0.5 mg/dL from baseline within 72 h after contrast exposure. Multivariable logistic regression for in-hospital mortality and Cox proportional hazards calculations for long-term mortality and requirement for dialysis were performed. RESULTS A total of 1160 patients were included in the study. CIAKI occurred in 19% of CKD patients and in 18% of non-CKD patients. In CKD and non-CKD patients, CIAKI was more frequent in patients requiring mechanical ventilation or inotropes or in those given furosemide, and it was associated with adverse in-hospital (prolonged hospitalization, acute dialysis and mortality) and long-term (increased creatinine, initiation of dialysis and mortality) outcomes. In multivariable analysis, CKD patients had greater in-hospital mortality if they developed CIAKI (adjusted OR 8, 95% CI 1.9-34.5, P = 0.005), and non-CKD patients had greater long-term mortality if they developed CIAKI (adjusted HR 2.2, 95% CI 1.2-4.1, P = 0.016). CONCLUSIONS CIAKI following coronary angiography was associated with adverse in-hospital and long-term outcomes in both CKD and non-CKD patients.
Collapse
Affiliation(s)
- Javier A Neyra
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | | | | | | | | |
Collapse
|