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Chaudhary S, Kashani KB. Acute Kidney Injury Management Strategies Peri-Cardiovascular Interventions. Interv Cardiol Clin 2023; 12:555-572. [PMID: 37673499 DOI: 10.1016/j.iccl.2023.06.008] [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: 09/08/2023]
Abstract
In many countries, the aging population and the higher incidence of comorbid conditions have resulted in an ever-growing need for cardiac interventions. Acute kidney injury (AKI) is a common complication of these interventions, associated with higher mortalities, chronic or end-stage kidney disease, readmission rates, and hospital and post-discharge costs. The AKI pathophysiology includes contrast-associated AKI, hemodynamic changes, cardiorenal syndrome, and atheroembolism. Preventive measures include limiting contrast media dose, optimizing hemodynamic conditions, and limiting exposure to other nephrotoxins. This review article outlines the current state-of-art knowledge regarding AKI pathophysiology, risk factors, preventive measures, and management strategies in the peri-interventional period.
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Affiliation(s)
- Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Pioli MR, Couto RM, Francisco JDA, Antoniassi DQ, de Souza CR, de Olivio MY, Anhê GF, Giopatto S, Sposito AC, Nadruz W, Coelho-Filho OR, Modolo R. Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions. Arq Bras Cardiol 2023; 120:e20220529. [PMID: 36856244 PMCID: PMC9972663 DOI: 10.36660/abc.20220529] [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: 07/25/2022] [Accepted: 10/05/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH). OBJETIVE To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures. METHODS In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05. RESULTS In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68). CONCLUSION The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.
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Affiliation(s)
- Mariana Rodrigues Pioli
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina TranslacionalCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Translacional, Programa de Farmacologia, Campinas, SP – Brasil
| | - Renata Muller Couto
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - José de Arimatéia Francisco
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - Diego Quilles Antoniassi
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - Célia Regina de Souza
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - Matheus Ynada de Olivio
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - Gabriel Forato Anhê
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina TranslacionalCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Translacional, Programa de Farmacologia, Campinas, SP – Brasil
| | - Silvio Giopatto
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - Andrei C. Sposito
- Universidade Estadual de CampinasLaboratório de Aterosclerose e Biologia VascularCampinasSPBrasilUniversidade Estadual de Campinas (UNICAMP) – Laboratório de Aterosclerose e Biologia Vascular (Atherolab), Campinas, SP – Brasil
| | - Wilson Nadruz
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
| | - Otavio Rizzi Coelho-Filho
- Universidade Estadual de CampinasCampinasSPBrasilUniversidade Estadual de Campinas (UNICAMP) – Disciplina de Cardiologia, Campinas, SP – Brasil
| | - Rodrigo Modolo
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Medicina InternaCampinasSPBrasilUniversidade Estadual de Campinas Faculdade de Ciências Médicas – Departamento de Medicina Interna – Divisão de Cardiologia, Campinas, SP – Brasil
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Fluid administration strategies for the prevention of contrast-associated acute kidney injury. Curr Opin Nephrol Hypertens 2022; 31:414-424. [PMID: 35894275 DOI: 10.1097/mnh.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The known timing of contrast media exposure in patients identified as high-risk for contrast-associated acute kidney injury (CA-AKI) enables the use of strategies to prevent this complication of intravascular contrast media exposure. Although multiple preventive strategies have been proposed, periprocedural fluid administration remains as the primary preventive strategy. This is a critical review of the current evidence evaluating a variety of fluid administration strategies in CA-AKI. RECENT FINDINGS Fluid administration strategies to prevent CA-AKI include comparisons of intravenous (i.v.) to no fluid administration, different fluid solutions, duration of fluid administration, oral hydration, left ventricular end diastolic-pressure guided fluid administration and forced diuresis techniques. SUMMARY Despite an abundance of fluid administration trials, it is difficult to make definitive recommendations about preventive fluid administration strategies due to low scientific quality of published studies. The literature supports use of i.v. compared with no fluid administration, especially in high-risk patients undergoing intra-arterial contrast media exposure. Use of isotonic saline is recommended over 0.45% saline or isotonic sodium bicarbonate. Logistical considerations support shortened over longer i.v. fluid administration strategies, despite an absence of evidence of equivalent efficacy. Current literature does not support oral hydration for high-risk patients. The use of tailored fluid administration in heart failure patients and forced diuresis with matching fluid administration are promising new fluid administration strategies.
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Xie W, Zhou Y, Liao Z, Lin B. Effect of Oral Hydration on Contrast-Induced Acute Kidney Injury among Patients after Primary Percutaneous Coronary Intervention. Cardiorenal Med 2021; 11:243-251. [PMID: 34823253 DOI: 10.1159/000520088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the protective effect of oral hydration volume to weight ratio (OHV/W) on contrast-induced acute kidney injury (CI-AKI) among patients with ST-elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI). METHODS A total of 754 patients with STEMI undergoing PCI were selected. Each patient was encouraged to drink as much water as possible 24 h after PCI. Total volume intake was recorded for all patients. The ratio of OHV/W was calculated. The occurrence of CI-AKI was defined as ≥0.5 mg/dL absolute or ≥25% relative increase in serum creatinine within 48-72 h following PCI. Logistic regression analysis and generalized additive model were performed to evaluate the relationship between OHV/W and CI-AKI. RESULTS There was a nonlinear relationship between OHV/W and CI-AKI with an inflection point of 15.69 mL/kg. On the right side of the inflection point (OHV/W ≥15.69 mL/kg), a negative relationship was detected between OHV/W and CI-AKI (HR = 0.90, 95% CI: 0.82∼0.98, p = 0.0126). However, no relationship was observed between OHV/W and CI-AKI on the left of inflection point (HR = 1.19, 95% CI: 0.95∼1.49, p = 0.1302). Subgroup analysis showed that significant interactions were observed only for gender difference (p for interaction = 0.0155), male patients had a significantly lower risk of CI-AKI (HR = 0.84, 95% CI: 0.75∼0.93, p = 0.0012). CONCLUSION OHV/W ≥15.6 mL/kg for 24 h post-procedure may be an effective preventive strategy of CI-AKI. In addition, male patients may particularly benefit from OHV to prevent CI-AKI.
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Affiliation(s)
- Weining Xie
- Department of Scientific Research, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China,
| | - Yuge Zhou
- Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Foshan, China
| | - Zhishan Liao
- Department of Cardiology, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
| | - Biying Lin
- Department of Nephrology, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
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Zhang P, Zhang X, Zhang J, Song Y, Liu T, Zeng Z, Fu X, Fu H, Zhang H, Qin Q, Fu N, Guo Z. Novel Nanoliposomes Alleviate Contrast-Induced Nephropathy by Mediating Apoptosis Response in New Zealand Rabbits. Front Mol Biosci 2021; 8:681849. [PMID: 34295921 PMCID: PMC8290201 DOI: 10.3389/fmolb.2021.681849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to test the preventive effects of nano liposomes against contrast-induced nephropathy (CIN) in New Zealand rabbits. Sixty New Zealand rabbits were randomly divided into four groups, with 15 rabbits in each group: control group, contrast group, hydration group and nano liposome group. Serum creatinine (Scr) and Blood Urea Nitrogen (BUN) were measured before and after injection of the contrast agent iopromide. Oxidative stress markers, such as superoxide dismutase (SOD) and malondialdehyde (MDA), and apoptosis markers, such as Bcl2-Associated X (Bax) and B-cell lymphoma-2 (Bcl-2), were measured by enzyme-linked immunosorbent assay (ELISA). Rabbits were killed 24 h after injection of the contrast medium and both kidneys were removed. Real-time Polymerase Chain Reaction (RT-PCR) and Western blot assays were performed in kidney tissue. Pathological changes were analyzed under the optical and electron microscope. Compared with the hydration group, the nano liposome group showed improved protection of renal function, with significantly different Scr and BUN levels, incidence of CIN, apoptosis index, RT-PCR and Western blot protein expression patterns. Under the optical and electron microscope, the renal injury in the nano liposome group was less than in the hydration group. However, based on SOD and MDA, there was no significant difference in oxidative stress when compared with the hydration group. Apoptosis is an important mechanism in CIN. Nano liposomes can prevent the occurrence of CIN by decreasing apoptosis, reducing damage to the kidney by the contrast agent.
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Affiliation(s)
- Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xue Zhang
- Department of Cardiology, The Third Central Hospital of Tianjin, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yanqiu Song
- Institute of Cardiovascular Disease, Tianjin Chest Hospital, Tianjin, China
| | - Ting Liu
- Institute of Cardiovascular Disease, Tianjin Chest Hospital, Tianjin, China
| | - Zhican Zeng
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Xiaofeng Fu
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Han Fu
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Hong Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Qin Qin
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Zhigang Guo
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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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.
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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
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Häner JD, Räber L. Oral post-hydration after primary PCI for STEMI. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:425. [PMID: 31700861 DOI: 10.21037/atm.2019.08.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jonas Dominik Häner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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