Comparison of Serum Cystatin C and Creatinine Level Changes for Prognosis of Patients After Peripheral Arterial Angiography

Contrast-induced nephropathy in non-cardiac vascular procedures, a narrative review: Part 2

This is Part 2 of a narrative review summarizing the literature on CIN after non-cardiac vascular diagnostic or therapeutic procedures, focusing on peripheral artery disease (PAD) and renal artery stenosis (RAS). Part 1 discussed CIN in relation to aortic aneurysms and carotid stenosis. We comment on the incidence, biomarkers, risk factors, and consequences of CIN in patients with PAD or RAS, as well as on strategies to prevent CIN. Future perspectives in the field of CIN in relation to non-cardiac vascular procedures are also considered.

Cystatin C as a biomarker of chronic kidney disease: latest developments

INTRODUCTION

Chronic kidney disease (CKD) is common, occurring in over 10% of individuals globally, and is increasing in prevalence. The limitations of traditional biomarkers of renal dysfunction, such as serum creatinine, have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as serum cystatin C, has the potential to improve disease monitoring and patient care.

AREAS COVERED

The present paper assesses the utility and limitations of serum cystatin C as a biomarker for CKD in light of the current literature.

EXPERT OPINION

Serum cystatin C has been well established as an early and accurate biomarker of CKD that is particularly helpful in patients for whom creatinine is an inadequate marker or for whom more cumbersome methods of glomerular filtration rate (GFR) measurement are impractical. Current research questions are no longer focused on if, but rather when and how often cystatin C should be used in the evaluation of CKD patients. However, transition of all reagents and estimated GFR equations to the newly established International Standard is critical for developing generalizable data.

Utility of cystatin C-based equations in patients undergoing dialysis

Serum cystatin C (CysC) measurement is regarded as a simple and practical alternative to measure residual renal function for dialysis patients. Recent studies have shown that CysC has better diagnostic accuracy or at least equivalence to creatinine in predicting the early stages of renal damage, and is closely related to clinical outcomes of dialysis patients. Thus, the applicability of CysC-derived equations in patients undergoing dialysis should be paid attention. Here, we review the role of CysC in diagnosis, renal function evaluation, and prognosis outcomes for dialysis patients, so as to provide them with useful suggestions on evaluating renal function and predicting adverse outcomes in clinical practice.

Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature

OBJECTIVE

We conducted a meta-analysis to compare the incidence of acute kidney injury (AKI) with carbon dioxide (CO₂ ) versus iodinated contrast media (ICM).

BACKGROUND

Contrast induced-acute kidney injury (CI-AKI) is a known complication following endovascular procedures with ICM. CO₂ has been employed as an alternative imaging medium as it is nontoxic to the kidneys.

METHODS

Search of indexed databases was performed and 1,732 references were retrieved. Eight studies (7 observational, 1 Randomized Controlled Trial) formed the meta-analysis. Primary outcome was AKI. Fixed effect model was used when possible in addition to analysis of publication bias.

RESULTS

In this meta-analysis, 677 patients underwent 754 peripheral angiographic procedures. Compared with ICM, CO₂ was associated with a decreased incidence of AKI (4.3% vs. 11.1%; OR 0.465, 95% CI: 0.218-0.992; P = 0.048). Subgroup analysis of four studies that included granular data for patients with chronic kidney disease (CKD) did not demonstrate a decreased incidence of AKI with CO₂ (4.1% vs. 10.0%; OR 0.449, 95% CI: 0.165-1.221, P = 0.117). Patients undergoing CO₂ angiography experienced a higher number of nonrenal events including limb/abdominal pain (11 vs. 0; P = 0.001) and nausea/vomiting (9 vs. 1; P = 0.006).

CONCLUSIONS

In comparison to ICM, CO₂ use is associated with a modestly reduced rate of AKI with more frequent adverse nonrenal events. In studies that use CO₂ as the primary imaging agent, the average incidence of AKI remained high at 6.2%-supporting the concept that factors other than renal toxicity from ICM may contribute to renal impairment following peripheral angiography. © 2017 Wiley Periodicals, Inc.