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McDonald JS, McDonald RJ. Risk of Acute Kidney Injury Following IV Iodinated Contrast Media Exposure: 2023 Update, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol 2024; 223:e2330037. [PMID: 37791729 DOI: 10.2214/ajr.23.30037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Iodinated contrast material (ICM) has revolutionized the field of diagnostic radiology through improvements in diagnostic performance and the expansion of clinical indications for radiographic and CT examinations. Historically, nephrotoxicity was a feared complication of ICM use, thought to be associated with a significant risk of morbidity and mortality. Such fears often precluded the use of ICM in imaging evaluations, commonly at the expense of diagnostic performance and timely diagnosis. Over the past 20 years, the nephrotoxic risk of ICM has become a topic of debate, as more recent evidence from higher-quality studies now suggests that many cases of what was considered contrast-induced acute kidney injury (CI-AKI) likely were cases of mistaken causal attribution; most of these cases represented either acute kidney injury (AKI) caused by any of myriad other known factors that can adversely affect renal function and were coincidentally present at the time of contrast media exposure (termed "contrast-associated AKI" [CA-AKI]) or a manifestation of the normal variation in renal function that increases with worsening renal function. This Special Series Review discusses the current state of knowledge regarding CI-AKI and CA-AKI, including the incidence, risk factors, outcomes, and prophylactic strategies in the identification and management of these clinical conditions.
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Affiliation(s)
- Jennifer S McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Robert J McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Stålhammar F, Aurumskjöld ML, Meyer S, Wiklund M, Wingren P, Liuba P, Hedström E. Photon-counting computed tomography for paediatric congenital heart defects yields images of high diagnostic quality with low radiation doses at both 70 kV and 90 kV. Pediatr Radiol 2024; 54:1187-1196. [PMID: 38700554 PMCID: PMC11182870 DOI: 10.1007/s00247-024-05939-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Photon-counting computed tomography (PCCT) is a new clinical method that may show better diagnostic quality at lower radiation doses than conventional CT. OBJECTIVE To investigate the diagnostic quality and radiation dose of paediatric cardiovascular PCCT for diagnosis of congenital heart defects at 70 kV and 90 kV. MATERIALS AND METHODS This retrospective assessment included clinical non-gated paediatric PCCT examinations for assessment of congenital heart defects. Radiation doses were recorded, and overall and specific diagnostic quality (1-4) were scored by four paediatric radiologists. Agreement, differences, and trends were assessed by percent rater agreement, intraclass correlation, Mann-Whitney tests, and Jonckheere-Terpstra tests. RESULTS Seventy children with congenital heart defects were examined at 70 kV (n = 35; age 2 days-16 years; 63% boys) or 90 kV (n = 35; age 2 days-17 years; 51% boys). All observers gave a median score of 4 (high diagnostic quality) for both 70 kV and 90 kV, with no difference in median values between tube voltages (all P > 0.06). Agreement for overall scores was 66-94% for 70 kV and 60-77% for 90 kV. Agreement for specific scores was 80-97% for 70 kV and 83-89% for 90 kV. Size-dependent dose estimate was 0.68 mGy (0.25-2.02 mGy) for 70 kV and 1.10 mGy (0.58-2.71 mGy; P < 0.001) for 90 kV. Effective dose was 0.30 mSv (0.15-0.82 mSv) for 70 kV and 0.39 mSv (0.22-1.51 mSv; P = 0.01) for 90 kV. CONCLUSION Paediatric cardiovascular PCCT yields images for congenital heart defects of high diagnostic quality with low radiation dose at both 70 kV and 90 kV.
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Affiliation(s)
- Fredrik Stålhammar
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Radiology, Skåne University Hospital, S-22185, Lund, Sweden
| | - Marie-Louise Aurumskjöld
- Medical Radiation Physics, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sofie Meyer
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Radiology, Skåne University Hospital, S-22185, Lund, Sweden
| | - Marie Wiklund
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Radiology, Skåne University Hospital, S-22185, Lund, Sweden
| | - Pär Wingren
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Radiology, Skåne University Hospital, S-22185, Lund, Sweden
| | - Petru Liuba
- Paediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Paediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Radiology, Skåne University Hospital, S-22185, Lund, Sweden.
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden.
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Berglund F, Eilertz E, Nimmersjö F, Wolf A, Nordlander C, Palm F, Parenmark F, Westerbergh J, Liss P, Frithiof R. Acute and long-term renal effects after iodine contrast media-enhanced computerised tomography in the critically ill-a retrospective bi-centre cohort study. Eur Radiol 2024; 34:1736-1745. [PMID: 37658144 PMCID: PMC10873227 DOI: 10.1007/s00330-023-10059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/21/2023] [Accepted: 06/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES To determine if current clinical use of iodine contrast media (ICM) for computerised tomography (CT) increases the risk of acute kidney injury (AKI) and long-term decline in renal function in patients treated in intensive care. METHODS A retrospective bi-centre cohort study was performed with critically ill subjects undergoing either ICM-enhanced or unenhanced CT. AKI was defined and staged based on the Kidney Disease Improve Global Outcome AKI criteria, using both creatinine and urine output criteria. Follow-up plasma creatinine was recorded three to six months after CT to assess any long-term effects of ICM on renal function. RESULTS In total, 611 patients were included in the final analysis, median age was 65.0 years (48.0-73.0, quartile 1-quartile 3 (IQR)) and 62.5% were male. Renal replacement therapy was used post-CT in 12.9% and 180-day mortality was 31.2%. Plasma creatinine level on day of CT was 100.0 µmol/L (66.0-166.5, IQR) for non-ICM group and 77.0 µmol/L (59.0-109.0, IQR) for the ICM group. The adjusted odds ratio for developing AKI if the patient received ICM was 1.03 (95% confidence interval 0.64-1.66, p = 0.90). No significant association between ICM and increase in plasma creatinine at long-term follow-up was found, with an adjusted effect size of 2.92 (95% confidence interval - 6.52-12.36, p = 0.543). CONCLUSIONS The results of this study do not indicate an increased risk of AKI or long-term decline in renal function when ICM is used for enhanced CT in patients treated at intensive care units. CLINICAL RELEVANCE STATEMENT Patients treated in intensive care units had no increased risk of acute kidney injury or persistent decline in renal function after contrast-enhanced CT. This information underlines the need for a proper risk-reward assessment before denying patients a contrast-enhanced CT. KEY POINTS • Iodine contrast media is considered a risk factor for the development of acute kidney injury. • Patients receiving iodine contrast media did not have an increased incidence of acute kidney injury or persistent decline in renal function. • A more clearly defined risk of iodine contrast media helps guide clinical decisions whether to perform contrast-enhanced CTs or not.
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Affiliation(s)
- Felix Berglund
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
| | - Ebba Eilertz
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Fredrik Nimmersjö
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Adam Wolf
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Fredrik Palm
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Fredric Parenmark
- Centre for Research and Development, Uppsala University, Uppsala, Sweden
| | - Johan Westerbergh
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Per Liss
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
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Masoomi Z, Nasirian AM, Namazi M, Zangiabadian M, Dayani A, Shahidi M, Saghafi H, Jolfayi AG. Prevalence of contrast-induced nephropathy after primary percutaneous coronary intervention at a tertiary referral hospital. Heliyon 2024; 10:e25926. [PMID: 38404852 PMCID: PMC10884434 DOI: 10.1016/j.heliyon.2024.e25926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/01/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Objective This study aimed to quantify the incidence of Contrast-induced nephropathy (CIN) in patients undergoing primary percutaneous coronary intervention (PPCI) due to acute ST-elevation myocardial infarction (STEMI). Methods From April 2019 to March 2022, a prospective, observational study enrolled 213 consecutive STEMI patients referred to a tertiary hospital for PPCI. Participants were divided into tow groups based on the presence or absence of contrast-induced nephropathy. The chi-square test (χ2) and Student's t-test evaluated the data, with logistic regression identifying CIN's independent predictors. Results Results: In this study, the incidence of contrast-induced nephropathy was observed at 13.1% (N = 28). Several factors were more prevalent among patients exhibiting contrast-induced nephropathy. These factors encompassed: radial access for coronary angiography over the femoral method (P = 0.021), elevated contrast volume (P = 0.003), smoking (P = 0.009), diabetes (P = 0.04), heart failure (P = 0.049), a history of coronary artery bypass graft (P = 0.006), diminished left ventricular ejection fraction indicating systolic dysfunction (P = 0.012), cardiogenic shock (P = 0.046), increased BUN at the time of admission (P = 0.043), decreased initial GFR (P = 0.004), and prior consumption of medications such as aspirin (P = 0.002), diuretics (P = 0.046), beta blockers (P = 0.04), angiotensin-converting enzyme inhibitors (P = 0.033), angiotensin receptor blockers (P = 0.02). Other relevant conditions included anemia (P = 0.012), leukocytosis (P = 0.011), hypercholesterolemia (P = 0.034), and reduced HDL levels (P = 0.004).Through logistic regression, key predictors for the onset of contrast-induced nephropathy were determined, which included heart failure (OR: 5.52; 95% CI: 1.08-28.24), radial access (OR: 12.71; 95% CI: 1.45-110.9), hypercholesterolemia (OR: 1.02; 95% CI: 1.004-1.04), increased BUN upon admission (OR: 1.11; 95% CI: 1.006-1.24), and leukocytosis (OR: 2.03; 95% CI: 1.18-3.49). Conclusions While heart failure, radial access, hypercholesterolemia, elevated BUN at admission, and leukocytosis significantly influenced renal filtration deterioration post-PPCI, it's evident that CIN is multifactorial. Further studies are crucial to elucidate the underlying factors.
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Affiliation(s)
- Zahra Masoomi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Ali Mohammad Nasirian
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoor Namazi
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Moein Zangiabadian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Abdoreza Dayani
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shahidi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Hossein Saghafi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Amir Ghaffari Jolfayi
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Fontana F, Piacentino F, Gnesutta A, Macchi E, Coppola A, Saccomanno A, Gatta T, Recaldini C, Minenna M, Tamborini C, Dossi F, Ascenti V, Barbera S, Cicero G, Carcano G, Ascenti G, Castiglioni B, Venturini M. Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media. J Clin Med 2024; 13:524. [PMID: 38256659 PMCID: PMC10816911 DOI: 10.3390/jcm13020524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation (p < 0.05) was observed between BMI and CA at all vascular levels, indicating reduced contrast enhancement with increasing BMI. Spectral CT, along with reducing iodine load, allows for obtaining high-quality images without a significant increase in noise. The reduction in iodine load can have positive implications in clinical practice, improving patient safety and resource efficiency.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Aroa Gnesutta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Angiola Saccomanno
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Tonia Gatta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Chiara Recaldini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Manuela Minenna
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Claudio Tamborini
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Filippo Dossi
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, 20133 Milano, Italy;
| | - Simone Barbera
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giuseppe Cicero
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Battistina Castiglioni
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
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Campion D, Ponzo P, Risso A, Caropreso P, Caviglia GP, Sanavia T, Frigo F, Bonetto S, Giovo I, Rizzo M, Martini S, Bugianesi E, Mengozzi G, Marzano A, Manca A, Saracco GM, Alessandria C. A prospective, multicenter, three-cohort study evaluating contrast-induced acute kidney injury (CI-AKI) in patients with cirrhosis. J Hepatol 2024; 80:62-72. [PMID: 37865273 DOI: 10.1016/j.jhep.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND & AIMS Nephrotoxicity of intravenous iodinated contrast media (ICM) in cirrhosis is still a debated issue, due to scarce, low-quality and conflicting evidence. This study aims to evaluate the incidence and predisposing factors of acute kidney injury (AKI) in patients with cirrhosis undergoing contrast-enhanced computed tomography (CECT). METHODS We performed a prospective, multicenter, cohort study including 444 inpatients, 148 with cirrhosis (cohort 1) and 163 without cirrhosis (cohort 3) undergoing CECT and 133 with cirrhosis (cohort 2) unexposed to ICM. Kidney function parameters were assessed at T0, 48-72 h (T1), 5 and 7 days after CECT/enrollment. Urinary neutrophil gelatinase-associated lipocalin (U-NGAL) was measured in 50 consecutive patients from cohort 1 and 50 from cohort 2 as an early biomarker of tubular damage. RESULTS AKI incidence was not significantly increased in patients with cirrhosis undergoing CECT (4.8%, 1.5%, 2.5% in cohorts 1, 2, 3 respectively, p = n.s.). Most AKI cases were mild and transient. The presence of concomitant infections was the only independent predictive factor of contrast-induced AKI (odds ratio 22.18; 95% CI 2.87-171.22; p = 0.003). No significant modifications of U-NGAL between T0 and T1 were detected, neither in cohort 1 nor in cohort 2 (median ΔU-NGAL: +0.2 [-7.6 to +5.5] ng/ml, +0.0 [-6.8 to +9.5] ng/ml, respectively [p = 0.682]). CONCLUSIONS AKI risk after CECT in cirrhosis is low and not significantly different from that of the general population or of the cirrhotic population unexposed to ICM. It mostly consists of mild and rapidly resolving episodes of renal dysfunction and it is not associated with tubular kidney injury. Patients with ongoing infections appear to be the only ones at higher risk of AKI. IMPACT AND IMPLICATIONS Nephrotoxicity due to intravenous iodinated contrast media (ICM) in patients with cirrhosis is still a debated issue, as the available evidence is limited and based on very heterogeneous studies, often conducted on small and retrospective cohorts. In this prospective three-cohort study we found that intravenous administration of ICM was associated with a low risk of AKI, similar to that of the general population and to that of patients with cirrhosis unexposed to ICM. Patients with ongoing infections were the only ones to have a significantly increased risk of contrast-induced AKI. Therefore, the actual recommendations of performing contrast imaging studies cautiously in cirrhosis do not seem to be reasonable anymore, with the exception of infected patients, who have a significantly higher risk of contrast-induced AKI.
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Affiliation(s)
- Daniela Campion
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Ponzo
- Division of Gastroenterology, S. Croce e Carle Hospital, Cuneo, Italy
| | - Alessandro Risso
- Division of Gastroenterology, S. Croce e Carle Hospital, Cuneo, Italy
| | - Paola Caropreso
- Clinical Biochemistry Laboratory, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Gian Paolo Caviglia
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Tiziana Sanavia
- Computational Biomedicine Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Frigo
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Bonetto
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ilaria Giovo
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Martina Rizzo
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Martini
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elisabetta Bugianesi
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giulio Mengozzi
- Clinical Biochemistry Laboratory, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alfredo Marzano
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Aldo Manca
- Division of Gastroenterology, S. Croce e Carle Hospital, Cuneo, Italy
| | - Giorgio Maria Saracco
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Carlo Alessandria
- Division of Gastroenterology and Hepatology, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
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Lai J, Luo Z, Chen L, Wu Z. Advances in nanotechnology-based targeted-contrast agents for computed tomography and magnetic resonance. Sci Prog 2024; 107:368504241228076. [PMID: 38332327 PMCID: PMC10854387 DOI: 10.1177/00368504241228076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
X-ray computed tomography (CT) and magnetic resonance (MR) imaging are essential tools in modern medical diagnosis and treatment. However, traditional contrast agents are inadequate in the diagnosis of various health conditions. Consequently, the development of targeted nano-contrast agents has become a crucial area of focus in the development of medical image-enhancing contrast agents. To fully understand the current development of nano-contrast agents, this review provides an overview of the preparation methods and research advancements in CT nano-contrast agents, MR nano-contrast agents, and CT/MR multimodal nano-contrast agents described in previous publications. Due to the physicochemical properties of nanomaterials, such as self-assembly and surface modifiability, these specific nano-contrast agents can greatly improve the targeting of lesions through various preparation methods and clearly highlight the distinction between lesions and normal tissues in both CT and MR. As a result, they have the potential to be used in the early stages of disease to improve diagnostic capacity and level in medical imaging.
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Affiliation(s)
- Jianjun Lai
- Institute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Zhizeng Luo
- Institute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou, China
| | - Liting Chen
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Zhibing Wu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
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Vemireddy L, Bansal S. Contrast-Associated Acute Kidney Injury: Definitions, Epidemiology, Pathophysiology, and Implications. Interv Cardiol Clin 2023; 12:489-498. [PMID: 37673493 DOI: 10.1016/j.iccl.2023.06.007] [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
Acute kidney injury (AKI) is a common occurrence after contrast media administration. Hemodynamic changes, direct tubular injury, and reactive oxygen species are the proposed mechanisms involved in AKI. However, in most scenarios, it is not possible to establish causality despite extensive clinical evaluation, therefore, contrast-associated AKI (CA-AKI) has become a widely accepted term to define AKI postcontrast. CA-AKI is associated with worse clinical outcomes including cardiovascular events and mortality; however, discussions are ongoing whether CA-AKI is a marker of an increased risk of adverse outcomes or a mediator of such outcomes.
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Affiliation(s)
- Lalith Vemireddy
- Division of Nephrology, Department of Medicine, The University of Texas Health at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX 78229, USA.
| | - Shweta Bansal
- Division of Nephrology, The University of Texas Health at San Antonio, San Antonio, TX, USA. https://twitter.com/SBansalNeph
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Balan C, Ciuhodaru T, Bubenek-Turconi SI. Kidney Injury in Critically Ill Patients with COVID-19 - From Pathophysiological Mechanisms to a Personalized Therapeutic Model. J Crit Care Med (Targu Mures) 2023; 9:148-161. [PMID: 37588184 PMCID: PMC10425930 DOI: 10.2478/jccm-2023-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Acute kidney injury is a common complication of COVID-19, frequently fuelled by a complex interplay of factors. These include tubular injury and three primary drivers of cardiocirculatory instability: heart-lung interaction abnormalities, myocardial damage, and disturbances in fluid balance. Further complicating this dynamic, renal vulnerability to a "second-hit" injury, like a SARS-CoV-2 infection, is heightened by advanced age, chronic kidney disease, cardiovascular diseases, and diabetes mellitus. Moreover, the influence of chronic treatment protocols, which may constrain the compensatory intrarenal hemodynamic mechanisms, warrants equal consideration. COVID-19-associated acute kidney injury not only escalates mortality rates but also significantly affects long-term kidney function recovery, particularly in severe instances. Thus, the imperative lies in developing and applying therapeutic strategies capable of warding off acute kidney injury and decelerating the transition into chronic kidney disease after an acute event. This narrative review aims to proffer a flexible diagnostic and therapeutic strategy that recognizes the multi-faceted nature of COVID-19-associated acute kidney injury in critically ill patients and underlines the crucial role of a tailored, overarching hemodynamic and respiratory framework in managing this complex clinical condition.
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Affiliation(s)
- Cosmin Balan
- Prof. Dr. C. C. Iliescu Emergency Cardiovascular Diseases Institute, Bucharest, Romania
| | - Tudor Ciuhodaru
- Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iași, Romania
| | - Serban-Ion Bubenek-Turconi
- Prof. Dr. C. C. Iliescu Emergency Cardiovascular Diseases Institute, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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10
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Chaudhari H, Mahendrakar S, Baskin SE, Reddi AS. Contrast-Induced Acute Kidney Injury: Evidence in Support of Its Existence and a Review of Its Pathogenesis and Management. Int J Nephrol Renovasc Dis 2022; 15:253-266. [PMID: 36311164 PMCID: PMC9604418 DOI: 10.2147/ijnrd.s371700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
The role of contrast-induced nephropathy (CIN) remains controversial. Many experts contend that CIN does not exist or is extremely rare. The diagnosis was previously made too frequently and inappropriately in the presence of coexisting and confounding comorbidities and risk factors making it difficult to singularly isolate the etiologic role of intravenous contrast media in acute kidney injury (AKI). It is probable that many patients were denied important diagnostic information from radiocontrast studies for fear of CIN. Recently, a new terminology for CIN was introduced, and the term CIN was replaced by two interrelated new terms: one is contrast-associated acute kidney injury (CA-AKI), and the second one is contrast-induced acute kidney injury (CI-AKI). CA-AKI occurs in association with risk factors or comorbidities, therefore, it is a correlative diagnosis. On the other hand, CI-AKI is a subtype of CA-AKI that results directly from iodinated contrast media. In this review, we present evidence from various studies that argue against CI-AKI and also those that suggest its existence but with much lower frequency. We will also provide the current status of the pathophysiology and management of CA-AKI/CI-AKI.
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Affiliation(s)
- Harshad Chaudhari
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA,Correspondence: Harshad Chaudhari, Email
| | - Smita Mahendrakar
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Stuart E Baskin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Alluru S Reddi
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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11
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Abstract
AKI is a potential complication of intravascular iodinated contrast exposure. Contrast-associated AKI, which typically manifests as small and transient decrements in kidney function that develop within several days of contrast administration, is associated with serious adverse outcomes, including progressive kidney dysfunction and death. However, a causal link between the small increases in serum creatinine that characteristically occur with contrast-associated AKI and serious adverse outcomes remains unproven. This is important given mounting evidence that clinically indicated, potentially lifesaving radiographic procedures are underutilized in patients with CKD. This has been hypothesized to be related to provider concern about precipitating contrast-associated AKI. Intravascular gadolinium-based contrast, an alternative to iodinated contrast that is administered with magnetic resonance imaging, has also been linked with potential serious adverse events, notably the development of nephrogenic systemic fibrosis in patients with severe impairment in kidney function. Patients hospitalized in the intensive care unit frequently have clinical indications for diagnostic and therapeutic procedures that involve the intravascular administration of contrast media. Accordingly, critical care providers and others treating critically ill patients should possess a sound understanding of the risk factors for and incidence of such outcomes, the ability to perform evidence-based risk-benefit assessments regarding intravascular contrast administration, and knowledge of empirical data on the prevention of these iatrogenic complications.
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Affiliation(s)
- Winn Cashion
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven D Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania .,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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12
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Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score-matched cohort studies. Eur Radiol 2022; 32:8432-8442. [PMID: 35727320 DOI: 10.1007/s00330-022-08916-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/07/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Intravenous application of contrast media is part of a wide spectrum of diagnostic procedures for better imaging quality. Clinical avoidance of contrast-enhanced imaging is an ever-present quandary in patients with impaired kidney function. The objective of this study was to estimate the risk for acute kidney injury (AKI), dialysis and mortality among patients undergoing contrast-enhanced CT compared to propensity score-matched controls (i.e. contrast-unenhanced CT). Selected cohort studies featured high-risk patients with advanced kidney disease and critical illness. METHODS This review was designed to conform to the Preferred Reporting Items in Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed was searched from August 2021 to November 2021 for all-language articles without date restriction. A random-effects model (DerSimonian and Laird method) was used for meta-analysis. RESULTS Twenty-one articles were included, comprising data of 169,455 patients. The overall risk of AKI was similar in the contrast-enhanced and unenhanced groups (OR: 0.97 [95% CI: 0.85; 1.11], p = 0.64), regardless of baseline renal function and underlying disease. Substantial heterogeneity was detected (I2 = 90%, p ≤ 0.0001). Multivariable logistic regression identified hypertension (p = 0.03) and estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 (p = 0.0001) as factors associated with greater risk of post-contrast AKI. CONCLUSIONS Based on propensity score-matched pairs obtained from 21 cohort studies, we found no evidence for increased risk for AKI, dialysis or mortality after contrast-enhanced CT among patients with eGFR ≥ 45 mL/min/1.73 m2. In congruence with the emerging evidence in the literature, caution should be exercised in patients with hypertension and eGFR ≤ 30 mL/min/1.73 m2. KEY POINTS • The application of contrast media for medical imaging is not associated with higher odds for AKI, induction of renal replacement therapy, or mortality. Many comorbidities traditionally associated with greater risk for acute kidney injury do not appear to predispose for renal decline after contrast media exposure. • Underlying hypertension and eGFR less than or equal to 30 mL/min/1.73 m2 seem to predispose for post-contrast acute kidney injury. • Propensity score matching cannot account for unmeasured influences on AKI incidence, which needs to be addressed in the interpretation of results.
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13
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Patients with Different Stages of Chronic Kidney Disease Undergoing Intravenous Contrast-Enhanced Computed Tomography-The Incidence of Contrast-Associated Acute Kidney Injury. Diagnostics (Basel) 2022; 12:diagnostics12040864. [PMID: 35453910 PMCID: PMC9025335 DOI: 10.3390/diagnostics12040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Iodinated contrast medium (CM) is the third most common cause of acute kidney injury (AKI). However, the association is poorly known between the definitions of AKI between different stages of chronic kidney disease after intravenous CM administration. Methods: The dataset, covering a period of ~15 years (1 June 2008 to 31 March 2015), consisted of 20,018 non-dialytic adult patients who had received intravenous injections of non-ionic iso-osmolar CM, iodixanol, for enhanced computed tomography imaging. Contrast-associated AKI (CA-AKI), dialysis-required AKI, and mortality were analyzed. Results: A total of 12,271 participants were enrolled. CA-AKI increased significantly starting from stage 3A onward (p < 0.001). In summary, incidences of CA-AKI against different levels of chronic kidney disease were as follows: stage 1 (8.3%) = stage 2 (6.7%) < stage 3A (9.9%) < stage 3B (14.3%) < stage 4 (20.5%) = stage 5 (20.4%). The incidences of dialysis within 30 days were as follows: stage 1 (1%) = stage 2 (1.4%) = stage 3A (2.7%) < stage 3B (5.7%) < stage 4 (18%) < stage 5 (54.1%). The prediction of dialysis was good based on the baseline serum creatinine > 1.5 mg/dL (72.78% of sensitivity, 86.07% of specificity, 0.851 of area under curve) or baseline estimated glomerular filtration rate ≤ 38.49 mL/min/1.732 m2 (70.19% of sensitivity, 89.08% of specificity, 0.853 of area under curve). In multivariate Cox regression analysis model for CA-AKI, independent risk factors were stage 4 chronic kidney disease (p = 0.001) and shock (p = 0.001). Conclusion: Baseline serum creatinine and estimated glomerular filtration rate were good predictors for dialysis-required AKI. CA-AKI increased significantly since stage 3A chronic kidney disease. Stage 4 and 5 chronic kidney disease have the same risk for CA-AKI, but stage 5 chronic kidney disease has markedly higher risk for dialysis.
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Ma K, Li J, Shen G, Zheng D, Xuan Y, Lu Y, Li W. Development and Validation of a Risk Nomogram Model for Predicting Contrast-Induced Acute Kidney Injury in Patients with Non-ST-Elevation Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention. Clin Interv Aging 2022; 17:65-77. [PMID: 35115770 PMCID: PMC8801515 DOI: 10.2147/cia.s349159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To establish a nomogram model to predict the risk of contrast-induced acute kidney injury (CI-AKI) by analyzing the risk factors of CI-AKI and to evaluate its effectiveness. Methods Retrospectively analyze the clinical data of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI) in our cardiology department from September 2018 to June 2021. Of these, patients who underwent PCI in an earlier period formed the training cohort (70%; n = 809) for nomogram development, and those who underwent PCI thereafter formed the validation cohort (30%; n = 347) to confirm the model’s performance. The independent risk factors of CI-AKI were determined by LASSO regression and multivariable logistic regression analysis. By using R software from which nomogram models were subsequently generated. The nomogram was developed and evaluated based on discrimination, calibration, and clinical efficacy using the concordance statistic (C-statistic), calibration plot, and decision curve analysis (DCA), respectively. Results The nomogram consisted of six variables: age >75, left ventricular ejection fraction, diabetes mellitus, fibrinogen-to-albumin ratio, high-sensitive C-reactive protein, and lymphocyte count. The C-index of the nomogram is 0.835 (95% CI: 0.800–0.871) in the training cohort and 0.767 (95% CI: 0.711–0.824) in the validation cohort, respectively. The calibration plots exhibited that the nomogram was in good agreement between prediction and observation in the training and validation cohorts. Decision curve analysis and clinical impact curve suggested that the predictive nomogram had clinical utility. Conclusion The nomogram model established has a good degree of differentiation and accuracy, which is intuitively and individually to screen high-risk groups and has a certain predictive value for the occurrence of CI-AKI in NSTE-ACS patients after PCI.
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Affiliation(s)
- Kai Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Jing Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Guoqi Shen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Di Zheng
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Yongli Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
| | - Wenhua Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People’s Republic of China
- Correspondence: Wenhua Li, Tel +86 18052268293, Email
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15
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Barrios López A, García Martínez F, Rodríguez JI, Montero-San-Martín B, Gómez Rioja R, Diez J, Martín-Hervás C. Incidence of contrast-induced nephropathy after a computed tomography scan. RADIOLOGIA 2021; 63:307-313. [PMID: 34246421 DOI: 10.1016/j.rxeng.2020.02.005] [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: 03/17/2019] [Accepted: 02/13/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The term contrast-induced nephropathy is used to describe acute deterioration of renal function after the intravenous administration of iodinated contrast material. We aimed to estimate the incidence of contrast-induced nephropathy and to analyze the evolution of different biomarkers of renal function in patients who underwent computed tomography with intravenous contrast administration after premedication with oral hydration and N-acetylcysteine. MATERIAL AND METHODS This prospective observational study included 112 patients with chronic renal failure (glomerular filtration rate (GFR) 30ml-60ml/min/1.73m2) scheduled for computed tomography with intravenous iodinated contrast material. We recorded demographic variables, dose of contrast material, diabetes mellitus, hypertension, and serum hemoglobin. We measured serum creatinine and GFR after premedication and after the CT examination. We summarized variables as means, standard deviations, and percentages. We used the Wilcoxon and Mann-Whitney tests to compare pre- and post-CT values and Pearson's r to analyze correlations. RESULTS Incidence acute kidney injury: 0.9%; 95%CI: 0.36-1.4. Mean difference between pre- and post-CT creatinine: 0.04; 95%CI: 0.002-0.09, p<0.004. Mean difference between pre- and post-CT GFR: -3.06; 95%CI: -4.66 to -1.47), p<0.001. CONCLUSIONS The incidence of contrast-induced nephropathy in patients with chronic renal failure and GFR 30ml-60ml/min/1.73m2 is low. The biomarkers of renal function analyzed improve in patients who receive premedication and the minimum dose of contrast material.
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Affiliation(s)
- A Barrios López
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain.
| | - F García Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - J I Rodríguez
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | | | - R Gómez Rioja
- Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain
| | - J Diez
- Servicio de Bioestadística, IdiPAZ - Hospital Universitario La Paz, Madrid, Spain
| | - C Martín-Hervás
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
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16
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Koyanagi H, Tsutsumi Y, Tokuda Y, Tanaka A, Endo M, Furukawa Y, Abe S. Computed tomography imaging using split-bolus contrast injection with volume scan of aortic root and heart for preoperative evaluation of transcatheter aortic valve implantation. Heart Vessels 2021; 37:132-141. [PMID: 34236462 DOI: 10.1007/s00380-021-01899-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate using split-bolus contrast injection (SPBI) with volume scanning of the heart and aortic root with helical scanning of the access route, compared to single bolus contrast injection (SI) with variable helical pitch scanning (VHP) of the heart and aortic root and access route in a preoperative evaluation before transcatheter aortic valve implantation (TAVI). Thirty-five patients who underwent preoperative CT before TAVI using SPBI (contrast media: 24.5 mgI /kg/s, injected for 12 s for heart scan and then injected for 8 s for access route) were examined. Electrocardiogram (ECG) gated scans of the heart were performed by volume scan, after a period of time, non-gated helical scans of the aorto-iliac were performed (SPBI method). For comparison, 40 patients who had a single bolus injection (26.5 mg I/kg/s, injected for period of the scan time plus 3 s) and a VHP scan (SI method) before the SPBI method was performed were included in the study. The image qualities of the coronary arteries, aortic root, and access route (aorta-iliac), as well as radiation and iodine doses, were assessed. In visual assessment, image quality of coronary artery was significantly better with the SPBI method (grade; excellent: 57.1% in SPBI vs. 24.3% in SI, p = 0.03). There was no significant difference in image quality of the aortic root by visual assessment. The signal-to-noise (SNR) and contrast-to-noise ratio (CNR) of coronary and aortic root were not significantly different between the two methods. The access route showed significantly higher SNR (45.7 ± 11.5 vs. 34.3 ± 9.8, p < 0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p < 0.001) for the SPBI method. The SPBI method compared to SI method reduced iodine dose by 10% and radiation dose by 45%. Preoperative CT imaging before TAVI using SPBI with volume scan is useful and can reduce iodine and radiation doses.
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Affiliation(s)
- Hitomi Koyanagi
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Yoshinori Tsutsumi
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Maki Endo
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yasushi Furukawa
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Shinji Abe
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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18
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Laible M, Jenetzky E, Möhlenbruch MA, Bendszus M, Ringleb PA, Rizos T. The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Front Neurol 2021; 12:665614. [PMID: 34163423 PMCID: PMC8215575 DOI: 10.3389/fneur.2021.665614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT. Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models. Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001). Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.
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Affiliation(s)
- Mona Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neurology, University of Ulm, Ulm, Germany
| | - Ekkehart Jenetzky
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany.,Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Mainz, Germany
| | | | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Timolaos Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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19
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Goulden R, Rowe BH, Abrahamowicz M, Strumpf E, Tamblyn R. Association of Intravenous Radiocontrast With Kidney Function: A Regression Discontinuity Analysis. JAMA Intern Med 2021; 181:767-774. [PMID: 33818606 PMCID: PMC8022267 DOI: 10.1001/jamainternmed.2021.0916] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Radiocontrast has long been thought of as nephrotoxic; however, a number of recent observational studies found no evidence of an association between intravenous contrast and kidney injury. Because these studies are at high risk of confounding and selection bias, alternative study designs are required to enable more robust evaluation of this association. OBJECTIVE To determine whether intravenous radiocontrast exposure is associated with clinically significant long-term kidney impairment, using a study design that permits stronger causal interpretation than existing observational research. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all emergency department patients aged 18 years or older undergoing D-dimer testing between 2013 and 2018 in the Canadian province of Alberta. A fuzzy regression discontinuity design was used, exploiting the fact that individuals just either side of the eligibility cutoff for computed tomographic pulmonary angiogram (CTPA)-typically 500 ng/mL-have markedly different probabilities of contrast exposure, but should otherwise be similar with respect to potential confounders. EXPOSURES Intravenous contrast in the form of a CTPA. MAIN OUTCOMES AND MEASURES Estimated glomerular filtration rate (eGFR) up to 6 months following the index emergency department visit. RESULTS During the study period 156 028 individuals received a D-dimer test. The mean age was 53 years, 68 206 (44%) were men and 87 822 (56%) were women, and the mean baseline eGFR level was 86 mL/min/1.73 m2. Patients just above and below the CTPA eligibility cutoff were similar in terms of measured confounders. There was no evidence for an association of contrast with eGFR up to 6 months later, with a mean change in eGFR of -0.4 mL/min/1.73 m2 (95% CI, -4.9 to 4.0) associated with CTPA exposure. There was similarly no evidence for an association with need for kidney replacement therapy (risk difference [RD], 0.07%; 95% CI, -0.47% to 0.61%), mortality (RD, 0.3%; 95% CI, -2.9% to 3.2%), and acute kidney injury (RD, 4.3%; 95% CI, -2.7% to 12.9%), though the latter analysis was limited by missing data. Subgroup analyses were potentially consistent with harm among patients with diabetes (mean eGFR change -6.4 mL/min/1.73 m2; 95% CI, -15.4 to 0.2), but not among those with other reported risk factors for contrast-induced nephropathy; these analyses, however, were relatively underpowered. CONCLUSIONS AND RELEVANCE Using a cohort study design and analysis that permits stronger causal interpretation than existing observational research, we found no evidence for a harmful effect on kidney function of intravenous contrast administered for CTPA in an emergency setting.
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Affiliation(s)
- Robert Goulden
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry and School of Public Health, both at the University of Alberta, Edmonton, Alberta, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Economics, Faculty of Arts, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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20
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Huang Y, Huang F, Yang L, Hu W, Liu Y, Lin Z, Meng X, Zeng M, He C, Xu Q, Xie G, Liu C, Liang M, Li X, Kang N, Xu D, Wang J, Zhang L, Mao X, Yang C, Xu M, Qi X, Mao H. Development and validation of a radiomics signature as a non-invasive complementary predictor of gastroesophageal varices and high-risk varices in compensated advanced chronic liver disease: A multicenter study. J Gastroenterol Hepatol 2021; 36:1562-1570. [PMID: 33074566 DOI: 10.1111/jgh.15306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/12/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Gastroesophageal varices (GEV) present in compensated advanced chronic liver disease (cACLD) and can develop into high-risk varices (HRV). The gold standard for diagnosing GEV is esophagogastroduodenoscopy (EGD). However, EGD is invasive and less tolerant. This study aimed to develop and validate radiomics signatures based on noncontrast-enhanced computed tomography (CT) images for non-invasive diagnosis of GEV and HRV in patients with cACLD. METHODS The multicenter trial enrolled 161 patients with cACLD from six university hospitals in China between January 2015 and September 2019, who underwent both EGD and noncontrast-enhanced CT examination within 14 days prior to the endoscopy. Two radiomics signatures, termed rGEV and rHRV, respectively, were built based on CT images in a training cohort of 129 patients and validated in a prospective validation cohort of 32 patients (ClinicalTrials. gov identifier: NCT03749954). RESULTS In the training cohort, both rGEV and rHRV exhibited high discriminative abilities on determining the existence of GEV and HRV with the area under receiver operating characteristic curve (AUC) of 0.941 (95% confidence interval [CI] 0.904-0.978) and 0.836 (95% CI 0.766-0.905), respectively. In validation cohort, rGEV and rHRV showed high discriminative abilities with AUCs of 0.871 (95% CI 0.739-1.000) and 0.831 (95% CI 0.685-0.978), respectively. CONCLUSIONS This study demonstrated that rGEV and rHRV could serve as the satisfying auxiliary parameters for detection of GEV and HRV with good diagnostic performance.
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Affiliation(s)
- Yifei Huang
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fangze Huang
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Li Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yanna Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zihuai Lin
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangpan Meng
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Manling Zeng
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chaohui He
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| | - Qing Xu
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guanghang Xie
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuan Liu
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingkai Liang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoguo Li
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ning Kang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Dan Xu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jitao Wang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Liting Zhang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaorong Mao
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Changqing Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Xu
- Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hua Mao
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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21
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Stephan T, Felbel D, Rattka M, Rottbauer W, Markovic S. Impact of radial access on contrast-induced acute kidney injury in patients with coronary artery bypass grafts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:123-131. [PMID: 33992588 DOI: 10.1016/j.carrev.2021.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated the impact of radial access on contrast-induced acute kidney injury (CI-AKI) in patients with coronary artery bypass graft (CABG) undergoing cardiac catheterization. METHODS This retrospective monocenter study included 527 CABG patients undergoing cardiac catheterization via radial (58.1%, N = 306) or femoral access (41.9%, N = 221). Primary outcome measure was CI-AKI defined in accordance with the KDIGO criteria. Independent predictors for CI-AKI were assessed. 1-year mortality was assessed depending on the occurrence of CI-AKI. RESULTS In total, 99 CABG patients (18.8%) developed CI-AKI within 48 h after cardiac catheterization. Compared to patients without CI-AKI, amount of contrast media used (203.1 ± 102.6 ml vs. 204.2 ± 98.2 ml; P = 0.892) as well as procedural times (87.9 ± 44.8 vs. 79.8 ± 37.0; P = 0.190) were similarly. Regarding vascular access, there was no significant difference in the incidence of CI-AKI between radial and femoral approach (19.0% vs. 18.6%; p = 0.907). However, poor left ventricular ejection fraction (odds ratio [OR] = 1.72, P = 0.026), chronic kidney disease (OR = 2.30, P = 0.001) and acute coronary syndrome (OR = 1.64, P = 0.043) were independent predictors for CI-AKI. The occurrence of CI-AKI was significantly associated with an increased 1-year mortality (hazard ratio [HR] = 2.52, P = 0.003). CONCLUSIONS With 18.8%, CI-AKI is a frequent complication in CABG patients undergoing cardiac catheterization. Radial access did not decrease the risk when compared to the femoral approach.
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Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany.
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22
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Yun D, Kim DK, Lee JP, Kim YS, Oh S, Lim CS. Can sodium fluorescein cause contrast-induced nephropathy? Nephrol Dial Transplant 2021; 36:819-825. [PMID: 31773157 DOI: 10.1093/ndt/gfz243] [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] [Received: 08/16/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury (AKI), and can be diagnosed when the etiology of AKI is unclear other than via a contrast agent. Fluorescent angiography (FAG) with fluorescein sodium dye is generally considered to be safe for patients with kidney diseases. However, it remains unresolved whether or not FAG can induce CIN. METHODS Patients from two tertiary hospitals who underwent FAG and had serum creatinine results within 4 weeks before FAG and 3 days after FAG between 2001 and 2017 were retrieved. Cases with concurrent iodinated contrast imaging or undergoing dialysis were excluded from the analysis. CIN was defined by two criteria: CIN criteria as >0.5 mg/dL or >25% increase in serum creatinine (sCr) level within 3 days after FAG, and contrast-induced acute kidney injury (CIAKI) criteria as ≥0.3 mg/dL increase within 2 days or ≥50% increase within 7 days after FAG. RESULTS A total of 979 patients were screened, and we found 124 patients with AKI after FAG. After excluding 32 patients with clear causes of AKI other than FAG, the incidence rates of CIN were 7.3% by CIN criteria and 6.4% by CIAKI criteria. CIN incidence had a U-shaped distribution according to chronic kidney disease (CKD) stages in CIN criteria, while linear association between CIN incidence and CKD stages were found in CIAKI criteria. Kaplan-Meier curves showed the CIN group was significantly associated with end-stage renal disease (ESRD) progression (log-rank P < 0.001, in both CIN criteria and CIAKI criteria), and adjusted hazard ratios by multivariable Cox regression were 2.23 [95% confidence interval (CI) 1.468-3.378] in CIN criteria and 2.17 (95% CI 1.462-3.232) in CIAKI criteria. CONCLUSIONS According to CIN and CIAKI criteria, FAG may cause CIN and appeared to be a possible risk factor for ESRD progression. However, CIN or CIAKI criteria themselves may overestimate AKI and require meticulous attention to the interpretation of results.
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Affiliation(s)
- Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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23
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Son EA, Kondratyuk MR, Fominykh EV, Fomin VV. A Clinical Case: the Risk Factors of Acute Kidney Injury in a Cardiological Patient. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recent epidemiological studies have demonstrated that the development of a potentially reversible moderate acute kidney injury is associated with worsening clinical outcomes and an increased risk of death. This is especially true for patients with plural comorbidities who require procedures with IV radiopaque agents. This paper presents a clinical case of an elderly patient who requires coronary angiography, and who has common clinical conditions such as hypertension, multifocal atherosclerosis with the development of renal artery disease and the presence of a history of acute cerebrovascular accident and myocardial infarction, and chronic heart failure as well. Particular attention is given to assessing the risk of developing contrast-induced acute kidney injury in patients with cardiovascular disease, as well as discussing current views on the possibility of prescribing drugs that affect the reninangiotensin system in cardiac patients with concomitant renal artery disease.
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Affiliation(s)
- E. A. Son
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. R. Kondratyuk
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. V. Fominykh
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V. V. Fomin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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24
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INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease. J Clin Exp Hepatol 2021; 11:354-386. [PMID: 33994718 PMCID: PMC8103529 DOI: 10.1016/j.jceh.2020.09.005] [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: 07/31/2019] [Accepted: 09/27/2020] [Indexed: 01/10/2023] Open
Abstract
Renal dysfunction is very common among patients with chronic liver disease, and concomitant liver disease can occur among patients with chronic kidney disease. The spectrum of clinical presentation and underlying etiology is wide when concomitant kidney and liver disease occur in the same patient. Management of these patients with dual onslaught is challenging and requires a team approach of hepatologists and nephrologists. No recent guidelines exist on algorithmic approach toward diagnosis and management of these challenging patients. The Indian National Association for Study of Liver (INASL) in association with Indian Society of Nephrology (ISN) endeavored to develop joint guidelines on diagnosis and management of patients who have simultaneous liver and kidney disease. For generating these guidelines, an INASL-ISN Taskforce was constituted, which had members from both the societies. The taskforce first identified contentious issues on various aspects of simultaneous liver and kidney diseases, which were allotted to individual members of the taskforce who reviewed them in detail. A round-table meeting of the Taskforce was held on 20-21 October 2018 at New Delhi to discuss, debate, and finalize the consensus statements. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system with minor modifications. The strength of recommendations (strong and weak) thus reflects the quality (grade) of underlying evidence (I, II, III). We present here the INASL-ISN Joint Position Statements on Management of Patients with Simultaneous Liver and Kidney Disease.
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25
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Latus J, Schwenger V, Schlieper G, Reinecke H, Hoyer J, Persson PB, Remppis BA, Mahfoud F. [Contrast medium-induced acute kidney injury-Consensus paper of the working group "Heart and Kidney" of the German Cardiac Society and the German Society of Nephrology]. Internist (Berl) 2020; 62:111-120. [PMID: 33349899 DOI: 10.1007/s00108-020-00938-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This consensus paper summarizes the expert consensus and recommendations of the working group "Heart and Kidney" of the German Cardiac Society (DGK) and the German Society of Nephrology (DGfN) on contrast medium-induced acute kidney injury. Potentially nephrotoxic contrast agents containing iodine are frequently used in interventional medicine and for computer tomography diagnostics. Acute kidney injury occurs in approximately 8-17% of patients exposed to contrast media. The risk factors and underlying pathophysiology are discussed and recommendations for the prophylaxis and treatment of contrast medium-induced acute nephropathy are presented.
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Affiliation(s)
- J Latus
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Deutschland
| | - V Schwenger
- Klinik für Nieren‑, Hochdruck- und Autoimmunerkrankungen, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Deutschland
| | - G Schlieper
- Zentrum für Nieren‑, Hochdruck- und Stoffwechselerkrankungen, Hannover, Deutschland
| | - H Reinecke
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinik Münster, Münster, Deutschland
| | - J Hoyer
- Klinik für Innere Medizin, Nephrologie und Internistische Intensivmedizin, Universitätsklinikum Marburg, Marburg, Deutschland
| | - P B Persson
- Institute of Physiology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B A Remppis
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - F Mahfoud
- Klinik für Innere Medizin III, Kardiologie und Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, IMED, Kirrberger Str. 1, 66421, Homburg/Saar, Deutschland.
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26
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Nijssen EC, Rennenberg R, Nelemans P, van Ommen V, Wildberger JE. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. ROFO-FORTSCHR RONTG 2020; 193:151-159. [PMID: 33327033 DOI: 10.1055/a-1248-9178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite tremendous improvement in molecular properties over the last century, intravascular injection of iodinated contrast material may still have systemic and hemodynamic consequences. Patients with pre-existing renal insufficiency may be at risk for acute kidney injury, which may be associated with an increased risk of the need for dialysis and mortality in the long term. Many questions as to the physiological pathways, optimal definition, and incidence of contrast-induced acute kidney injury remain open. These uncertainties are reflected in the changing landscape of this field in terms of nomenclature, research, and clinical practice. METHODS Clinical practice guidelines for the prevention of post-contrast acute kidney injury all recommend giving prophylaxis in the form of intravenous hydration to high-risk patients. Solid evidence for this strategy is lacking. This article gives an overview of the changing landscape of post-contrast acute kidney injury and prophylactic intravenous hydration, with the aim of supporting informed decision-making in clinical practice. RESULTS Recent data have caused a shift in guideline recommendations: 90 % of patients formerly considered high-risk for contrast-induced acute kidney injury no longer qualify for prophylaxis. The remaining high-risk patients, with severe chronic kidney disease, represent a vulnerable population for whom intravenous hydration may provide some benefits but also carries risk. CONCLUSION Intravenous hydration may benefit 'new' high-risk patients. However, it also confers risk. A dual approach to screening patients will help avoid this risk in clinical practice. KEY POINTS · Intravenous hydration is the cornerstone for preventing contrast-induced acute kidney injury. · Solid evidence is lacking; recent data caused a shift in guideline recommendations. · Intravenous hydration may benefit 'new' high-risk patients with severe chronic kidney disease; however, it also confers risk. · A dual approach to screening patients will help avoid this risk in clinical practice. CITATION FORMAT · Nijssen E, Rennenberg R, Nelemans P et al. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. Fortschr Röntgenstr 2021; 193: 151 - 159.
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Affiliation(s)
- Estelle Claire Nijssen
- Radiology & Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Roger Rennenberg
- Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Patty Nelemans
- Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Vincent van Ommen
- Cardiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Joachim E Wildberger
- Radiology & Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
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27
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Lakhal K, Ehrmann S, Robert-Edan V. Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review. Crit Care 2020; 24:641. [PMID: 33168006 PMCID: PMC7653744 DOI: 10.1186/s13054-020-03365-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
As we were taught, for decades, that iodinated contrast-induced acute kidney injury should be dreaded, considerable efforts were made to find out effective measures in mitigating the renal risk of iodinated contrast media. Imaging procedures were frequently either downgraded (unenhanced imaging) or deferred as clinicians felt that the renal risk pertaining to contrast administration outweighed the benefits of an enhanced imaging. However, could we have missed the point? Among the abundant literature about iodinated contrast-associated acute kidney injury, recent meaningful advances may help sort out facts from false beliefs. Hence, there is increasing evidence that the nephrotoxicity directly attributable to modern iodinated CM has been exaggerated. Failure to demonstrate a clear benefit from most of the tested prophylactic measures might be an indirect consequence. However, the toxic potential of iodinated contrast media is well established experimentally and should not be overlooked completely when making clinical decisions. We herein review these advances in disease and pathophysiologic understanding and the associated clinical crossroads through a typical case vignette in the critical care setting.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France.
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep Network, CHRU Tours, Tours France and Centre d'étude des Pathologies Respiratoires INSERM U1100, Université de Tours, Tours, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes, France
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28
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Minimal risk of contrast-induced kidney injury in a randomly selected cohort with mildly reduced GFR. Eur Radiol 2020; 31:3248-3257. [PMID: 33155105 PMCID: PMC8043936 DOI: 10.1007/s00330-020-07429-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Previous large studies of contrast-induced or post-contrast acute kidney injury (CI-AKI/PC-AKI) have been observational, and mostly retrospective, often with patients undergoing non-enhanced CT as controls. This carries risk of inclusion bias that makes the true incidence of PC-AKI hard to interpret. Our aim was to determine the incidence of PC-AKI in a large, randomly selected cohort, comparing the serum creatinine (Scr) changes after contrast medium exposure with the normal intraindividual fluctuation in Scr. METHODS In this prospective study of 1009 participants (age 50-65 years, 48% females) in the Swedish CArdioPulmonary bioImage Study (SCAPIS), with estimated glomerular filtration rate (eGFR) ≥ 50 mL/min, all received standard dose intravenous iohexol at coronary CT angiography (CCTA). Two separate pre-CCTA Scr samples and a follow-up sample 2-4 days post-CCTA were obtained. Change in Scr was statistically analyzed and stratification was used in the search of possible risk factors. RESULTS Median increase of Scr post-CCTA was 0-2 μmol/L. PC-AKI was observed in 12/1009 individuals (1.2%) according to the old ESUR criteria (> 25% or > 44 μmol/L Scr increase) and 2 individuals (0.2%) when using the updated ESUR criteria (≥ 50% or ≥ 27 μmol/L Scr increase). Possible risk factors (e.g., diabetes, age, eGFR, NSAID use) did not show increased risk of developing PC-AKI. The mean effect of contrast media on Scr did not exceed the intraindividual Scr fluctuation. CONCLUSIONS Iohexol administration to a randomly selected cohort with mildly reduced eGFR is safe, and PC-AKI is very rare, occurring in only 0.2% when applying the updated ESUR criteria. KEY POINTS • Iohexol administration to a randomly selected cohort, 50-65 years old with mildly reduced eGFR, is safe and PC-AKI is very rare. • Applying the updated ESUR PC-AKI criteria resulted in fewer cases, 0.2% compared to 1.2% using the old ESUR criteria in this cohort with predominantly mild reduction of renal function. • The mean effect of CM on Scr did not exceed the intraindividual background fluctuation of Scr, regardless of potential risk factors, such as diabetes or NSAID use in our cohort of 1009 individuals.
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Mach M, Hasan W, Andreas M, Winkler B, Weiss G, Adlbrecht C, Delle-Karth G, Grabenwöger M. Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models. J Clin Med 2020; 9:jcm9113476. [PMID: 33126601 PMCID: PMC7692089 DOI: 10.3390/jcm9113476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022] Open
Abstract
Recent studies have suggested that contrast medium (CM) volume is associated with acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). However, in a high-risk elderly TAVR population, the prognostic value and ideal threshold of CM dosage for AKI is unclear. Data of 532 successive TAVR patients (age 81.1 ± 6.8 years, EuroSCORE II 4.8% ± 6.0%) were therefore retrospectively analyzed. Based on a recently published formula, the renal function (preprocedural serum creatinine: SCr) corrected ratio of CM and body weight (CM*SCr/BW) was calculated to determine the risk of postprocedural contrast-associated AKI. AKI occurred in 94 patients (18.3%) and significantly increased 1-year all-cause mortality (23.4% vs. 13.1%; p = 0.001). A significant correlation between AKI and 30-day as well as 1-year all-cause mortality was observed (p = 0.001; p = 0.007). However, no association between CM dosage or the CM*SCr/BW ratio with the occurrence of AKI was seen (p = 0.968; p = 0.442). In our all-comers, all-access cohort, we found no relationship between CM dosage, or the established risk ratio model and the occurrence of postprocedural AKI. Further research needs to be directed towards different pathophysiological causes and preventive measures as AKI impairs short- and long-term survival.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
- Correspondence: ; Tel.: +43-140-4005-2620
| | - Waseem Hasan
- Faculty of Medicine, Imperial College London, London SW7 2AZ, UK;
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Bernhard Winkler
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
| | - Gabriel Weiss
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
| | - Christopher Adlbrecht
- Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1210 Vienna, Austria; (C.A.); (G.D.-K.)
| | - Georg Delle-Karth
- Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, 1210 Vienna, Austria; (C.A.); (G.D.-K.)
| | - Martin Grabenwöger
- Heart Team Vienna, Department of Cardio-Vascular Surgery, Vienna North Hospital—Clinic Floridsdorf and the Karl Landsteiner Institute for Cardio-Vascular Research, 1130 Vienna, Austria; (B.W.); (G.W.); (M.G.)
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
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30
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Wang Y, Zhang H, Pang T, Zuo Z, Ren K. Rapamycin improves renal injury induced by Iodixanol in diabetic rats by deactivating the mTOR/p70S6K signaling pathway. Life Sci 2020; 259:118284. [PMID: 32798557 DOI: 10.1016/j.lfs.2020.118284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
Abstract
AIMS To study how to effectively prevent or reduce renal injury caused by contrast agents in diabetic patients. MAIN METHODS Sprague Dawley (SD) rats were bred with a high-fat diet for eight weeks, then intraperitoneally injected with Streptozotocin (STZ) to prepare the diabetes model. Rats were treated with Iodixanol to prepare a contrast-induced acute kidney injury (CIAKI) model. Moreover, 3-methyladenine (3-MA), an autophagy inhibitor, was administrated to diabetic rats with or without Rapamycin treatment. Serum creatinine (SCr) and blood urea nitrogen (BUN) were examined using Biochemical detector. Kidney injury molecule-1 (KIM-1), N-acetyl-β-D-amino glycosidase (NAG) in urine, inflammatory and oxidative stress factors in serum were determined by ELISA. The expression level of ROS was quantified by immunofluorescence (IF). The protein expressions of Bax, BCl-2, LC3, Beclin1, mTOR and p70S6K in renal tissue were detected by Western blot. KEY FINDINGS Rapamycin was demonstrated to improve renal injury induced by Iodixanol diabetic rats, decrease the levels of SCr, BUN, KIM-1, NAG, improve renal functions, reduce inflammatory response and oxidative stress injury, down-regulate Bax, while up-regulate BCl-2 and inhibit apoptosis. Moreover, Rapamycin could inhibit the phosphorylation of mTOR/p70S6K pathway-associated proteins, activate autophagy and increase the levels of LC3 and Beclin1. After treatment with 3MA, an inhibitor of mTOR/p70S6K signaling pathway, the protective effects of Rapamycin on CIAKI were weakened. SIGNIFICANCE Rapamycin can alleviate renal injury induced by Iodixanol diabetic rats, and its regulatory mechanisms may be related to the regulation of mTOR/p70S6K signaling pathway and the activating autophagy.
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Affiliation(s)
- Yan Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Department of Radiology, Panjin Liaohe Oilfield GEM Flower Hospital, Panjin, China
| | - Haoyu Zhang
- Department of Radiology, Panjin Liaohe Oilfield GEM Flower Hospital, Panjin, China
| | - Tianshu Pang
- Department of Anatomy, Jinzhou Medical University, Jinzhou, China
| | - Zhongfu Zuo
- Department of Anatomy, Jinzhou Medical University, Jinzhou, China
| | - Ke Ren
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China.
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Corbett M, Duarte A, Llewellyn A, Altunkaya J, Harden M, Harris M, Walker S, Palmer S, Dias S, Soares M. Point-of-care creatinine tests to assess kidney function for outpatients requiring contrast-enhanced CT imaging: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-248. [PMID: 32840478 PMCID: PMC7475798 DOI: 10.3310/hta24390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with low estimated glomerular filtration rates may be at higher risk of post-contrast acute kidney injury following contrast-enhanced computed tomography imaging. Point-of-care devices allow rapid measurement of estimated glomerular filtration rates for patients referred without a recent estimated glomerular filtration rate result. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of point-of-care creatinine tests for outpatients without a recent estimated glomerular filtration rate measurement who need contrast-enhanced computed tomography imaging. METHODS Three systematic reviews of test accuracy, implementation and clinical outcomes, and economic analyses were carried out. Bibliographic databases were searched from inception to November 2018. Studies comparing the accuracy of point-of-care creatinine tests with laboratory reference tests to assess kidney function in adults in a non-emergency setting and studies reporting implementation and clinical outcomes were included. Risk of bias of diagnostic accuracy studies was assessed using a modified version of the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Probabilities of individuals having their estimated glomerular filtration rates correctly classified were estimated within a Bayesian framework and pooled using a fixed-effects model. A de novo probabilistic decision tree cohort model was developed to characterise the decision problem from an NHS and a Personal Social Services perspective. A range of alternative point-of-care testing approaches were considered. Scenario analyses were conducted. RESULTS Fifty-four studies were included in the clinical reviews. Twelve studies reported diagnostic accuracy for estimated glomerular filtration rates; half were rated as being at low risk of bias, but there were applicability concerns for most. i-STAT (Abbott Point of Care, Inc., Princeton, NJ, USA) and ABL (Radiometer Ltd, Crawley, UK) devices had higher probabilities of correctly classifying individuals in the same estimated glomerular filtration rate categories as the reference laboratory test than StatSensor® devices (Nova Biomedical, Runcorn, UK). There was limited evidence for epoc® (Siemens Healthineers AG, Erlangen, Germany) and Piccolo Xpress® (Abaxis, Inc., Union City, CA, USA) devices and no studies of DRI-CHEM NX 500 (Fujifilm Corporation, Tokyo, Japan). The review of implementation and clinical outcomes included six studies showing practice variation in the management decisions when a point-of-care device indicated an abnormal estimated glomerular filtration rate. The review of cost-effectiveness evidence identified no relevant studies. The de novo decision model that was developed included a total of 14 strategies. Owing to limited data, the model included only i-STAT, ABL800 FLEX and StatSensor. In the base-case analysis, the cost-effective strategy appeared to be a three-step testing sequence involving initially screening all individuals for risk factors, point-of-care testing for those individuals with at least one risk factor, and including a final confirmatory laboratory test for individuals with a point-of-care-positive test result. Within this testing approach, the specific point-of-care device with the highest net benefit was i-STAT, although differences in net benefit with StatSensor were very small. LIMITATIONS There was insufficient evidence for patients with estimated glomerular filtration rates < 30 ml/minute/1.73 m2, and on the full potential health impact of delayed or rescheduled computed tomography scans or the use of alternative imaging modalities. CONCLUSIONS A three-step testing sequence combining a risk factor questionnaire with a point-of-care test and confirmatory laboratory testing appears to be a cost-effective use of NHS resources compared with current practice. The risk of contrast causing acute kidney injury to patients with an estimated glomerular filtration rate of < 30 ml/minute/1.73 m2 is uncertain. Cost-effectiveness of point-of-care testing appears largely driven by the potential of point-of-care tests to minimise delays within the current computed tomography pathway. FUTURE WORK Studies evaluating the impact of risk-stratifying questionnaires on workflow outcomes in computed tomography patients without recent estimated glomerular filtration rate results are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42018115818. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 39. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Ana Duarte
- Centre for Health Economics (CHE), University of York, York, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - James Altunkaya
- Centre for Health Economics (CHE), University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Martine Harris
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK
| | - Simon Walker
- Centre for Health Economics (CHE), University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics (CHE), University of York, York, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Marta Soares
- Centre for Health Economics (CHE), University of York, York, UK
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Shin H, Taghavifar S, Salehi S, Joyce P, Gholamrezanezhad A. Current comments on contrast media administration in patients with renal insufficiency. Clin Imaging 2020; 69:37-44. [PMID: 32652456 DOI: 10.1016/j.clinimag.2020.06.040] [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] [Received: 10/03/2019] [Revised: 06/07/2020] [Accepted: 06/26/2020] [Indexed: 01/10/2023]
Abstract
Contrast media administration has been associated with complications such as nephropathy, cardiovascular morbidity, and neurovascular events, particularly in patients with renal insufficiency. This association has been questioned in recent studies. This review was performed to summarize the most current evidence on contrast induced nephropathy (CIN), contributing factors, and considerations in patients with renal insufficiency. The risk of CIN was over-estimated by the previous studies, due to a lack of control groups or presence of non-randomized control groups, which led to a selection bias. However, the thresholds associated with an increased risk of CIN are controversial and require risk-benefit analysis on an individual basis. Regarding the administration of contrast media (CM) in the emergency setting, the majority of studies suggested that CM exposure does not meaningfully increase the risk of acute kidney injury in critically ill patients (including trauma patients). Several strategies have been suggested to reduce the risk of CIN, including volume expansion to increase renal blood flow, sodium bicarbonate or N-acetylcysteine administration, and use of low-osmolal contrast media in end-stage renal disease.
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Affiliation(s)
- Heeseop Shin
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Sana Salehi
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
| | - Peter Joyce
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
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Use of Contrast Medium Volume to Guide Prophylactic Hydration to Prevent Acute Kidney Injury After Contrast Administration: A Meta-Analysis. AJR Am J Roentgenol 2020; 215:15-24. [PMID: 32348183 DOI: 10.2214/ajr.19.22325] [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: 12/13/2022]
Abstract
OBJECTIVE. The purpose of this study was to determine whether contrast medium volume and method of administration and baseline estimated glomerular filtration rate influence the efficacy of prophylactic hydration for prevention of acute kidney injury after contrast administration. MATERIALS AND METHODS. An online search of PubMed conducted on August 25, 2017, produced a total of 697 studies. After the reports were reviewed, nine were included in this study. The extracted data on all patients in these studies were separated into a group that received prophylactic hydration and a group that did not. The following three parameters were used for subgroup analysis: contrast medium volume, contrast administration method, and baseline estimated glomerular filtration rate. The t test was performed, and study-level odds ratios with 95% CIs and p values were calculated. Tests of heterogeneity were conducted. RESULTS. When the volume of contrast agent administered exceeded 100 mL, hydration was beneficial in the prevention of contrast-induced acute kidney injury (odds ratio, 0.546). If the volume was less than 100 mL, hydration had no efficacy in preventing contrast-induced acute kidney injury (odds ratio, 0.917). Administration route and baseline estimated glomerular filtration rate exerted no effect on the efficacy of prophylactic hydration. CONCLUSION. For patients who receive less than 100 mL of contrast medium, the prevalent practice for contrast-enhanced CT studies, prophylactic hydration may not be necessary, regardless of the estimated glomerular filtration rate or route of contrast administration. For patients undergoing procedures requiring administration of large volumes of contrast medium, however, hydration is recommended to prevent contrast-induced acute kidney injury.
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Abstract
More than sixty years have elapsed since contrast induced nephropathy (CIN) was first described in the medical literature. This term has since been extensively explored, with a variety of studies conducted to investigate its incidence and various mechanisms examined to explain its pathophysiology. However, the topic of CIN remains one of controversy with a widely variable and often questionable incidence derived from various studies. The past two decades have seen a surge in reports questioning the existing of CIN altogether and if more harm is actually being caused to patients out of fear of this potential complication. We have attempted to review relevant studies regarding CIN and highlight the key points of its surmised understanding. The review has a higher focus on more recent literature and updates, in order to determine if an accurate estimate can be made on the incidence of CIN. While there was certainly no lack of material available, practically all the studies reviewed were limited by one or more significant drawbacks that limited the reliability of their conclusions regarding CIN. Based on the information reviewed, the strengths and the flaws encountered in other studies can be used to design a randomized control trial that may help in concluding the longstanding debate on this topic. However due to time, financial, and perhaps even ethical constraints such a trial will be difficult to arrange, and so a definitive answer on CI-AKI, and whether it really exist, may continue to elude clinicians.
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Affiliation(s)
| | - Cindy S Yip
- Department of Medicine, SUNY at Buffalo, NY, USA
| | - Pradeep Arora
- Department of Medicine, SUNY at Buffalo, NY, USA.,Division of Nephrology at VAMC, Buffalo, NY, USA
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Huynh K, Baghdanian AH, Baghdanian AA, Sun DS, Kolli KP, Zagoria RJ. Updated guidelines for intravenous contrast use for CT and MRI. Emerg Radiol 2020; 27:115-126. [PMID: 31925592 DOI: 10.1007/s10140-020-01751-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/03/2020] [Indexed: 12/29/2022]
Abstract
Intravenous (IV) contrast material is used extensively for CT and MRI scans done in emergency departments (ED). Its use is essential to make many critical diagnoses in ED patients. While adverse reactions can occur, newer research has added to our knowledge of IV contrast media tolerance and safety leading to improved and more liberal guidelines for intravenous contrast use. The updated information described in this review article indicates how intravenous contrast can be used safely in more patients, more expeditiously and with fewer precautions than with prior guidelines. This review article explains the basis for the new recommendations for intravenous contrast material use and describes indicated precautions and preparations to avoid adverse reactions for iodinated agents used for CT and gadolinium agents for MRI.
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Affiliation(s)
- Kevin Huynh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Arthur H Baghdanian
- Department of Radiology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Armonde A Baghdanian
- Department of Radiology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Derek S Sun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - K Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Ronald J Zagoria
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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Rudnick MR, Leonberg-Yoo AK, Litt HI, Cohen RM, Hilton S, Reese PP. The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk? Am J Kidney Dis 2020; 75:105-113. [DOI: 10.1053/j.ajkd.2019.05.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/07/2019] [Indexed: 01/07/2023]
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Ribitsch W, Horina JH, Quehenberger F, Rosenkranz AR, Schilcher G. Contrast Induced Acute Kidney Injury and its Impact on Mid-Term Kidney Function, Cardiovascular Events and Mortality. Sci Rep 2019; 9:16896. [PMID: 31729409 PMCID: PMC6858434 DOI: 10.1038/s41598-019-53040-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022] Open
Abstract
The existence and clinical relevance of contrast induced acute kidney injury (CI-AKI) is still heavily debated and angiographic procedures are often withheld in fear of CI-AKI, especially in CKD-patients. We investigated the incidence of CI-AKI in cardiovascular high risk patients undergoing intra-arterial angiography and its impact on mid-term kidney function, cardiovascular events and mortality. We conducted a prospective observational trial on patients undergoing planned intra-arterial angiographic procedures. All subjects received standardized intravenous hydration prior to contrast application. CI-AKI was defined according to a ≥25% increase of creatinine from baseline to either 24hrs or 48hrs after angiography. Plasma creatinine and eGFR were recorded from the institutional medical record system one and three months after hospital discharge. Patients were followed up for two years to investigate the long term effects of CI-AKI on cardiovascular events and mortality. We studied 706 (317 female) patients with a mean eGFR of 52.0 ± 15 ml·min−1·1.73 m−2. The incidence of CI-AKI was 10.2% (72 patients). In 94 (13.3%) patients serum creatinine decreased ≥25% either 24 or 48 hours after angiography. Patients with CI-AKI had a lower creatinine and a higher eGFR at baseline, but no other independent predictors of CI-AKI could be identified. Kidney function was not different between both groups one and three months after discharge. After a two year follow up the overall incidence of cardiovascular events was 56.5% in the CI-AKI group and 58.8% in the Non CI-AKI group (p = 0.8), the incidence of myocardial infarctions, however, was higher in CI-AKI-patients. Overall survival was also not different between patients with CI-AKI (88.6%) and without CI-AKI (84.7%, p = 0.48). The occurrence of CI-AKI did not have any negative impact on mid-term kidney function, the incidence of cardiovascular events and mortality. Considerable fluctuations of serum creatinine interfere with the presumed diagnosis of CI-AKI. Necessary angiographic procedures should not be withheld in fear of CI-AKI.
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Affiliation(s)
- Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
| | - Joerg H Horina
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Gernot Schilcher
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.,Intensive Care Unit, Department of Internal Medicine, MUG, Graz, Austria
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Abstract
STUDY OBJECTIVE Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction. METHODS This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT. RESULTS We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ± 7.66 mL·min·1.73 m and 11.56 ± 5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51-25.23, P = .015) was a significant risk factor for PC-AKI. CONCLUSION This study demonstrated that, among the echocardiographic variables, E/E was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.
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Affiliation(s)
| | | | - Hyuk-Hoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, 16499, Suwon, Republic of Korea
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Gallardo X, Almirall J, Castaner E, Andreu M, Gonzalez E, Consola B. Assessing the nephrotoxicity of intravenous iodinated contrast agents in patients with chronic renal failure in the absence of interfering acute disease. Acta Radiol 2019; 60:1445-1449. [PMID: 30997828 DOI: 10.1177/0284185119840764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Xavier Gallardo
- Department of Radiology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Jaume Almirall
- Department of Nephrology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Eva Castaner
- Department of Radiology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Marta Andreu
- Department of Radiology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Elena Gonzalez
- Department of Vascular Surgery, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Beatriz Consola
- Department of Radiology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
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Tandukar S, Rondon-Berrios H, Weisbord SD. Intravascular Iodinated Contrast Is an Independent Cause of Acute Kidney Injury Following Coronary Angiography. South Med J 2019; 112:541-546. [PMID: 31583416 DOI: 10.14423/smj.0000000000001029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Recent studies have questioned whether intravascular iodinated contrast remains an independent cause of acute kidney injury (AKI). We sought to assess whether iodinated contrast administered during coronary angiography is an independent cause of AKI. METHODS We identified all of the patients who underwent coronary angiography between July 1, 2015 and June 30, 2017 with a discharge diagnosis of AKI that developed within 7 days following angiography. Using chart review, we categorized patients as having multifactorial AKI if ≥1 insults other than intravascular contrast potentially contributed to kidney injury or contrast-induced AKI (CI-AKI) if the only insult was contrast administration. We compared the severity of AKI and renal function upon discharge between patients with CI-AKI and multifactorial AKI. RESULTS We identified 78 patients who experienced AKI within 7 days following angiography, 10 (13%) of whom had CI-AKI and 68 of whom (87%) experienced multifactorial AKI. Nine (90%) patients with CI-AKI manifested stage 1 disease, 1 (10%) had stage 2 disease, and 9 (90%) experienced full recovery of kidney function. More patients with multifactorial AKI developed stage 2 or 3 disease (42% vs 10%, χ2 = 3.73, P = 0.05) and experienced either partial recovery of kidney function or persistent kidney impairment compared with patients with CI-AKI (25% vs 10%, χ2 = 1.9, P = 0.17), although the latter comparison was not statistically significant. CONCLUSIONS The intravascular administration of iodinated contrast remains an independent cause of AKI. Compared with those with multifactorial AKI, patients with CI-AKI appear to be more likely to experience mild decrements in kidney function that recover completely.
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Affiliation(s)
- Srijan Tandukar
- From the Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Helbert Rondon-Berrios
- From the Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven D Weisbord
- From the Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Contrast-Induced Acute Kidney Injury Among Patients With Chronic Kidney Disease Undergoing Imaging Studies: A Meta-Analysis. AJR Am J Roentgenol 2019; 213:728-735. [DOI: 10.2214/ajr.19.21309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Radiological iodinated contrast-induced nephropathy. Rev Clin Esp 2019; 219:403-410. [PMID: 30318246 DOI: 10.1016/j.rce.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/20/2022]
Abstract
The use of iodinated contrast media can cause renal toxicity. Whether contrast media are exclusively responsible for kidney damage is currently the subject of debate, given that in most cases, other potential causes of the renal failure are present. With current low-osmolar and iso-osmolar contrast media, the incidence rate of contrast-induced nephropathy is estimated to be <1% in the low-risk population but can increase to 37% in patients who are administered contrast by an intra-arterial administration and/or who have renal failure with an estimated glomerular filtration rate (eGFR) <30mL/min/1.73m2. To minimize the risk of renal toxicity, the recommendation is to administer the least amount of contrast possible and ensure appropriate volume expansion by infusing 0.9% saline solution.
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Radiological iodinated contrast-induced nephropathy. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shih YJ, Kuo YT, Ho CH, Wu CC, Ko CC. Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study. PeerJ 2019; 7:e7757. [PMID: 31592348 PMCID: PMC6776070 DOI: 10.7717/peerj.7757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) are considered at risk of contrast-induced acute kidney injury and possible subsequent need for dialysis therapy. Computed tomography (CT) is the most commonly performed examination requiring intravenous iodinated contrast media (ICM) injection. The actual risk of dialysis in CKD patients undergoing CT with ICM remains controversial. Furthermore, it is also uncertain whether these at-risk patients can be identified by means of administrative data. Our study is conducted in order to determine the incidence and risk of dialysis within 30 days after undergoing contrast enhanced CT in CKD coded patients. Methods This longitudinal, nation-wide, populated-based study is carried out by analyzing the Taiwan National Health Insurance Research Database retrospectively. Patients coded under the diagnosis of CKD who underwent CT are identified within randomly selected one million subjects of the database. From January 2012 to December 2013, 487 patients had undergone CT with ICM. A total of 924 patients who underwent CT without ICM are selected as the control group. Patients with advanced CKD or intensive care unit (ICU) admissions are assigned to the subgroups for analysis. The primary outcome is measured by dialysis events within 30 days after undergoing CT scans. The cumulative incidence is assessed by the Kaplan–Meier method and log-rank test. The risk of 30-day dialysis relative to the control group is analyzed by the Cox proportional hazards model after adjusting for age, sex, and baseline comorbidities. Results The numbers and percentages of dialysis events within 30 days after undergoing CT scans are 20 (4.1%) in the CT with ICM group and 66 (7.1%) in the CT without ICM group (p = 0.03). However, the adjusted hazard ratio (aHR) for 30-day dialysis was 0.84 (95% CI [0.46–1.54], p = 0.57), which is statistically non-significant. In both advanced CKD and ICU admission subgroups, there are also no significant differences in 30-day dialysis risks with the aHR of 1.12 (95% CI [0.38–3.33], p = 0.83) and 0.95 (95% CI [0.44–2.05], p = 0.90), respectively. Conclusions Within 30 days of receiving contrast-enhanced CT scans, 4.1% of CKD coded patients required dialysis, which appear to be lower compared with subjects who received non-contrast CT scans. However, no statistically significant difference is observed after adjustments are made for other baseline conditions. Thereby, the application of administrative data to identify patients with CKD cannot be viewed as a risk factor for the necessity to undergo dialysis within 30 days of receiving contrast-enhanced CT scans.
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Affiliation(s)
- Yun-Ju Shih
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chia-Chun Wu
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Einstein AJ, Newhouse JH. Differences in Nephrotoxicity between Modes of Iodinated Contrast Material Administration in Patients Suspected of Having Coronary Artery Disease. Radiology 2019; 292:673-675. [DOI: 10.1148/radiol.2019191163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew J. Einstein
- From the Department of Medicine (A.J.E.), Seymour, Paul and Gloria Milstein Division of Cardiology (A.J.E.), and Department of Radiology (A.J.E., J.H.N.), Columbia University Irving Medical Center and New York-Presbyterian Hospital, 622 W 168th St, PH 10-203, New York, NY 10032
| | - Jeffrey H. Newhouse
- From the Department of Medicine (A.J.E.), Seymour, Paul and Gloria Milstein Division of Cardiology (A.J.E.), and Department of Radiology (A.J.E., J.H.N.), Columbia University Irving Medical Center and New York-Presbyterian Hospital, 622 W 168th St, PH 10-203, New York, NY 10032
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Hachulla AL, Noble S, Ronot M, Guglielmi G, de Perrot T, Montet X, Vallée JP. Low Iodine Contrast Injection for CT Acquisition Prior to Transcatheter Aortic Valve Replacement: Aorta Assessment and Screening for Coronary Artery Disease. Acad Radiol 2019; 26:e150-e160. [PMID: 30076081 DOI: 10.1016/j.acra.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES To assess both the complete aorta and coronary artery disease (CAD) using low iodine contrast computed-tomography angiography before transcatheter aortic valve replacement. MATERIALS AND METHODS 84 patients underwent computed-tomography angiography before transcatheter aortic valve replacement: 42 with standard iodine injection protocol (P1:120 mL); 42 with a low dose iodine injection protocol (P2:60 mL). Mean attenuation and subjective image quality were rated at different levels of the aorta, iliac and coronary arteries. Sensitivity, specificity, negative and positive predictive values for depiction of CAD were calculated according to the coronary angiography. RESULTS Mean attenuation was significantly higher in P1 for the ascending aorta (p < 0.001). No significant difference was observed regarding image quality of the aortic valve (p = 0.876), the ascending aorta (p = 0.306), or the abdominal aorta (p = 1.0). Diagnostic image quality of coronary arteries was excellent for P1 and P2 (94.6% vs 96.5%, p = 0.08). Sensitivity, specificity, negative and positive predictive values, and accuracy for depiction of CAD were excellent for P1 and P2 (100% vs 100%; 79% vs 86%, 70% vs 87%, 100% vs 100% and 86% vs 93%) without significant differences (p = 0.93; p = 0.58; p = 0.90; p = 1.0; p = 0.74), respectively. CONCLUSION Despite a difference in aortic mean attenuation, a reduced iodine injection protocol showed similar image quality and detection of CAD in comparison with a standard injection protocol.
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Ferrer Puchol M, Montesinos García P, Forment Navarro M, Sanz Rodrigo E, Blanco Pérez E, Taberner López E. The administration of contrast media: Is there a risk of acute kidney injury? RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Steffens L, Hayes L, Wiebe AZ. Pharmacology of Contrast-Induced Nephropathy. AACN Adv Crit Care 2019; 30:97-104. [PMID: 31151940 DOI: 10.4037/aacnacc2019550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Laura Steffens
- Laura Steffens is Clinical Pharmacist, Emergency Department/Intensive Care Unit, Department of Pharmacy Services, University of Utah Health, Salt Lake City, Utah. Lisa Hayes is Clinical Pharmacy Specialist, Emergency Department/Intensive Care Unit, Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee. Amanda Z. Wiebe is Clinical Pharmacist, Cardiovascular Intensive Care Unit/Surgical Intensive Care Unit, Department of Pharmacy Services, University of Utah Health, 50 N Medical Drive, Salt Lake City, UT 84112
| | - Lisa Hayes
- Laura Steffens is Clinical Pharmacist, Emergency Department/Intensive Care Unit, Department of Pharmacy Services, University of Utah Health, Salt Lake City, Utah. Lisa Hayes is Clinical Pharmacy Specialist, Emergency Department/Intensive Care Unit, Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee. Amanda Z. Wiebe is Clinical Pharmacist, Cardiovascular Intensive Care Unit/Surgical Intensive Care Unit, Department of Pharmacy Services, University of Utah Health, 50 N Medical Drive, Salt Lake City, UT 84112
| | - Amanda Z Wiebe
- Laura Steffens is Clinical Pharmacist, Emergency Department/Intensive Care Unit, Department of Pharmacy Services, University of Utah Health, Salt Lake City, Utah. Lisa Hayes is Clinical Pharmacy Specialist, Emergency Department/Intensive Care Unit, Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee. Amanda Z. Wiebe is Clinical Pharmacist, Cardiovascular Intensive Care Unit/Surgical Intensive Care Unit, Department of Pharmacy Services, University of Utah Health, 50 N Medical Drive, Salt Lake City, UT 84112
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Affiliation(s)
- Roxana Mehran
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M., G.D.D.); and the Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - George D Dangas
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M., G.D.D.); and the Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Steven D Weisbord
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M., G.D.D.); and the Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
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Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study. Eur Radiol 2019; 29:3927-3934. [DOI: 10.1007/s00330-019-06147-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
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