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Nakamura T, Watanabe M, Sugiura J, Kyodo A, Nobuta S, Nogi K, Nakada Y, Ishihara S, Hashimoto Y, Nakagawa H, Ueda T, Seno A, Nishida T, Onoue K, Hikoso S. Prognostic impact and predictors of persistent renal dysfunction in acute kidney injury after percutaneous coronary intervention for acute myocardial infarction. Sci Rep 2024; 14:6299. [PMID: 38491142 PMCID: PMC10943215 DOI: 10.1038/s41598-024-56929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
This study aimed to evaluate the prognostic impact and predictors of persistent renal dysfunction in acute kidney injury (AKI) after an emergency percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). A total of 877 patients who underwent emergency PCI for AMI were examined. AKI was defined as serum creatinine (SCr) ≥ 0.3 mg/dL or ≥ 50% from baseline within 48 h after PCI. Persistent AKI was defined as residual impairment of SCr ≥ 0.3 mg/dL or ≥ 50% from baseline 1 month after the procedure. The primary outcome was the composite endpoints of death, myocardial infarction, hospitalization for heart failure, stroke, and dialysis. AKI and persistent AKI were observed in 82 (9.4%) and 25 (2.9%) patients, respectively. Multivariate Cox proportional hazards analysis demonstrated that persistent AKI, but not transient AKI, was an independent predictor of primary outcome (hazard ratio, 4.99; 95% confidence interval, 2.30-10.8; P < 0.001). Age > 75 years, left ventricular ejection fraction < 40%, a high maximum creatinine phosphokinase MB level, and bleeding after PCI were independently associated with persistent AKI. Persistent AKI was independently associated with worse clinical outcomes in patients who underwent emergency PCI for AMI. Advanced age, poor cardiac function, large myocardial necrosis, and bleeding were predictors of persistent AKI.
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Affiliation(s)
- Takuya Nakamura
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Junichi Sugiura
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Saki Nobuta
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Nakamura T, Watanabe M, Nogi K, Kosugi T, Hashimoto Y, Ueda T, Doi N, Kawata H, Horii M, Ishigami K, Nakajima T, Watabe H, Abe D, Kuwahara K, Okumura Y, Ozu N, Suzuki S, Kasama S, Saito Y. Prevention of Contrast-Induced Nephropathy After Emergency Percutaneous Coronary Intervention With a Single Bolus Administration of High-Concentrate Sodium Bicarbonate ― Rationale and Design of a Single-Arm Study Compared With Historical Controls ―. Circ Rep 2023; 5:152-156. [PMID: 37025932 PMCID: PMC10072897 DOI: 10.1253/circrep.cr-22-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Contrast-induced nephropathy (CIN) is clinically important because of its poor prognosis. The incidence of CIN is higher in emergency than elective percutaneous coronary intervention (PCI) because there is no established method to prevent CIN. The aim of this study is to evaluate whether bolus administration of a concentrated solution of sodium bicarbonate can prevent CIN in patients undergoing emergency PCI. Methods and Results: This multicenter prospective single-arm trial with historical controls will include patients who are aged ≥20 years and will undergo cardiac catheterization for suspected acute myocardial infarction (AMI). Patients will receive an intravenous bolus administration of concentrated sodium bicarbonate solution (7% or 8.4%, 20 mEq) and will be observed for 72±12 h. Data for the control group, comprising all patients who underwent PCI for AMI between January 1, 2020 and December 31, 2020 across participating hospitals, will be extracted. The primary endpoint is the incidence of CIN, defined as an increase in serum creatinine of >0.5 mg/dL or >25% from baseline within 48±12 h. We will evaluate the endpoints in the prospective group and compare them with those in the historical control group. Conclusions: This study will evaluate whether a single bolus administration of concentrated sodium bicarbonate can prevent CIN after emergency PCI.
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Affiliation(s)
- Takuya Nakamura
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University
| | | | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Naofumi Doi
- Department of Cardiology, Nara Prefecture Seiwa Medical Center
| | - Hiroyuki Kawata
- Department of Cardiology, Nara Prefecture General Medical Center
| | - Manabu Horii
- Department of Cardiovascular Medicine, Nara City Hospital
| | | | - Tamio Nakajima
- Department of Internal Medicine, Yamato Kashihara Hospital
| | - Hiroaki Watabe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Daisuke Abe
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital
| | - Naoki Ozu
- Clinical and Translational Science, Nara Medical University Hospital
| | - Shota Suzuki
- Clinical and Translational Science, Nara Medical University Hospital
| | - Shu Kasama
- Clinical and Translational Science, Nara Medical University Hospital
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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Watanabe M. Prediction of Persistent Renal Dysfunction Following Contrast-Induced Nephropathy After Cardiac Catheterization Procedures. Circ J 2023; 87:266-267. [PMID: 36384896 DOI: 10.1253/circj.cj-22-0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
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Takahashi T, Watanabe T, Aono T, Otaki Y, Wanezaki M, Nishiyama S, Kutsuzawa D, Kato S, Tamura H, Arimoto T, Takahashi H, Watanabe M. Prognostic Impact of Renal Dysfunction at 1-Year Follow-Up on Clinical Outcomes After Percutaneous Coronary Intervention. J Atheroscler Thromb 2022. [PMID: 36123047 DOI: 10.5551/jat.63746] [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: 11/11/2022] Open
Abstract
AIMS Renal dysfunction is an independent predictor of adverse outcomes in patients with coronary artery disease (CAD). However, the prognostic impact of mid-term changes in renal dysfunction status remains unclear. This study aimed to investigate the impact of mid-term changes in renal dysfunction status on long-term clinical outcomes in CAD patients who underwent percutaneous coronary intervention (PCI). METHODS We enrolled 382 consecutive patients with CAD who underwent PCI. Renal dysfunction was defined as a reduced estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73m 2. Renal dysfunction status was evaluated at baseline and 1-year follow-up after PCI. We divided the study population into three groups: persistent renal dysfunction, new-onset renal dysfunction, and no or improved renal dysfunction at 1-year follow-up as compared with on baseline. The endpoints of this study were composite events, including all-cause death, acute coronary syndrome, target vessel revascularization, and stroke. RESULTS At baseline, renal dysfunction was observed in 77 patients (20%). At the 1-year follow-up, new-onset renal dysfunction was observed in 46 patients (12%), and 59 patients (15%) had persistent renal dysfunction. Kaplan-Meier analysis revealed a significantly higher event rate in patients with persistent renal dysfunction and new-onset renal dysfunction (log-rank test, P=0.0003). In the multivariate Cox proportional hazards analysis, persistent renal dysfunction and new-onset renal dysfunction were independently associated with composite events after adjusting for confounding factors (adjusted hazard ratios 4.08 and 2.64, 95% confidence intervals 1.72-9.57 and 1.03-6.31, P=0.0016, P=0.0045, respectively). CONCLUSION Persistent and new-onset renal dysfunction at 1-year follow-up were associated with unfavorable outcomes in patients with CAD who underwent PCI.
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Affiliation(s)
- Tetsuya Takahashi
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital
| | - Tetsu Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tomonori Aono
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Yoichiro Otaki
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Masahiro Wanezaki
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Satoshi Nishiyama
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Daisuke Kutsuzawa
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Shigehiko Kato
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Harutoshi Tamura
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Takanori Arimoto
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Hiroki Takahashi
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Masafumi Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
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Watanabe M, Aonuma K, Murohara T, Okumura Y, Morimoto T, Okada S, Nakamura S, Uemura S, Kuwahara K, Takayama T, Doi N, Nakajima T, Horii M, Ishigami K, Nomoto K, Abe D, Oiwa K, Tanaka K, Koyama T, Sato A, Ueda T, Soeda T, Saito Y. Prevention of Contrast-Induced Nephropathy After Cardiovascular Catheterization and Intervention With High-Dose Strong Statin Therapy in Japan - The PREVENT CINC-J Study. Circ J 2022; 86:1455-1463. [PMID: 35466156 DOI: 10.1253/circj.cj-21-0869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
BACKGROUND Previous studies have reported that high-dose strong statin therapy reduces the incidence of contrast-induced nephropathy (CIN) in statin naïve patients; however, the efficacy of high-dose strong statins for preventing CIN in real-world clinical practice remains unclear. The aim of this study was to evaluate the efficacy of strong statin therapy in addition to fluid hydration for preventing CIN after cardiovascular catheterization. METHODS AND RESULTS This prospective, multicenter, randomized controlled trial included 420 patients with chronic kidney disease who underwent cardiovascular catheterization. They were assigned to receive high-dose pitavastatin (4 mg/day × 4 days) on the day before and of the procedure and 2 days after the procedure (Statin group, n=213) or no pitavastatin (Control group, n=207). Isotonic saline hydration combined with a single bolus of sodium bicarbonate (20 mEq) was scheduled for administration to all patients. In the control group, statin therapy was continued at the same dose as that before randomization. CIN was defined as a ≥0.5 mg/dL increase in serum creatinine or ≥25% above baseline at 48 h after contrast exposure. Before randomization, 83% of study participants were receiving statin treatment. The statin group had a higher incidence of CIN than the control group (3.0% vs. 0%, P=0.01). The 12-month rate of major adverse cardiovascular events was similar between the 2 groups. CONCLUSIONS High-dose pitavastatin increases the incidence of CIN in this study population.
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Affiliation(s)
- Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital
| | | | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University
| | | | - Shiro Uemura
- Division of Cardiology, Kawasaki Medical School Hospital
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine
| | | | - Naofumi Doi
- Department of Cardiology, Nara Prefecture Seiwa Medical Center
| | | | - Manabu Horii
- Department of Cardiovascular Medicine, Nara City Hospital
| | | | | | - Daisuke Abe
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital
| | - Koji Oiwa
- Department of Cardiology, Japan Community Health Care Organization, Yokohama Chuo Hospital
| | | | | | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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Saito Y, Deguchi Y, Nakao M, Shiraishi H, Sakamoto N, Kobayashi S, Kobayashi Y. Predictivity of acute kidney injury risk scores for late kidney injury in patients with chronic coronary syndrome. Heart Vessels 2022; 37:1971-1976. [PMID: 35635569 DOI: 10.1007/s00380-022-02105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/04/2022]
Abstract
Late rather than acute kidney injury after percutaneous coronary intervention (PCI) has been recently recognized as a predictor of future adverse events in patient with coronary artery disease. The risk-predicting models for acute kidney injury reported by Mehran et al., Bartholomew et al., and Tsai et al. were derived from a large cohort and externally validated, although the applicability of these models for predicting late kidney injury is unknown. A total of 327 patients undergoing elective PCI procedures were included. We calculated the three scores and tested their diagnostic ability for predicting late kidney injury (> 6 months after PCI), defined as an increase in creatinine levels ≥ 0.3 mg/dl or ≥ 50% from baseline. During the median follow-up period of 28 months, 27 (8.3%) patients had late kidney injury. All three scores significantly predicted late kidney injury, among which the score by Tsai et al. had a better diagnostic ability (area under the curve 0.83, best cut-off value 14, p < 0.001). With the best cut-off value, patients with Tsai score ≥ 14 had a significantly higher rate of late kidney injury than their counterpart (27.4% vs. 2.8%, p < 0.001). In conclusion, established risk scores for acute kidney injury may be useful for predicting late kidney injury after PCI in patients with chronic coronary syndrome.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Yuki Deguchi
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Motohiro Nakao
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Hirokazu Shiraishi
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Naoya Sakamoto
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Satoru Kobayashi
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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崔 运, 姚 亮, 冯 敏, 张 婧, 张 大. [Diffusion-weighted magnetic resonance imaging instead of contrast-enhanced imaging for evaluating immediate therapeutic efficacy of high-intensity focused ultrasound ablation of adenomyosis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1583-1587. [PMID: 34755676 PMCID: PMC8586868 DOI: 10.12122/j.issn.1673-4254.2021.10.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the feasibility of diffusion-weighted magnetic resonance imaging (DWI) instead of contrast-enhanced (CE) imaging for evaluation of the immediate therapeutic efficacy of high-intensity focused ultrasound (HIFU) ablation for treatment of adenomyosis. METHODS We retrospectively analyzed the data of 29 patients aged 40.5 ± 5.4 years under going HIFU treatment for adenomyosis in our hospital between December, 2017 and July, 2020. The patients received MRI examination both before and within 24 h after the operation. Two observers analyzed the morphology of the ablation area on DWI and classified the lesions into type 1 (spot-like or no obvious signal intensity changes), type 2 (patchy signal intensity changes) and type 3 (ring-like signal intensity changes). The inter- and intra-observer reliability of morphological assessment was assessed using kappa test. The volume of necrotic tissues following the ablation was measured with both DWI and CE imaging, and the consistency of the measurements and the inter- and intra-observer reliability of DWI-based measurements were evaluated using Bland-Altman plot tests. RESULTS The median volume of necrotic tissues was 36.9 cm3 (range 16.4-65.5 cm3) following ablation of the 29 lesions. DWI findings identified 24-25 (82.8%-86.2%) lesions with type 2 or 3 signal changes following the ablation with measurable necrotic tissue volume. On DW images, the Kappa value of intra- and inter-observer reliability for morphological classification of the ablation area reached 0.798 (P=0.000) and 0.933 (P= 0.000), respectively. Bland-Altman plots showed a good consistency of the necrotic volumes measured by CE and at DWI with a strong inter- and intra-observer reliability of DWI-based volume measurements (with only one point outside the range of 95% limits of agreement). The remaining 4 or 5 lesions, which presented with type 1 signal changes following ablation, were all small in size (the largest was only 18.61 cm3) and showed poor therapeutic responses to the ablation. CONCLUSION DWI-based morphological assessment and necrotic tissue volume measurement can replace CE imaging for assessment of the immediate therapeutic efficacy of HIFU ablation for treatment of adenomyosis.
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Affiliation(s)
- 运能 崔
- 南方医科大学附属佛山妇幼保健院放射科,广东 佛山 528000Department of Radiology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China
| | - 亮凤 姚
- 南方医科大学附属佛山妇幼保健院放射科,广东 佛山 528000Department of Radiology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China
| | - 敏清 冯
- 南方医科大学附属佛山妇幼保健院妇科,广东 佛山 528000Department of Gynecology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China
| | - 婧 张
- 南方医科大学附属佛山妇幼保健院放射科,广东 佛山 528000Department of Radiology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China
| | - 大伟 张
- 南方医科大学附属佛山妇幼保健院放射科,广东 佛山 528000Department of Radiology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan 528000, China
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Kwon C, Kang KM, Choi YH, Yoo RE, Sohn CH, Han SS, Yoon SH. Renal Safety of Repeated Intravascular Administrations of Iodinated or Gadolinium-Based Contrast Media within a Short Interval. Korean J Radiol 2021; 22:1547-1554. [PMID: 34132080 PMCID: PMC8390825 DOI: 10.3348/kjr.2020.1153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to investigate whether repeated intravascular administration of iodinated contrast media (ICM) or gadolinium-based contrast agents (GBCAs) within a short interval was associated with an increased risk of post-contrast acute kidney injury (PC-AKI). MATERIALS AND METHODS This retrospective study included 300 patients (mean age ± standard deviation, 68.5 ± 8.1 years; 131 male and 169 female) who had undergone at least one ICM-enhanced perfusion brain CT scan, had their baseline and follow-up serum creatinine levels available, and had not undergone additional contrast-enhanced examinations 72 hours before and after a time window of interest were included. The study population was divided into three groups: single-dose group and groups of patients who had received multiple contrast administrations in the time window of interest with the minimum contrast repeat interval either within 4 hours (0-4-hour group) or between 4 to 48 hours (4-48-hour group). Multivariable logistic regression analysis was conducted to evaluate the association between AKI and repeated ICM administrations. A similar supplementary analysis was performed including both ICM and GBCA. RESULTS When ICM was only considered ignoring GBCA, among 300 patients, 207 patients received a single dose of ICM, 58 had repeated doses within 4 hours (0-4-hour group), and 35 patients had repeated doses between 4 to 48 hours (4-48-hour group). Most patients (> 95%) had a baseline estimated glomerular filtration rate (eGFR) of ≥ 30 mL/min/1.73 m². AKI occurred in 7.2%, 13.8%, and 8.6% of patients in the single-dose, 0-4-hour, and 4-48-hour groups, respectively. In the 0-4-hour and 4-48-hour groups, additional exposure to ICM was not associated with AKI after adjusting for comorbidities and nephrotoxic drugs (all p values > 0.05). CONCLUSION Repeated intravascular administrations of ICM within a short interval did not increase the risk of AKI in our study patients suspected of acute stroke with a baseline eGFR of ≥ 30 mL/min/1.73 m².
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Affiliation(s)
- Chiheon Kwon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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Deguchi Y, Saito Y, Nakao M, Shiraishi H, Sakamoto N, Kobayashi S, Kobayashi Y. Trajectory of renal function change and kidney injury after percutaneous coronary intervention in patients with stable coronary artery disease. Heart Vessels 2020; 36:315-320. [PMID: 32930865 DOI: 10.1007/s00380-020-01701-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
Acute kidney injury usually assessed within 48 h after percutaneous coronary intervention (PCI) is associated with poor clinical outcomes, and persistent kidney damage is also strongly related to long-term mortality. However, little is known about longitudinal renal function change from a very early period to long-term follow-up after PCI. A total of 327 patients with stable coronary artery disease underwent elective PCI. Renal function was assessed with serum creatinine levels and estimated glomerular filtration rate (eGFR) at baseline, 1 day after PCI, at 1 year and at the latest follow-up. Kidney injury was defined as an increase in creatinine levels ≥ 0.3 mg/dl or ≥ 50% from baseline at each timepoint. Major adverse cardiovascular events (MACE) was defined as a composite of death, myocardial infarction, and stroke. eGFR was significantly increased 1 day after PCI, while it was progressively decreased at 1-year and long-term follow-up (median 28 months). Overall, eGFR was declined by - 2.3 ml/min/1.73 m2 per year. Only one (0.3%) patient developed kidney injury 1 day after PCI, whereas kidney injury at 1-year and long-term follow-up was observed in 15 (4.6%) and 27 (8.3%). During the follow-up period, 23 (7.0%) patients had MACE. The incidence of subsequent MACE was significantly higher in patients with kidney injury at 1 year than those without. In conclusion, kidney injury within 24 h after elective PCI was rarely observed. eGFR was progressively decreased over time, and mid-term kidney injury at 1 year was associated with future MACE.
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Affiliation(s)
- Yuki Deguchi
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Yuichi Saito
- Yale University School of Medicine, New Haven, USA.
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Motohiro Nakao
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Hirokazu Shiraishi
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Naoya Sakamoto
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Satoru Kobayashi
- Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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