1
|
Somkereki C, Palfi R, Scridon A. Prevention of contrast-associated acute kidney injury in an era of increasingly complex interventional procedures. Front Med (Lausanne) 2024; 10:1180861. [PMID: 38264052 PMCID: PMC10803418 DOI: 10.3389/fmed.2023.1180861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Radiological and interventional cardiology procedures are in continuous expansion, leading to an important increase in the incidence of contrast-associated acute kidney injury (CA-AKI). Although numerous methods of CA-AKI prevention have been studied, at present, there is no consensus on the definition of this entity or on its prevention. In this paper, we aim to provide a critical analysis of the existing data on the epidemiology, pathophysiology, and clinical significance of CA-AKI. Existing and emergent approaches for CA-AKI prevention are also discussed, with a focus on parenteral fluid administration and on the most recent clinical and experimental data. We also emphasize a number of questions that remain to be answered, and we identify hotspots for future research.
Collapse
Affiliation(s)
- Cristina Somkereki
- Cardiology Department, Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
- Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
| | - Renata Palfi
- Cardiology Department, Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
| | - Alina Scridon
- Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
| |
Collapse
|
2
|
Sůva M, Kala P, Poloczek M, Kaňovský J, Štípal R, Radvan M, Hlasensky J, Hudec M, Brázdil V, Řehořová J. Contrast-induced acute kidney injury and its contemporary prevention. Front Cardiovasc Med 2022; 9:1073072. [PMID: 36561776 PMCID: PMC9763312 DOI: 10.3389/fcvm.2022.1073072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.
Collapse
Affiliation(s)
- Marek Sůva
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia,*Correspondence: Petr Kala,
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Kaňovský
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Roman Štípal
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Radvan
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jiří Hlasensky
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Hudec
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Vojtěch Brázdil
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jitka Řehořová
- Department of Internal Medicine and Gastroenterology, University Hospital, Brno, Czechia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Liu X, Zhang P, Zhang J, Zhang X, Yang S, Fu N. The Preventive Effect of Alprostadil on the Contrast-Induced Nephropathy of Coronary Heart Disease Treated by Percutaneous Coronary Intervention in Moderate and High-Risk Population Stratified by Mehran Score. Angiology 2021; 73:33-41. [PMID: 34098771 DOI: 10.1177/00033197211015540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Mehran risk score (MRS) was used to classify patients with coronary heart disease and evaluate the preventive effect of alprostadil on contrast-induced nephropathy (CIN) after percutaneous coronary intervention. The patients (n = 1146) were randomized into an alprostadil and control group and then divided into 3 groups on the basis of the MRS: low-risk, moderate-risk, and high-risk groups. The primary end point was the occurrence of CIN (alprostadil + hydration vs simple hydration treatment); secondary end points included serum creatinine, blood urea nitrogen, creatinine clearance rate, cystatin C, interleukin-6, C-reactive protein, proteinuria, and differences in the incidence of major adverse events. In the low-risk, moderate-risk, and high-risk groups, the incidence of CIN in the control and alprostadil group was 2.9 versus 2.6% (P = .832), 11.4 versus 4.9% (P = .030), 19.1 versus 7.7% (P = .041), respectively. Multivariate logistic regression analysis showed that alprostadil treatment was a favorable protective factor for moderate-risk and high-risk CIN patients (OR = 0.343, 95% CI: 0.124-0.951, P = .040). Alprostadil can be used as a preventive treatment for moderate- and high-risk CIN patients classified by the MRS. The reduction of CIN by alprostadil may be related to an anti-inflammatory effect.
Collapse
Affiliation(s)
- Xiaogang Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xue Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Shicheng Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| |
Collapse
|
5
|
Xu H, Wang H, Zhang C, Xiao J, Hua N, Tang X, Xie J, Zhang Z. Efficacy of Alprostadil in Preventing Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis. Angiology 2021; 72:878-888. [PMID: 33853365 DOI: 10.1177/00033197211004412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to determine the efficacy of alprostadil in preventing contrast-induced nephropathy (CIN). Eligible studies were searched using the keywords through the databases of PubMed, Cochrane, Embase, China Biological Medicine Database, China National Knowledge Infrastructure, and Vanfun. Quality evaluation of the included studies was conducted according to international evidence evaluation and recommended Grades of Recommendations Assessment, Development, and Evaluation standards. We included 29 studies with 5623 patients. Compared with hydration, 10 µg/d alprostadil or 20 µg/d alprostadil plus hydration significantly decreased the incidence of CIN. Compared with hydration, alprostadil plus hydration significantly reduced serum creatinine and blood urea nitrogen at 24, 48, and 72 hours and 7 days after coronary angiography (CAG). Alprostadil (20 µg/d) plus hydration significantly decreased serum cystatin versus hydration at 24, 48, and 72 hours after CAG. Compared with hydration, alprostadil plus hydration significantly increased glomerular filtration rate at 24 and 72 hours after CAG. Alprostadil plus hydration significantly decreased neutrophil gelatinase-associated lipocalin levels compared to hydration at 24, 48, and 72 hours after CAG. Alprostadil plus hydration significantly decreased urine macroglobulin versus hydration at 24 and 48 hours after CAG.
Collapse
Affiliation(s)
- Hongling Xu
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.,These authors contributed equally to this paper
| | - Hongye Wang
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.,These authors contributed equally to this paper
| | - Chuang Zhang
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.,These authors contributed equally to this paper
| | - Jun Xiao
- Department of Geriatric Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ning Hua
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xuezheng Tang
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiaqi Xie
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhengbin Zhang
- Department of Cardiology, The 8th Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| |
Collapse
|
6
|
Paraskevas KI, Geroulakos G, Vlahakos DV. Contrast-Induced Nephropathy after Endovascular Aneurysm Repair, Carotid and Peripheral Interventions. Curr Vasc Pharmacol 2019; 18:531-532. [PMID: 31455200 DOI: 10.2174/1570161117999190821145924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, 'Attikon' University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, 'Attikon' University Hospital, Athens, Greece
| | | |
Collapse
|
7
|
Xie J, Jiang M, Lin Y, Li L. Re: Effect of Alprostadil in the Prevention of Contrast-Induced Nephropathy: A Meta-Analysis of 36 Randomized Controlled Trials. Angiology 2019; 71:97. [PMID: 31426651 DOI: 10.1177/0003319719870398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jian Xie
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China
| | - Mingyang Jiang
- First Clinical Medical College, Guangxi Medical University, Nanning, Guangxi, China
| | - Yunni Lin
- First Clinical Medical College, 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
|
8
|
Affiliation(s)
- Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| |
Collapse
|
9
|
Zhao Y, Geng X, Zhang T, Wang X, Xue Y, Dong K. Assessment of radiation dose and iodine load reduction in head-neck CT angiography using two scan protocols with wide-detector. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:981-993. [PMID: 31450541 DOI: 10.3233/xst-190541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare image quality, radiation dose, and iodine intake of head-neck CT angiography (CTA) acquired by wide-detector with the gemstone spectral imaging (GSI) combination with low iodine intake or routine scan protocol. METHODS Three hundred patients who had head-neck CTA were enrolled and divided into three groups according to their BMI values: group A (18.5 kg/m2 ≦ BMI <24.9 kg/m2), group B (24.9 kg/m2 ≦ BMI <29.9 kg/m2) and group C (29.9 kg/m2 ≦ BMI ≦ 34.9 kg/m2) with 100 patients in each group. Patients in each group were randomly divided into two subgroups (n = 50) namely, A1, A2, B1, B2, C1 and C2. The patients in subgroups A1, B1 and C1 underwent GSI with low iodine intake (270 mgI/ml, 50 ml) and combined with the ASiR-V algorithm. Other patients underwent three dimensional (3D) smart mA modulation with routine iodine intake (350 mgI/ml, 60 ml). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were calculated after angiography. Images were then subjectively assessed using a 5-point scale. CT dose index of volume and dose-length product (DLP) was converted to the effective dose (ED) and then compared. RESULTS The mean CT values, SNR, CNR and subjective image quality in subgroups A2, B2 and C2 are significantly lower than in subgroups A1, B1, and C1 (P < 0.01), respectively. The ED values in subgroup A1, B1, and C1 are 55.18%, 61.89%, and 69.64% lower than those in A2, B2, and C2, respectively (P < 0.01). The total iodine intakes in subgroups A1, B1, and C1 are 35.72% lower than those in subgroups A2, B2, and C2. CONCLUSIONS The gemstone spectral imaging with monochromatic images at 53-57 keV combined with ASiR-V algorithm allows significant reduction in iodine load and radiation dose in head-neck CT angiography than those yielded in routine scan protocol. It also enhances signal intensity of head-neck CTA and maintains image quality.
Collapse
Affiliation(s)
- Yongxia Zhao
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Xue Geng
- College of Medicine, Hebei University, Baoding, China
| | - Tianle Zhang
- College of Medicine, Hebei University, Baoding, China
| | - Xiuzhi Wang
- College of Medicine, Hebei University, Baoding, China
| | - Yize Xue
- College of Medicine, Hebei University, Baoding, China
| | - Kexin Dong
- College of Medicine, Hebei University, Baoding, China
| |
Collapse
|