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Piechocki M, Przewłocki T, Pieniążek P, Trystuła M, Podolec J, Kabłak-Ziembicka A. A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review: Part I-Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients. J Clin Med 2024; 13:1471. [PMID: 38592280 PMCID: PMC10935176 DOI: 10.3390/jcm13051471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Atherosclerosis is a generalized and progressive disease. Ageing is a key risk factor for atherosclerosis progression that is associated with the increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity and quality of life, and it is associated with reduced life expectancy. Although there is evidence on coronary artery disease management in the elderly, there is insufficient data on the management in older patients presented with atherosclerotic lesions outside the coronary territory. Despite this, trials and observational studies systematically exclude older patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment and referral for endovascular or surgical interventions. Therefore, we attempted to gather data on the prevalence, risk factors, and management strategies in patients with extra-coronary atherosclerotic lesions.
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Affiliation(s)
- Marcin Piechocki
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
| | - Piotr Pieniążek
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
| | - Jakub Podolec
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Locham S, Rodriguez A, Balceniuk MD, Mix D, Newhall K, Doyle A, Glocker R, Ellis J, Stoner M. Contrast-Associated Acute Kidney Injury in High-Risk Patients Undergoing Peripheral Vascular Interventions. Vasc Endovascular Surg 2023:15385744231162941. [PMID: 36880982 DOI: 10.1177/15385744231162941] [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: 03/08/2023]
Abstract
Objective: This study aims to evaluate the use of prophylactic intravenous hydration (IV prophylaxis) and carbon dioxide (CO2) angiography in reducing contrast associated-acute kidney injury (CA-AKI) and determine the overall incidence and risk factors of CA-AKI in high-risk patients undergoing peripheral vascular interventions (PVI). Method: Only patients undergoing elective PVI from 2017 to 2021 with chronic kidney disease (CKD) stage 3-5 in the Vascular Quality Initiative (VQI) database were included. Patients were grouped into IV prophylaxis vs no prophylaxis. The study's primary outcome was CA-AKI, defined as a rise in creatinine (>.5 mg/dL) or new dialysis within 48 hours following contrast administration. Standard univariate and multivariable (logistic regression) analyses were conducted. Results: A total of 4497 patients were identified. Of these, 65% received IV prophylaxis. The overall incidence of CA-AKI was .93%. No significant difference was seen in overall contrast volume (mean (SD): 66.89(49.54) vs 65.94(51.97) milliliters, P > .05) between the 2 groups. After adjusting for significant covariates, the use of IV prophylaxis (OR (95% CI): 1.54(.77-3.18), P = .25) and CO2 angiography (OR (95%CI): .95(.44-2.08), P = .90) was not associated with a significant reduction in CA-AKI compared to the patients with no prophylaxis. The severity of CKD and diabetes were the only predictor of CA-AKI. Compared to patients with no CA-AKI, patients with CA-AKI were at risk of higher 30-day mortality (OR (95% CI): 11.09 (4.25-28.93)) and cardiopulmonary complications (OR (95% CI): 19.03 (8.74-41.39) following PVI (Both P < .001). Conclusion: Using a large national vascular database, our study demonstrates that prophylactic use of IV hydration and CO2 angiography in high-risk CKD patients is not associated with a reduction in renal injury following PVI. Reduced kidney function and history of diabetes is an independent predictor of CA-AKI and patients that develop post-procedural AKI are at an increased risk of morbidity and mortality.
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Affiliation(s)
- Satinderjit Locham
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Alejandra Rodriguez
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mark D Balceniuk
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Doran Mix
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Karina Newhall
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Adam Doyle
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Roan Glocker
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jennifer Ellis
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Michael Stoner
- Division of Vascular Surgery, Department of Surgery, 6923University of Rochester Medical Center, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Moitinho MS, Silva Junior JRD, Cunha MDB, Barbosa DA, Caixeta AM, Pimpinato AG, Junglos AF, Belasco AGDS, Fonseca CDD. Contrast-induced acute kidney injury in patients submitted to coronary angioplasty: prospective cohort. Rev Esc Enferm USP 2022; 56:e20210435. [PMID: 35781323 DOI: 10.1590/1980-220x-reeusp-2021-0435en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/20/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the incidence, risk factors, and associations of clinical outcomes for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after coronary angioplasty. METHOD Prospective cohort of 182 patients followed for three months after undergoing angioplasty, from July 2020 to June 2021. The analyzed variables were sociodemographic, clinical, and those related to the procedure. RESULTS The incidence of CI-AKI was 35.7% (n = 65) and was associated with old age, diabetes mellitus, and chronic kidney disease (p = 0.004, p < 0.001, and p = 0.009, respectively). Out of the 17 patients who died within 90 days, 76.5% had CI-AKI (n = 13), the odds ratio between death and CI-AKI was approximately 7.2 times (95% confidence interval (CI), [2.41;26.36]; p = 0.001). The decrease of one unit in the patient's baseline hemoglobin showed a 6.5% increase for CI-AKI (95% CI, [-0.089; -0.040]; p < 0.0001). CONCLUSION CI-AKI is prevalent in patients with ACS after angioplasty and is related to diabetes mellitus and chronic kidney disease, showing high mortality rates.
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Affiliation(s)
- Matheus Santos Moitinho
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Jumar Reis Da Silva Junior
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Maximina De Barros Cunha
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Dulce Aparecida Barbosa
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | - Adriano Mendes Caixeta
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cardiologia Intervencionista, São Paulo, SP, Brazil
| | - Attilio Galhardo Pimpinato
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cardiologia Intervencionista, São Paulo, SP, Brazil
| | - Alana Francine Junglos
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil
| | | | - Cassiane Dezoti da Fonseca
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem clínica e cirúrgica, São Paulo, SP, Brazil.,Universidade Federal de Sergipe, Programa de Pós-Graduação em Enfermagem, São Cristóvão, SE, Brazil
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Moitinho MS, Silva Junior JRD, Cunha MDB, Barbosa DA, Caixeta AM, Pimpinato AG, Junglos AF, Belasco AGDS, Fonseca CDD. Lesão renal aguda induzida por contraste em pacientes submetidos à angioplastia coronariana: coorte prospectiva. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0435pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Analisar a incidência, os fatores de risco e as associações dos desfechos clínicos para Lesão Renal Aguda Induzida Por Contraste (LRA-IC) em pacientes com Síndrome Coronariana Aguda (SCA) após angioplastia coronariana. Método: Coorte prospectivo de 182 pacientes seguidos por três meses após angioplastia, entre julho de 2020 e junho de 2021. As variáveis foram sociodemográficas, clínicas e relacionadas ao procedimento. Resultados: A incidência de LRA-IC foi de 35,7% (n = 65) e esteve associada à idade avançada, diabetes mellitus e doença renal crônica (respectivamente p = 0,004, p < 0,001 e p = 0,009). Dos 17 pacientes que faleceram em até 90 dias, 76,5% tiveram LRA-IC (n = 13), a razão de chances entre óbito e LRA-IC foi de aproximadamente 7,2 vezes (intervalo de confiança (IC) 95%, [2,41;26,36]; p = 0.001). A diminuição de uma unidade na hemoglobina basal do paciente demonstrou um aumento de 6,5% para LRA-IC (IC 95%, [–0,089; –0,040]; p < 0,0001). Conclusão: Em pacientes com SCA após angioplastia, a LRA-IC tem alta incidência e está relacionada com diabetes mellitus e doença renal crônica, apresentando altos índices de mortalidade.
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Moro AB, Strauch JGN, Groto AD, Toregeani JF. Creatinine level variation in patients subjected to contrast-enhanced tomography: a meta-analysis. J Vasc Bras 2021; 20:e20200161. [PMID: 34267786 PMCID: PMC8256998 DOI: 10.1590/1677-5449.200161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/16/2021] [Indexed: 11/21/2022] Open
Abstract
Variation in the creatinine levels of patients who have undergone contrast-enhanced computed tomography (CT) has been adopted as a practical method for assessment of possible kidney damage caused by the contrast. Criteria employed include an absolute increase in serum creatinine ≥ 0.5 mg/dL or a relative increase ≥ 25% as indicative of possible renal disorders, such as contrast-induced nephropathy (CIN). Our objective was to analyze the incidence of CIN by means of a meta-analysis of nine articles related to incidence of kidney damage caused by contrast, calculating odds ratios (OR) and confidence intervals (95%CI) using RStudio. The overall incidence of CIN in patients who had CT scans was 11.29%, with an OR of 1.38 (95%CI 0.88–2.16). Non-ionic contrasts are safer than other types of contrast, and volumes exceeding 115 mL may be associated with CIN. Preexisting kidney disease had a statistically significant relationship with worse CIN rates.
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Affiliation(s)
| | | | | | - Jeferson Freitas Toregeani
- Centro Universitário Fundação Assis Gurgacz - FAG, Cascavel, PR, Brasil.,Universidade Estadual do Oeste do Paraná - UNIOESTE, Cascavel, PR, Brasil
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Moitinho MS, Santos ES, Caixeta AM, Belasco AGDS, Barbosa DA, Fonseca CDD. Contrast-Induced Nephropathy in patients submitted to percutaneous coronary intervention: an integrative review. Rev Bras Enferm 2020; 73:e20200190. [PMID: 33338170 DOI: 10.1590/0034-7167-2020-0190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE to demonstrate scientific evidence on incidence and factors associated with contrast-induced nephropathy in patients undergoing percutaneous coronary intervention. METHODS an integrative review carried out in the VHL, PubMed, VHL Regional Portal and SciELO databases, of articles published between 2014 and 2019. RESULTS the sample consisted of five original articles, two cohorts, two control cases and a clinical trial. The incidence of contrast-induced nephropathy ranged from 6% to 24%. It stands out among patients with advanced age, male gender, diabetes mellitus, systemic arterial hypertension, volume of contrast infused and osmolarity. Intravenous hydration, sodium bicarbonate, ascorbic acid and statin were important prophylactic agents. CONCLUSION this study envisioned the main risk factors for contrast-induced nephropathy in patients undergoing percutaneous coronary intervention and elucidated preventive measures that guide multidisciplinary health care aiming at a quality and safe care.
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Sardinha DM, Simor A, de Oliveira Moura LD, da Silva AGI, Batista Lima KV, Dias Garcez JC, de Vasconcelos LA, Siqueira dos Santos AL, Gondin Costa Lima LN. Risk Factors for Acute Renal Failure after Cardiac Catheterization Most Cited in the Literature: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103392. [PMID: 32414041 PMCID: PMC7277454 DOI: 10.3390/ijerph17103392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 01/03/2023]
Abstract
Acute renal failure (ARF) represents 17% of the complications of cardiac catheterization (CC), with a high death rate and longer hospitalization time. The objective of this review is to describe the most cited risk factors for acute kidney failure in the literature. It is a descriptive and exploratory Integrative Literature Review (ILR) with a qualitative approach, using articles published in the Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases between the years of 2009 and 2019 in English, Portuguese, and Spanish, including original articles, reviews, and case studies. The search was made using the following descriptors: cardiac catheterism, kidney diseases, risk factors, coronary catheterization, acute kidney injury, acute renal failure, and nephropathies. The organization and analysis of the data was through the application of a questionnaire that was structured by the authors, and the results are presented in a table. For the final sample, 10 articles were sought. The highlighted factors were being elderly, hypertensive, and diabetic; having previous kidney disease, hypotension, heart failure, higher contrast volumes, and types; the use of non-steroidal anti-inflammatory drugs associated to other risk factors; and atrial fibrillation. Atrial fibrillation was the main finding, which has recently been documented. The identification of risk factors provides health professionals with information to plan measures to prevent ARF, minimizing complications, length of stay, and mortality.
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Affiliation(s)
- Daniele Melo Sardinha
- Programa de Pós-Graduação em Epidemiologia e Vigilância em Saúde (PPGEVS), Instituto Evandro Chagas (IEC), Ananindeua 67030-000, Brazil;
- Correspondence: ; Tel.: +5591998188790
| | - Alzinei Simor
- Programa de Pós-Graduação em Enfermagem (PPGENF), Universidade do Estado do Pará (UEPA), Belém 66063-075, Brazil;
| | - Letícia Diogo de Oliveira Moura
- Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Visconde de Souza Franco Avenue, 72, Belém-Pará 66053-000, Brazil; (L.D.d.O.M.); (A.G.I.d.S.); (J.C.D.G.)
- Programa de Pós Graduação em Enfermagem—Modalidade Mestrado Profissional em Enfermagem—UFPA, Belém 67130-600, Brazil;
| | - Ana Gracinda Ignácio da Silva
- Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Visconde de Souza Franco Avenue, 72, Belém-Pará 66053-000, Brazil; (L.D.d.O.M.); (A.G.I.d.S.); (J.C.D.G.)
| | - Karla Valéria Batista Lima
- Programa de Pós Graduação em Enfermagem—Modalidade Mestrado Profissional em Enfermagem—UFPA, Belém 67130-600, Brazil;
| | - Juliana Conceição Dias Garcez
- Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Visconde de Souza Franco Avenue, 72, Belém-Pará 66053-000, Brazil; (L.D.d.O.M.); (A.G.I.d.S.); (J.C.D.G.)
| | | | - Anderson Lineu Siqueira dos Santos
- Programa de Pós-Graduação em Biologia Parasitária na Amazônica (PPGBPA), Instituto Evandro Chagas (IEC) e Universidade do Estado do Pará (UEPA), Belém 66087-670, Brazil;
| | - Luana Nepomuceno Gondin Costa Lima
- Programa de Pós-Graduação em Epidemiologia e Vigilância em Saúde (PPGEVS), Instituto Evandro Chagas (IEC), Ananindeua 67030-000, Brazil;
- Programa de Pós-Graduação em Biologia Parasitária na Amazônica (PPGBPA), Instituto Evandro Chagas (IEC) e Universidade do Estado do Pará (UEPA), Belém 66087-670, Brazil;
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