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Wang H, Gao T, Zhang R, Hu J, Wang Y, Wei J, Zhou Y, Dong H. The intellectual base and global trends in contrast-induced acute kidney injury: a bibliometric analysis. Ren Fail 2023; 45:2188967. [PMID: 36929915 PMCID: PMC10026803 DOI: 10.1080/0886022x.2023.2188967] [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] [Indexed: 03/18/2023] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) has become the third leading cause of hospital-acquired kidney injury. A comprehensive analysis of the current state of research in the field of CI-AKI will help to reveal trends and hot topics in the field. To date, there are no published bibliometric analyses related to CI-AKI studies. Here, we analyze the relevant literature since the emergence of the concept and provide valuable insights. The literature was collected from the Web of Science Core Collection. The data were analyzed visually using CiteSpace and VOSviewer software. We collected a total of 4775 papers, with the United States and Guangdong Acad Med Sci as the major publishing powers in terms of country/region and institution. J AM COLL CARDIOL was the journal with the most published and cocited articles. Cluster analysis showed that clinical trials are the current research hotspot. The areas of risk assessment, prevention strategies, risk factors, and vascular lesions have been popular in recent years. Research on the mechanism of injury in CI-AKI will be the focus of future research, which will be crucial to reduce the clinical incidence of CI-AKI. In summary, this study provides a comprehensive analysis of the development process in the field of CI-AKI and discusses future research directions based on the analysis of objective data from many studies on CI-AKI.
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Affiliation(s)
- Heng Wang
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Tingting Gao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruijing Zhang
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Hu
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuwen Wang
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianing Wei
- Key Laboratory of Cardiovascular Disease Diagnosis, Treatment and Clinical Pharmacology of Shanxi Province, The Second Hospital of Shanxi Medical University Cardiovascular Medicine, Taiyuan, China
| | - Yun Zhou
- Shanxi Province Integrated Traditional and Western Medicine Hospital, Taiyuan, China
| | - Honglin Dong
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
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Stavroulakis K, Tsilimparis N, Saratzis A, Rantner B, Stana J, Dayama A, Davies MG, Gouveia E Melo R. Acute Kidney Injury Following Revascularization in Patients With Chronic Limb-Threatening Ischemia and Non-Dialysis-Dependent Chronic Kidney Disease: Insights From the NSQIP Database at 30-Day Follow-Up. J Endovasc Ther 2023:15266028231173297. [PMID: 37191239 DOI: 10.1177/15266028231173297] [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: 05/17/2023]
Abstract
BACKGROUND Patients with chronic limb-threatening ischemia (CLTI) and chronic kidney disease (CKD) are at risk of developing renal injury following revascularization. We aimed to compare the risk of adverse renal events following endovascular revascularization (ER) or open surgery (OS) in patients with CLTI and CKD. METHODS A retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) databases (2011-2017) was performed including patients with CLTI and non-dialysis-dependent CKD, comparing ER to OS. The primary outcome was a composite of postprocedural kidney injury or failure within 30 days. Thirty-day mortality, major adverse cardiac and cerebrovascular events (MACCE), amputation, readmission or target lesion revascularization (TLR) were compared using multivariate logistic regression and propensity-score matched analysis. RESULTS A total of 5009 patients were included (ER: 2361; OS: 3409). The risk for the composite primary outcome was comparable between groups (odds ratio [OR]: 0.78, 95% confidence interval (CI): 0.53-1.17) as for kidney injury (n=54, OR: 0.97, 95% CI: 0.39-1.19) or failure (n=55, OR: 0.68, 95% CI: 0.39-1.19). In the adjusted regression, a significant benefit was observed with ER for the primary outcome (OR: 0.60, p=0.018) and renal failure (OR: 0.50, p=0.025), but not for renal injury (OR: 0.76, p=0.34). Lower rates of MACCE, TLR, and readmissions were observed after ER. Thirty-day mortality and major amputation rates did not differ. In the propensity score analysis, revascularization strategy was not associated with renal injury or failure. CONCLUSIONS In this cohort, the incidence of renal events within 30 days of revascularization in CLTI was low and comparable between ER and OR. CLINICAL IMPACT In a cohort of 5009 patients with chronic limb-threatening ischemia and non-end-stage chronic kidney disease (CKD), postprocedural kidney injury or failure within 30 days was comparable between patients submitted to open or endovascular revascularization (ER). Lower rates of major adverse cardiac and cerebrovascular events, target lesion revascularization, and readmissions were observed after endovascular revascularization. Based on these findings, ER should not be avoided due to fear of worsening renal function in CKD patients with chronic limb-threatening ischemia. In fact, these patients benefit more from ER regarding cardiovascular outcomes with no increased risk of kidney injury.
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Affiliation(s)
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Barbara Rantner
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Jan Stana
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Anand Dayama
- Division of Vascular and Endovascular Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Gouveia E Melo
- Department of Vascular Surgery, Ludwig Maximilian University Hospital, Munich, Germany
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Zhou Y, Wang J, Zhao J, Huang B, Yuan D, Wang T. Randomised controlled trial to evaluate the effect of contrast material dilution on renal function in patients after endovascular aortic repair: rationale and design for the CULTURE trial. BMJ Open 2023; 13:e069804. [PMID: 36948564 PMCID: PMC10040023 DOI: 10.1136/bmjopen-2022-069804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Postoperative renal function decline is a major concern for thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Diluting contrast medium in the power injector may be helpful in reducing the risk of contrast-induced nephropathy, but it can also blur fluoroscopic vision during surgery. The quality of the current evidence is very low; thus, this study is designed to investigate the effect of contrast dilution in the power injector on renal function changes in patients after endovascular aortic repair. METHOD AND ANALYSIS The study is a prospective, single-blind, parallel, non-inferiority, randomised controlled trial with two independent cohorts: Cohort TEVAR and EVAR. Individuals will enter the appropriate cohort based on clinical interviews if they meet the eligibility criteria. Participants in Cohort TEVAR and EVAR will be randomly allocated to the intervention group (diluting contrast medium to 50% in the power injector) and control group (pure contrast medium in the power injector) separately in a 1:1 ratio. The primary study points consist of the proportion of patients who develop acute kidney injury within 48 hours after TEAVR or EVAR (first stage) and freedom of major adverse kidney events at 12 months after TEAVR or EVAR (second stage). The safety endpoint is freedom of all types of endoleaks at 30 days after TEVAR or EVAR. Follow-up will be conducted at 30 days and 12 months after intervention. ETHICS AND DISSEMINATION The trial was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (approval number: 20201290). The results of the study will be disseminated through publications in peer-reviewed journals and presentations at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2100042555).
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Affiliation(s)
- Yuhang Zhou
- Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Sichuan University West China School of Medicine, Chengdu, Sichuan, China
| | - Jiarong Wang
- Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jichun Zhao
- Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Bin Huang
- Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ding Yuan
- Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Tiehao Wang
- Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Braet DJ, Graham NJ, Albright J, Osborne NH, Henke PK. A novel pre-operative risk assessment tool to identify patients at risk of contrast associated acute kidney injury after endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2023:S0890-5096(23)00117-6. [PMID: 36863491 DOI: 10.1016/j.avsg.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Contrast-associated acute kidney injury (CA-AKI) after endovascular abdominal aortic aneurysm repair (EVAR) is associated with mortality and morbidity. Risk stratification remains a vital component of preoperative evaluation. We sought to generate and validate a pre-procedure CA-AKI risk stratification tool for elective EVAR patients. METHODS We queried the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) database for elective EVAR patients and excluded those on dialysis, with a history of renal transplant, death during procedure, and without creatinine measures. Association with CA-AKI (rise in creatinine > 0.5 mg/dL) was tested using mixed effects logistic regression. Variables associated with CA-AKI were used to generate a predictive model via a single classification tree. The variables selected by the classification tree were then validated by fitting a mixed effects logistic regression model into the Vascular Quality Initiative (VQI) dataset. RESULTS Our derivation cohort included 7,043 patients, 3.5% of whom developed CA-AKI. After multivariate analysis, age (OR 1.021, 95% CI 1.004-1.040), female sex (OR 1.393, CI 1.012-1.916), GFR < 30 ml/min (OR 5.068, CI 3.255-7.891), current smoking (OR 1.942, CI 1.067-3.535), COPD (OR 1.402, CI 1.066-1.843), maximum AAA diameter (OR 1.018, CI 1.006-1.029), and presence of iliac artery aneurysm (OR 1.352, CI 1.007-1.816) were associated with increased odds of CA-AKI. Our risk prediction calculator demonstrated that patients with a GFR <30 ml/min, females, and patients with a maximum AAA diameter of > 6.9 cm are at higher risk of CA-AKI after EVAR. Using the VQI dataset (N = 62,986), we found that GFR <30 ml/min (OR 4.668, CI 4.007-5.85), female sex (OR 1.352, CI 1.213-1.507), and maximum AAA diameter > 6.9 cm (OR 1.824, CI 1.212-1.506) were associated with increased risk of CA-AKI after EVAR. CONCLUSIONS Herein, we present a simple and novel risk assessment tool that can be used pre-operatively to identify patients at risk of CA-AKI after EVAR. Patients with a GFR < 30 ml/min, maximum AAA diameter > 6.9 cm, and females who are undergoing EVAR may be at risk for CA-AKI after EVAR. Prospective studies are needed to determine the efficacy of our model.
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Affiliation(s)
- Drew J Braet
- Section of Vascular Surgery, Department of Surgery, University of Michigan.
| | | | | | - Nicholas H Osborne
- Section of Vascular Surgery, Department of Surgery, University of Michigan
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan
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Boucher N, Dreksler H, Hooper J, Nagpal S, MirGhassemi A, Miller E. Anaesthesia for vascular emergencies - a state of the art review. Anaesthesia 2023; 78:236-246. [PMID: 36308289 DOI: 10.1111/anae.15899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 01/11/2023]
Abstract
In this state-of-the-art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre-operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri-operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID-19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri-operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post-procedural evaluation.
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Affiliation(s)
- N Boucher
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - H Dreksler
- Division of Vascular Surgery, Department of Surgery, University of Ottawa, ON, Canada
| | - J Hooper
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,Department of Critical Care, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - S Nagpal
- Division of Vascular Surgery, Department of Surgery, University of Ottawa, ON, Canada
| | - A MirGhassemi
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - E Miller
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
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Dong SJ, Gao XY, Pei MX, Luo T, Fan D, Chen YL, Jin JF, Zhao XD. Effects and Mechanism of Salvianolic Acid B on the Injury of Human Renal Tubular Epithelial Cells Induced by Iopromide. Front Pharmacol 2022; 12:761908. [PMID: 35035354 PMCID: PMC8758562 DOI: 10.3389/fphar.2021.761908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023] Open
Abstract
With the increasing application of medical imaging contrast materials, contrast-induced nephropathy (CIN) has become the third major cause of iatrogenic renal insufficiency. CIN is defined as an absolute increase in serum creatinine levels of at least 0.50 mg/dl or an increase >25% of serum creatinine from baseline after exposure to contrast. In this study, the protective effects of salvianolic acid B (Sal B) were detected in human renal tubular epithelial cells (HK-2) exposed to iopromide. The results showed that different concentrations of Sal B counteract the loss of cell viability induced by iopromide, and reduce cell apoptosis, the reactive oxygen species (ROS) levels, and the levels of endoplasmic reticulum stress (ERS)–related and apoptosis-related proteins such as p-IRE-1α, p-eIF-2α/eIF-2α, p-JNK, CHOP, Bax/Bcl-2, and cleaved caspase-3. In addition, Sal B at a concentration of 100 μmol/L inhibited ERS and reduced cell damage to a similar extent as the ERS inhibitor 4-PBA. Importantly, treatment with Sal B could abolish the injury induced by ERS agonist tunicamycin, increasing cell viability and the mitochondrial membrane potential, as well as significantly reducing ROS levels and the expression of Bax/Bcl-2, cleaved-caspase-3, GRP78, p-eIF2α, p-JNK, and CHOP. These results suggested that the protective effect of Sal B against HK-2 cell injury induced by iopromide may be related to the inhibition of ERS.
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Affiliation(s)
- Shu-Jun Dong
- Department of Pathophysiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Xin-Yue Gao
- Department of Pathophysiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Ming-Xin Pei
- Department of Pathophysiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Ting Luo
- Department of Pathology, Suining Central Hospital, Suining, China
| | - Dong Fan
- Department of Pathology, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Yan-Ling Chen
- Department of Pathophysiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Jun-Feng Jin
- Department of Pathology, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Xiao-Duo Zhao
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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7
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Ying J, Wang J, Ying Z, Ran X, Zeng X, Chen D, Gao Y, Zhong L. Exploring the relationship between post-contrast acute kidney injury and different baseline creatinine standards: A retrospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1042312. [PMID: 36714583 PMCID: PMC9877403 DOI: 10.3389/fendo.2022.1042312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE According to previous studies, the incidence of post-contrast acute kidney injury(PC-AKI) in diabetic is far higher than that in the general population. Therefore, we explored the relationship between the incidence of PC-AKI and different baseline serum creatinine (SCr) levels, and determined the relationship between PC-AKI and different types of contrast media (CMs), different doses of CM, and different examination methods in this specific population. MATERIALS AND METHODS Patients with diabetes in whom CM was used between 2010 and 2020 at our institution were included. Participants were identified according to the following three schemes: Scheme 1 (n=5911), SCr was detected before and within 72 h after using CM; Scheme 2 (n=2385), SCr was detected within 24 h before and within 24-72 h after using CM; and Scheme 3 (n=81), SCr was detected within 24 h before and within 0-24, 24-48, and 48-72 h after using CM. The incidence of PC-AKI with different types of CM, incidence of PC-AKI on digital subtraction angiography (DSA) and enhanced computed tomography (CT), proportion of PC-AKI with different doses of CM, and baseline SCr at different stages of PC-AKI were compared. Multivariate logistic regression analysis was used to explore risk factors for PC-AKI. RESULTS A total of 29,081 patients were included in this study. The incidence of PC-AKI in Scheme 3 (22.22%) was higher than those in Schemes 1 (6.19%) and 2 (7.71%). The incidence of PC-AKI on DSA was higher than that on enhanced CT (8.30% vs. 5.80%; P<0.05). The incidence of PC-AKI in the increased-dose CM group was higher than that in the non-increased-dose CM group (7.9% vs. 5.7%; P<0.01). Moreover, there were differences in baseline SCr values at different stages of PC-AKI (P<0.01). Multivariate logistic regression analysis showed that hypertension, chronic kidney disease, heart failure, peripheral vascular disease, metformin, diuretics, and CM dose were risk factors for PC-AKI. CONCLUSION The incidence of PC-AKI increased significantly with increasing time requirement and frequency of SCr detection. Moreover, before using CM, we should control the blood pressure and heart failure, stop using metformin and diuretics, and use CMs at the minimum dose to avoid PC-AKI.
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Affiliation(s)
- Jixiang Ying
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Endocrinology and Metabolism, West China Longquan Hospital Sichuan University, and The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Junren Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran, ; Xiaoxi Zeng,
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran, ; Xiaoxi Zeng,
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Gao
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhong
- Department of Endocrinology and Metabolism, West China Longquan Hospital Sichuan University, and The First People’s Hospital of Longquanyi District, Chengdu, China
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Li J, Peng Y, Zhang X, Yang C, Li X, He H, Li Q, Shu C. Endovascular repair of abdominal aortic or iliac artery pathologies in patients with autosomal dominant polycystic kidney disease. INT ANGIOL 2021; 41:41-47. [PMID: 34751540 DOI: 10.23736/s0392-9590.21.04692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aims to evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) of abdominal aortic or iliac artery pathologies in patients with autosomal dominant polycystic kidney disease (ADPKD). METHODS From January 2014 to December 2019, fifteen consecutive patients (13 men, mean age 69.3 years, range 56-82 years) with abdominal aortic or iliac artery pathologies coexisting with ADPKD underwent EVAR in our department. Their general data, perioperative results and follow-up outcomes were retrospectively reviewed and analyzed. RESULTS:Among the fifteen patients, eleven had abdominal aortic aneurysms, one had isolated abdominal aortic dissection and the other three had iliac artery aneurysms. Three patients had thoracic penetrating aortic ulcer and two had intracranial aneurysms as the comorbidities. All patients underwent EVAR with the aorto-iliac pathologies successfully excluded. The average operative time was 171±73 minutes and average contrast volume was 87±12mL. The average follow-up time was 38.4 months (range 6-60). Aorta-bi-iliac stent-grafts were deployed in fourteen patients, while one patient received tubular stent-graft. Two patients underwent simultaneous TEVAR and EVAR, and One underwent EVAR 3 months after TEVAR. One patient was found to have a hematoma at the site of femoral access 3 days after EVAR. One patient was found to have a Type Ib endoleak 5 months after EVAR, and he recovered well with a secondary endovascular intervention. Contrast-induced nephropathy was observed in two patients (13%) post EVAR. Another patient developed renal failure 20 months after EVAR, and was treated with regular hemodialysis. All other patients did not have any reported significant deterioration of renal function during follow-up. No other adverse events, such as death, paraplegia, aneurysm rupture, or open surgery conversion occurred during operation and follow-up. CONCLUSIONS For patients with abdominal aortic or iliac artery diseases coexisting with ADPKD, EVAR had satisfactory mid-term outcomes, without significantly exacerbating the decline of renal function. However, patients with ADPKD might have multiple vascular lesions, especially intracranial aneurysms, which should be paid enough attention in clinical practice.
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Affiliation(s)
- Jiehua Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Yuan Peng
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Xiaolong Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Chenzi Yang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Xin Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Hao He
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Quanming Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Vascular Disease Institute, Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China - .,Vascular Disease Institute, Central South University, Changsha, Hunan, China.,Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Raffort J, Lareyre F, Katsiki N, Mikhailidis DP. Contrast-induced nephropathy in non-cardiac vascular procedures, a narrative review: Part 1. Curr Vasc Pharmacol 2021; 20:3-15. [PMID: 34238194 DOI: 10.2174/1570161119666210708165119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Contrast-induced nephropathy (CIN) is an important complication of iodinated contrast medium (CM) administration, which is associated with both short- and long-term adverse outcomes (e.g., cardiorenal events, longer hospital stay, and mortality). CIN has been mainly studied in relation to cardiac procedures, but it can also occur following non-cardiac vascular interventions. This is Part 1 of a narrative review summarizing the available literature on CIN after non-cardiac vascular diagnostic or therapeutic procedures for aortic aneurysm and carotid stenosis. We discuss the definition, pathophysiology, incidence, risk factors, biomarkers, and consequences of CIN in these settings, as well as preventive strategies and alternatives to limit iodinated CM use. Physicians and vascular surgeons should be aware of CM-related adverse events and the potential strategies to avoid them. Clearly, more research in this important field is required.
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Affiliation(s)
- Juliette Raffort
- Clinical Chemistry Laboratory, University Hospital of Nice. France
| | - Fabien Lareyre
- Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice. France
| | - Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University 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
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10
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Loschi D, Melloni A, Kahlberg A, Chiesa R, Melissano G. Kidney protection in thoracoabdominal aortic aneurysm surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:326-338. [PMID: 33307647 DOI: 10.23736/s0021-9509.20.11745-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute kidney injury (AKI) is a common complication of both open and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). Its definition varies across difference studies, some standardized definitions (RIFLE, AKIN, KDIGO) have been proposed but still not uniformly employed in published papers. Acute kidney injury is multifactorial and is associated with increased in-hospital mortality, long-term mortality and late renal function decline. In addition, AKI is also associated with perioperative spinal cord ischemia. No specific pharmacological strategy has received a strong recommendation with high level of evidence as a protective measure. Fenoldopam, methylprednisolone or mannitol use to prevent AKI is commonly employed, but not supported by literature data. Avoiding nephrotoxic drugs and maintaining an adequate MAP, during and after the procedure plays a key role in preserving kidney function. During open TAAA surgery, renal arteries may be reimplanted using different techniques. The choice of the best option must be tailored to the patient, to reduce ischemic time and guarantee long-term patency. Current experience suggests that cold crystalloid solutions are the best substrates in preventing ischemia-reperfusion injury. Renal perfusion using Custodiol® (Dr Franz-Kohler Chemie GmbH; Bensheim, Germany) 4 °C, even if currently considered off-label, represents an encouraging organ protection tool. In endovascular TAAA repair, techniques such as fusion imaging, use of diluted contrast, and CO<inf>2</inf> subtraction angiography have the potential to reduce postoperative AKI. Visceral vessels patency is closely related to the anatomy. Therefore, accurate endograft design according to these characteristics is crucial for long-term preservation of renal function.
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Affiliation(s)
- Diletta Loschi
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
| | - Andrea Melloni
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Kahlberg
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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11
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Cho KJ. Can CO 2 Be a Savior for Endovascular Aneurysm Repair Candidates with Renal Dysfunction? Critical Tips for Safe CO 2 Angiography. Vasc Specialist Int 2020; 36:66-70. [PMID: 32611838 PMCID: PMC7333086 DOI: 10.5758/vsi.200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/18/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kyung Jae Cho
- Department of Radiology, Frankel Cardiovascular Center, Michigan Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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12
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Cheng EL, Hong Q, Yong E, Chandrasekar S, Tan GWL, Lo ZJ. Validating the use of contrast-induced nephropathy prediction models in endovascular aneurysm repairs. J Vasc Surg 2020; 71:1546-1553. [DOI: 10.1016/j.jvs.2019.07.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/20/2019] [Indexed: 10/25/2022]
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13
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Ostermann M, Cennamo A, Meersch M, Kunst G. A narrative review of the impact of surgery and anaesthesia on acute kidney injury. Anaesthesia 2020; 75 Suppl 1:e121-e133. [PMID: 31903567 DOI: 10.1111/anae.14932] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The epidemiology of peri-operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri-operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri-operative acute kidney injury is associated with an increased risk of short- and long-term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury.
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Affiliation(s)
- M Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - A Cennamo
- Department of Critical Care, Guy's and St Thomas' Hospital, London, UK
| | - M Meersch
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - G Kunst
- Department of Anaesthesia, King's College London, King's College Hospital, London, UK.,School of Cardiovascular Medicine and Sciences, King's College London, British Heart Foundation Centre of Excellence, London, UK
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14
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Li X, Zhang W, Liu J, Gonzalez L, Liu D, Zhang L, Dardik A, Shu C. Contrast-Induced Kidney Nephropathy in Thoracic Endovascular Aortic Repair: A 2-Year Retrospective Study in 470 Patients. Angiology 2019; 71:242-248. [PMID: 31829038 DOI: 10.1177/0003319719893578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We identified changes in renal function in patients who underwent thoracic endovascular aortic repair (TEVAR) and the factors that may influence renal function. Information on 470 consecutive patients was collected. Kidney function and contrast volume were recorded. Unpaired t test, Spearman correlation, and logistic regression were used for statistical analysis. A Kaplan-Meier curve helped clarify our follow-up findings. Mean contrast volume was 90.5 ± 21.2 mL. The change in serum creatinine was significantly correlated with (1) preexisting renal pathology (P = .033) and (2) aortic dissection (AD) involving the renal arteries (P = .019). The change in serum urea nitrogen (ΔBUN) was only significantly correlated with AD involving the renal arteries (P = .0348). Contrast volume (P = .036, odds ratio = 1.010, 95% confidence interval: 1.001-1.019) was a risk factor for contrast-induced nephropathy (CIN) after TEVAR. Survival rates and renal failure rates among no CIN, CIN, and CIN-acute kidney injury groups at longest 27 months follow-up were significantly different. Creatinine and BUN were generally elevated post-TEVAR. Contrast-induced nephropathy post-TEVAR may correlate with renal comorbidities and renal artery involvement. Contrast volume is risk factor for CIN after TEVAR. More attention needs to be paid to patient renal function during follow-up.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Weichang Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Jia Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Luis Gonzalez
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Dingxiao Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Alan Dardik
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Chang Shu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Howell SJ, Thompson JP, Irwin MG. Current challenges in vascular anaesthesia. Br J Anaesth 2018; 117 Suppl 2:ii1-ii2. [PMID: 27566803 DOI: 10.1093/bja/aew271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S J Howell
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Clinical Sciences Building, St James's University Hospital, Leeds LS9 7TF, UK
| | - J P Thompson
- Department of Cardiovascular Sciences, University of Leicester; Anaesthesia & Critical Care, University Hospitals of Leicester NHS Trust, Robert Kilpatrick Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong
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16
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Yang JS, Peng YR, Tsai SC, Tyan YS, Lu CC, Chiu HY, Chiu YJ, Kuo SC, Tsai YF, Lin PC, Tsai FJ. The molecular mechanism of contrast-induced nephropathy (CIN) and its link to in vitro studies on iodinated contrast media (CM). Biomedicine (Taipei) 2018; 8:1. [PMID: 29480796 PMCID: PMC5826038 DOI: 10.1051/bmdcn/2018080101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 11/24/2022] Open
Abstract
Iodinated contrast media (iodinated CM) have increased ability to absorb x-rays and to visualize structures that normally are impossible to observe in a radiological examination. The use of iodinated CM may destory renal function, commonly known as contrast-induced nephropathy (CIN), which can result in acute renal failure (ARF). This review article mainly focuses on the following areas: (1) classifications of iodinated CM: ionic or non-ionic, high-osmolarity contrast media (HOCM), low-osmolarity contrast media (LOCM) and iso-osmolarity contrast media (IOCM); (2) an introduction to the physical and chemical properties of the non-ionic iodinated CM; (3) the management of anaphylactic reaction by iodinated CM; (4) a suggested single injection of adult doses and maximum dose for non-ionic iodinated CM; (5) the molecular mechanism of contrast-induced nephropathy (CIN); (6) In vitro studies on iodinated CM. Based on above information, this review article provide an insight for understanding the drug safety of iodinated CM.
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Affiliation(s)
- Jai-Sing Yang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - Yan-Ru Peng
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Shih-Chang Tsai
- Department of Biological Science and Technology, China Medical University, Taichung 404, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan - School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan - School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chi-Cheng Lu
- Department of Pharmacy, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan
| | - Hong-Yi Chiu
- Department of Pharmacy, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan
| | - Yu-Jen Chiu
- Division of Reconstructive and Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Sheng-Chu Kuo
- Chinese Medicinal Research and Development Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan - School of Pharmacy, China Medical University, Taichung 404, Taiwan
| | - Yuh-Feng Tsai
- Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan - School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan
| | - Ping-Chin Lin
- Department of Medical Imaging, Chia-Yi Christian Hospital, Chiayi 600, Taiwan
| | - Fuu-Jen Tsai
- Genetics Center, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan - School of Chinese Medicine, China Medical University, Taichung 404, Taiwan - Department of Medical Genetics, China Medical University Hospital, Taichung 404, Taiwan
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