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Suárez Carantoña C, Escobar Cervantes C, Fabregate M, López Rodríguez M, Bara Ledesma N, Soto Pérez-Olivares J, Ruiz Ortega RA, López Castellanos G, Olavarría Delgado A, Blázquez Sánchez J, Gómez Del Olmo V, Moralejo Martín M, Pumares Álvarez MB, Sánchez Gallego MDLC, Llàcer P, Liaño F, Manzano L. Oral Sodium Chloride in the Prevention of Contrast-Associated Acute Kidney Injury in Elderly Outpatients: The PNIC-Na Randomized Non-Inferiority Trial. J Clin Med 2023; 12:jcm12082965. [PMID: 37109303 PMCID: PMC10141633 DOI: 10.3390/jcm12082965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE We aimed to test the non-inferiority of oral versus intravenous hydration in the incidence of contrast-associated acute kidney injury (CA-AKI) in elderly outpatients undergoing a contrast-enhanced computed tomography (CE-CT) scan. METHODS PNIC-Na (NCT03476460) is a phase-2, single-center, randomized, open-label, non-inferiority trial. We included outpatients undergoing a CE-CT scan, >65 years having at least one risk factor for CA-AKI, such as diabetes, heart failure, or an estimated glomerular filtration rate (eGFR) of 30-59 mL/min/1.73 m². Participants were randomized (1:1) to oral sodium-chloride capsules or intravenous hydration. The primary outcome was an increase in serum creatinine >0.3 mg/dL or a reduction in eGFR >25% within 48 h. The non-inferiority margin was set at 5%. RESULTS A total of 271 subjects (mean age 74 years, 66% male) were randomized, and 252 were considered for the main analysis (per-protocol). A total of 123 received oral hydration and 129 intravenous. CA-AKI occurred in 9 (3.6%) of 252 patients and 5/123 (4.1%) in the oral-hydration group vs. 4/129 (3.1%) in the intravenous-hydration group. The absolute difference between the groups was 1.0% (95% CI -4.8% to 7.0%), and the upper limit of the 95% CI exceeded the pre-established non-inferiority margin. No major safety concerns were observed. CONCLUSION The incidence of CA-AKI was lower than expected. Although both regimens showed similar incidences of CA-AKI, the non-inferiority was not shown.
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Affiliation(s)
- Cecilia Suárez Carantoña
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Carlos Escobar Cervantes
- Cardiology Department, Hospital Universitario La Paz, IdiPaz, P.º de la Castellana, 261, 28046 Madrid, Spain
| | - Martín Fabregate
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - Mónica López Rodríguez
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Nuria Bara Ledesma
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - Javier Soto Pérez-Olivares
- Centro de Innovación en Tecnología para el Desarrollo Humano, Universidad Politécnica de Madrid (itdUPM), Av. Complutense s/n, 28040 Madrid, Spain
- Radiology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - Raúl Antonio Ruiz Ortega
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Genoveva López Castellanos
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Andreina Olavarría Delgado
- Radiology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - Javier Blázquez Sánchez
- Radiology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - Vicente Gómez Del Olmo
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Myriam Moralejo Martín
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - María Belén Pumares Álvarez
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | | | - Pau Llàcer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
| | - Fernando Liaño
- Department of Nephrology, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, CTRA M-607 Colmenar Viejo, Km 9.10, 28034 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), Pl. de San Diego, s/n, 28801 Alcalá de Henares, Spain
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Łoń I, Lewandowski J, Wieliczko M, Małyszko J. Retroperitoneal fibrosis, a rare entity with urorenal and vascular subtypes - preliminary data. Ren Fail 2022; 44:688-692. [PMID: 35440292 PMCID: PMC9037163 DOI: 10.1080/0886022x.2022.2064303] [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] [Indexed: 12/02/2022] Open
Abstract
Introduction Retroperitoneal fibrosis (RPF) is a rare disease associated with the formation of hard inflammatory and fibrous tissue in the retroperitoneum. Taking into consideration the fact that RPF is a rare disease with different subtypes, we compared the basal clinical and biochemical characteristics of the vascular and urorenal subtypes. Patients and methods From January 2005 until December 2021, 27 patients were identified as vascular subtype (18 males) and 11 as urorenal subtype (9 males). Results Patients with a primary urorenal origin had significantly worse kidney function as reflected by serum creatinine and eGFR (both p < 0.001); they also had higher serum cholesterol (p < 0.01). Hypertension, diabetes, hyperlipidemia and nicotinism were significantly more prevalent in vascular subtype (all p < 0.001). Conclusion Vascular subtype is more prevalent in our study with more cardiovascular risk factor present. Due to the diversity of symptoms, diagnosis of RPF becomes a challenge for specialists as well as therapy.
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Affiliation(s)
- Izabela Łoń
- Department of Hypertension, Angiology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Lewandowski
- Department of Hypertension, Angiology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Monika Wieliczko
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Łoń I, Wieliczko M, Lewandowski J, Małyszko J. Retroperitoneal fibrosis is still underdiagnosed entity with poor prognosis. Kidney Blood Press Res 2021; 47:151-162. [PMID: 34915518 DOI: 10.1159/000521423] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Retroperitoneal fibrosis (RPF) is a rare disease characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encircles abdominal organs including aorta and ureters. Data on the incidence of this disease are limited. SUMMARY The disease may be idiopathic or secondary to infections, malignancies, drugs or radiotherapy. Idiopathic form is an immune-mediated entity and a part of the broader spectrum of idiopathic diseases termed chronic periaortitis, characterized by a morphologically similar fibroinflammatory changes in aorta and surrounding tissues. Taking into account the dominant symptoms and clinical charac-teristics of patients with periaortitis, two subtypes of disease could be distinguished. Vascular subtype include patients with non-dilated aorta or with inflammatory abdominal aortic aneu-rysm, both with and without involvement of adjacent structures and with numerous risk factors for atherosclerosis. In renoureteral subtype obstructive uropathy manifesting with hydronephro-sis and acute kidney injury is predominant finding. Due to the variety of symptoms, diagnosis of RPF remains challenging, difficult and often delayed. A series of diagnostic tests should be performed, in order to confirm the diagnosis idiopathic RPF. Laboratory work-up include eval-uation of inflammatory indices and immunological studies. A biopsy and histopathological evaluation may be necessary to confirm diagnosis and differentiate the disease. Computed to-mography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are the modalities of choice for the diagnosis and follow-up of this disease. Management of ureteral obstruction, hydronephrosis, and aortic aneurysms often requires surgical evaluation and treatment. The pharmacological treatment of RPF has been evaluated in a few randomized trials and is mainly based on observational studies. Steroid therapy remains the gold standard of treatment. Key messages: Nowadays multidisciplinary team approach with clinical and diagnos-tic experience in both primary and secondary RPF as well as two major subtypes should be offered. Centers specialized in rare diseases with collaboration with other units and referral sys-tem yield the best possible outcomes.
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Affiliation(s)
- Izabela Łoń
- Department of Hypertension, Angiology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Monika Wieliczko
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Lewandowski
- Department of Hypertension, Angiology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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