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Lu J, He Y, Yang Y, Zhong X, Chen S, Wu B, Pan Y, Wang Y, Xiu J, Kang Y, Liu J, Liu Y, Chen S, Chen K, Chen L. Age-Related Effect of Uric Acid on Contrast-Induced Acute Kidney Injury of Patients Undergoing Coronary Angiography. Clin Interv Aging 2023; 18:2053-2061. [PMID: 38088947 PMCID: PMC10712252 DOI: 10.2147/cia.s419370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background The association between uric acid (UA) and contrast-induced acute kidney injury (CI-AKI) following coronary angiography (CAG) has been established. However, whether the association would vary with age remained undetermined. Methods We performed the retrospective analysis based on the Cardio-renal Improvement II study, (ClinicalTrials.gov NCT05050877), which enrolled consecutive patients undergoing coronary angiography in 5 teaching hospitals in China from 2007 to 2020. The primary outcome was CI-AKI defined as the rise of serum creatinine (SCr) ≥ 0.5 mg/dL or 25% compared with the baseline value within 48 hours following CAG. The effect of age on the association between uric acid and CI-AKI was assessed by the logistic regression model. Results A total of 36,550 patients (mean age 63.08±5.6-year-old, 41.7% men) were included in the study. After adjusting for the confounders, the risk of CI-AKI between each quartile of uric acid was insignificant in the young group. In patients of the middle group, lower UA was associated with a lower risk of CI-AKI while higher UA was associated with a higher risk (Q1 OR: 0.853, 95% CI: 0.734-0.993; Q4 OR: 1.797, 95% CI: 1.547-2.09). In patients of the elder group, lower and higher UA were both associated with a higher risk of CI-AKI (Q1 OR: 1.247, 95% CI: 1.003-1.553; Q4 OR: 1.688, 95% CI: 1.344-2.124). The restricted cubic spline indicated a non-linear association between UA and CI-AKI in middle and elder age groups but a linear association in the young age group. Conclusion The association between uric acid and CI-AKI vary in patients of different age. Patients with elder age should maintain a middle level of uric acid while patients with middle age should consider a lower level of uric acid to reduce the risk of CI-AKI. The level of UA was an insignificant risk factor for CI-AKI in young patients.
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Affiliation(s)
- Jin Lu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yanfang Yang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Xuejing Zhong
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Shaowen Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Bo Wu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yuxiong Pan
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yizhang Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Jiaming Xiu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Yu Kang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Shantou University Medical College, Shantou, 515041, People’s Republic of China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Shiqun Chen
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, 510100, People’s Republic of China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
| | - Liling Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, People’s Republic of China
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Xing H, Jiang Z, Wu Y, Ou S, Qin J, Xue L, Wu W. The role of urinary Dickkopf-3 in the prediction of acute kidney injury: a systematic review meta-analysis. Int Urol Nephrol 2023; 55:3175-3188. [PMID: 37072601 DOI: 10.1007/s11255-023-03593-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/07/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND To systematically evaluate the diagnostic efficacy of urinary Dickkopf-Related Protein 3 (DKK-3) in acute kidney injury and to explore the clinical application value of urinary DKK-3. METHOD English databases (PubMed, Embase, Cochrane, and WOS) and Chinese databases (VIP, WanFang data, and China National Knowledge Internet) were screened for relevant papers published before March 12, 2023. After literature screening and data extraction, quality assessment was performed according to the QUADAS-2 scoring system. Then, the combined diagnostic and predictive parameters were calculated using a bivariate mixed effect meta-analysis model. Deek's funnel plot asymmetry test assessed publication bias, and Fagan's nomogram plot was used to verify its clinical utility. RESULT A total of 5 studies involving 2787 patients were included in this meta-analysis, of which 4 focused on contrast-induced acute kidney injury (CI-AKI) and 1 focused on AKI associated with cardiac surgery. The analysis showed that urine Dickkopf-3 has high diagnostic accuracy for AKI, with a sensitivity of 0.55 (95% CI [0.41, 0.68]), specificity of 0.80 (95% CI [0.70, 0.87]), positive likelihood ratio (PLR) of 2.7 [1.8, 4.1], negative likelihood ratio (NLR) of 0.56 [0.42, 0.75], diagnostic odds ratio (DOR) of 5 [3, 9], and AUC of 0.74 [0.70-0.77]. We did not perform subgroup analyses for predictive value due to the small number of included studies. CONCLUSION Urinary DKK3 may have limited predictive ability for acute kidney injury, especially for AKI associated with cardiac surgery. Therefore, urinary DKK3 may serve as a potential predictor for AKI. However, clinical studies with larger samples are still needed for validation.
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Affiliation(s)
- Huameng Xing
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Metabolic Vascular Disease Key Laboratory, Luzhou, China
| | - Zheng Jiang
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Metabolic Vascular Disease Key Laboratory, Luzhou, China
| | - Yuxuan Wu
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Metabolic Vascular Disease Key Laboratory, Luzhou, China
| | - Santao Ou
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Metabolic Vascular Disease Key Laboratory, Luzhou, China
| | - Jianhua Qin
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Metabolic Vascular Disease Key Laboratory, Luzhou, China
| | - Ling Xue
- Department of Urology, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, Luzhou, China.
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China.
| | - Weihua Wu
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China.
- Metabolic Vascular Disease Key Laboratory, Luzhou, China.
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Yang D, Yang X, Chen S, Lv M, Tan J, Yang D. Ox-LDL aggravates contrast-induced injury of renal tubular epithelial cells. J Biochem Mol Toxicol 2023; 37:e23379. [PMID: 37186061 DOI: 10.1002/jbt.23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/04/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
Hypercholesterolemia can aggravate contrast-induced acute kidney injury, and the exacerbation of renal tubular epithelial cell (RTEC) injury is a major cause. However, the exact mechanisms remain obscure. Mitophagy, a type of autophagy, selectively eliminates damaged mitochondria and reduces mitochondrial oxidative stress, which is strongly implicated in cell homeostasis and acute kidney injury. Oxidized low-density lipoprotein (Ox-LDL) is accumulated in hypercholesterolemia and has a cytotoxic effect. This study aimed to determine whether and how ox-LDL exacerbates contrast-induced injury in RTECs and to further explore whether PINK1/Parkin-dependent mitophagy is involved in this process. Iohexol and ox-LDL were used alone or in combination to treat HK-2 cells. Rapamycin pretreatment was utilized to enhance mitophagy. Cell viability, apoptosis, mitochondrial membrane potential (MMP) and mitochondrial reactive oxygen species (mtROS) were detected by cell counting kit-8, TUNEL staining, JC-1 kit and MitoSOX fluorescence, respectively. The expression of mitophagy-related proteins (including PINK1, Parkin, and so on) and cleaved caspase-3 was confirmed by western blot. Colocalization of MitoTracker-labeled mitochondria and LysoTracker-labeled lysosomes was observed by fluorescence microscopy to evaluate mitophagy. The results of our study showed that ox-LDL aggravated MMP decline, mtROS release and apoptosis in iohexol-treated HK-2 cells, accompanied by a further increased autophagy level. Enhancement of PINK1/Parkin-dependent mitophagy by rapamycin alleviated apoptosis and mitochondrial injury in HK-2 cells in response to iohexol under ox-LDL condition. Therefore, our findings indicate that ox-LDL aggravates contrast-induced injury of RTECs by increasing mitochondrial damage and mitochondrial oxidative stress, which may be associated with the relative insufficiency of PINK1/Parkin-dependent mitophagy.
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Affiliation(s)
- Dingwei Yang
- Department of Nephrology, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Xueyan Yang
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Sha Chen
- Department of Nephrology, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Meiling Lv
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Dingping Yang
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Kumar R, Batra MK, Khowaja S, Ammar A, Kumar A, Shah JA, Sial JA, Saghir T, Karim M. CHA 2DS 2-VASc, a Simple Clinical Score Expanding Its Boundaries to Predict Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Interventions. Int J Nephrol Renovasc Dis 2022; 14:495-504. [PMID: 35002286 PMCID: PMC8725833 DOI: 10.2147/ijnrd.s347303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Promising results of CHA2DS2-VASc score have been reported for the prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, data of its predictive strength in the context of primary PCI are not available. Therefore, in this study, we have assessed predictive value of CHA2DS2-VASc score for CI-AKI after primary PCI. Methods This analytical cross-sectional study was conducted between January 2021 and June 2021 at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Inclusion criteria of the study was consecutive adult patients who had undergone primary PCI. Baseline CHA2DS2-VASc score was calculated, and either a 25% or 0.5 mg/dL increase in post-procedure serum creatinine level as compared to baseline level was categorized as CI-AKI. Results A total of 691 patients were included, of which 82.1% (567) were male. CI-AKI after primary PCI was observed in 63 (9.1%) patients, out of which 66.7% (42) of patients had CHA2DS2-VASc score of ≥2. The area under the curve (AUC) for the score was 0.725 [0.662 to 0.788] with a sensitivity and specificity of 66.7% [63.1% to 70.2%] and 66.7% [53.7% to 78.1%], respectively, at a cut-off value of ≥2. In multivariable analysis, left ventricular ejection fraction ≤30% and CHA2DS2-VASc ≥2 were found to be independent predictors with adjusted odds ratios of 2.19 [1.06–4.5] and 2.13 [1.13–4.01], respectively. Conclusion CHA2DS2-VASc score has a good predictive value for the prediction of CI-AKI after primary PCI. Criteria of CHA2DS2-VASc ≥2 can be used for the risk stratification of CI-AKI after primary PCI.
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Affiliation(s)
- Rajesh Kumar
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Mahesh Kumar Batra
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Sanam Khowaja
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ali Ammar
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ashok Kumar
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jehangir Ali Shah
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- Research Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Kumar R, Ahmed Khan K, Rai L, Ahmed Solangi B, Ammar A, Nauman Khan M, Ahmed I, Ahmed B, Saghir T, Akbar Sial J, Karim M. Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions. Int J Cardiol Heart Vasc 2021; 37:100905. [PMID: 34765719 PMCID: PMC8569474 DOI: 10.1016/j.ijcha.2021.100905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
Objectives This study aimed to compare Mehran Risk Score (MRS) with three well -known scoring systems namely CHA2DS2-VASc score, Canada Acute Coronary Syndrome Risk Score (C-ACS), and Thrombolysis in Myocardial Infarction risk index (TRI) to predict the contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI). Background CI-AKI is a common complication after primary PCI associated with an adverse prognosis. Methods In this study consecutive patients of primary PCI were included. Patients with chronic kidney diseases, exposure to the contrast medium within the past 7 days, and Killip class IV at presentation were excluded. MRS along with three risk scores namely CHA2DS2-VASc, C-ACS, and TRI were calculated for all patients and CI-AKI was defined as either 0.5 mg/dL or 25% relative increase in post-procedure serum creatinine. The area under the curve (AUC) curve was reported. Results Post primary PCI CI-AKI was observed in 63 (9.1%) patients out of 691 patients. The AUC was 0.745 [0.679-0.810] for MRS, 0.725 [0.662-0.788] for CHA2DS2-VASc, 0.671 [0.593-0.749] for C-ACS, and 0.734 [0.674-0.795] for TRI. Sensitivity and specificity were 61.9% [48.8-73.8%] and 76.0% [72.4-79.3%] for MRS ≥ 6.5, 66.7% [53.7-78.0%] and 66.7% [62.9-70.4%] for CHA2DS2-VASc ≥ 2, 52.4% [39.4-65.1%] and 79.9% [76.6-83.0%] for C-ACS ≥ 1, and 87.3% [76.5-94.4%] and 49.2% [45.2-53.2%] for TRI ≥ 16 respectively. Conclusions The MRS has shown higher discriminating power than CHA2DS2-VASc, C-ACS, and TRI. However, the TRI can be of good value in clinical practice due to its simplicity and high sensitivity in detecting patients at higher risk of CI-AKI after primary PCI.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Lajpat Rai
- National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
| | | | - Ali Ammar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Ifikhar Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
| | - Bilal Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Huang S, Tang Y, Liu T, Zhang N, Yang X, Yang D, Hong G. Corrigendum: A Novel Antioxidant Protects Against Contrast Medium-Induced Acute Kidney Injury in Rats. Front Pharmacol 2021; 12:724416. [PMID: 34305622 PMCID: PMC8299940 DOI: 10.3389/fphar.2021.724416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fphar.2020.599577.].
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Affiliation(s)
- Shuo Huang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Yanyan Tang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Tianjun Liu
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Ning Zhang
- School of Chemical Engineering, Anhui University of Science and Technology, Huainan, China
| | - Xueyan Yang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Dingwei Yang
- Department of Nephrology, Tianjin Hospital, Tianjin, China
| | - Ge Hong
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
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Li Y, Shi D, Zhang H, Yao X, Wang S, Wang R, Ren K. The Application of Functional Magnetic Resonance Imaging in Type 2 Diabetes Rats With Contrast-Induced Acute Kidney Injury and the Associated Innate Immune Response. Front Physiol 2021; 12:669581. [PMID: 34267672 PMCID: PMC8276794 DOI: 10.3389/fphys.2021.669581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS Contrast-induced acute kidney injury (CI-AKI) is the third most common in-hospital acquired AKI, and its mechanism is not fully clear. Its morbidity increases among populations with chronic kidney disease (CKD), older age, diabetes mellitus (DM), and so on. Immediate and effective noninvasive diagnostic methods are lacking, so CI-AKI often prolongs hospital stays and increases extra medical costs. This study aims to explore the possibility of diagnosing CI-AKI with functional magnetic resonance imaging (fMRI) based on type 2 DM rats. Moreover, we attempt to reveal the immune response in CI-AKI and to clarify why DM is a predisposing factor for CI-AKI. METHODS A type 2 DM rat model was established by feeding a high-fat and high-sugar diet combined with streptozotocin (STZ) injection. Iodixanol-320 was the contrast medium (CM) administered to rats. Images were obtained with a SIEMENS Skyra 3.0-T magnetic resonance imager. Renal histopathology was evaluated using H&E staining and immunohistochemistry (IHC). The innate immune response was revealed through western blotting and flow cytometry. RESULTS Blood oxygenation level-dependent (BOLD) imaging and intravoxel incoherent motion (IVIM) imaging can be used to predict and diagnose CI-AKI effectively. The R 2 ∗ value (r > 0.6, P < 0.0001) and D value (| r| > 0.5, P < 0.0001) are strongly correlated with histopathological scores. The NOD-like receptor pyrin 3 (NLRP3) inflammasome participates in CI-AKI and exacerbates CI-AKI in DM rats. Moreover, the percentages of neutrophils and M1 macrophages increase dramatically in rat kidneys after CM injection (neutrophils range from 56.3 to 56.6% and M1 macrophages from 48 to 54.1% in normal rats, whereas neutrophils range from 85.5 to 92.4% and M1 macrophages from 82.1 to 89.8% in DM rats). CONCLUSIONS/INTERPRETATION BOLD and IVIM-D can be effective noninvasive tools in predicting CI-AKI. The innate immune response is activated during the progression of CI-AKI and DM will exacerbate this progression.
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Affiliation(s)
- Yanfei Li
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Dafa Shi
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Haoran Zhang
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Xiang Yao
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Siyuan Wang
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - Rui Wang
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, China
| | - Ke Ren
- Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, China
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Abstract
Previous studies have identified numerous risk factors of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography. However, the association between anemia and CI-AKI remains conflicting. Thus, we conducted a meta-analysis to further clarify the relationship between anemia and CI-AKI. PubMed, EMBASE and Web of Science were systematically searched from inception to June 2020 to identify eligible studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to estimate the correlation between anemia and CI-AKI. The potential publication bias was estimated using funnel plot and Begg’s test. A total of 13 studies (five case-control studies and eight cohort studies) comprising 27,135 patients were included. The pooled results showed that anemia was a significant risk factor of CI-AKI (OR, 1.82; 95% CI, 1.27–2.61). Moreover, the results of subgroup analyses and sensitivity analyses were basically consistent with the overall pooled result. Funnel plot and Begg’s test indicated that there existed potential publication bias, but the result of trim and filled analysis showed that the pooled results kept stable after adding ‘missing’ studies. This meta-analysis suggested that anemia may be correlated with an increased incidence of CI-AKI in patients undergoing coronary angiography. However, our conclusions should be interpreted with caution due to some limitations. Therefore, further high-quality trials should be conducted to confirm our findings.
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Affiliation(s)
- Wei Liang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University , Lanzhou, China
| | - Cheng Jie Yu
- Medical Records Department, Lanzhou University First Hospital, Lanzhou University , Lanzhou, China
| | - Qiong Ying Wang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University , Lanzhou, China
| | - Jing Yu
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University , Lanzhou, China
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Seibert FS, Heringhaus A, Pagonas N, Rohn B, Bauer F, Trappe HJ, Landmesser U, Babel N, Westhoff TH. Dickkopf-3 in the prediction of contrast media induced acute kidney injury. J Nephrol 2020; 34:821-828. [PMID: 33275197 PMCID: PMC8192364 DOI: 10.1007/s40620-020-00910-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022]
Abstract
Background Dickkopf-3 (DKK3) has recently been discovered as a urinary biomarker for the prediction of acute kidney injury (AKI) after cardiac surgery. This finding needs to be confirmed for AKI in other clinical settings. The present study investigates whether DKK3 can predict contrast-induced AKI (CI-AKI). Methods We performed a prospective study in 490 patients undergoing coronary angiography. Primary endpoint was an increase in serum creatinine concentration ≥ 0.3 mg/dl within 72 h after the procedure. DKK3 was assessed < 24 h before coronary angiography. Predictive accuracy was assessed by receiver operating characteristic (ROC) curves. Results CI-AKI was observed in 30 (6.1%) patients, of whom 27 corresponded to stage I and 3 to stage II according to the Acute Kidney Injury Network (AKIN) criteria. Subjects who developed CI-AKI had a 3.8-fold higher urinary DKK3/creatinine ratio than those without CI-AKI (7.5 pg/mg [interquartile range [IQR] 1.2–1392.0] vs. 2.0 pg/mg [IQR 0.9–174.0]; p = 0.047). ROC analysis revealed an area under the curve (AUC) of 0.61. Among subjects without clinically overt chronic kidney disease (estimated glomerular filtration rate [eGFR] > 60 ml/min, urinary albumin creatinine ratio < 30 mg/g), the DKK3/creatinine ratio was 5.4-fold higher in those with subsequent CI-AKI (7.5 pg/mg [IQR 0.9–590.1] vs. 1.38 pg/mg [IQR 0.8–51.0]; p = 0.007; AUC 0.62). Coronary angiography was associated with a 43 times increase in the urinary DKK3/creatinine ratio. Conclusions Urinary DKK3 is an independent predictor of CI-AKI even in the absence of overt chronic kidney disease (CKD). The study thereby expands the findings on DKK3 in the prediction of postoperative loss of kidney function to other entities of AKI. Graphic abstract ![]()
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Affiliation(s)
- Felix S Seibert
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Anja Heringhaus
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Nikolaos Pagonas
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Department for Angiology, Centre for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Benjamin Rohn
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Frederic Bauer
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Hans-Joachim Trappe
- Department of Cardiology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité - Campus Benjamin Franklin, Berlin, Germany
| | - Nina Babel
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Timm H Westhoff
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
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Lamby P, Krüger-Genge A, Franke RP, Mrowietz C, Falter J, Graf S, Schellenberg EL, Jung F, Prantl L. Effect of iodinated contrast media on the oxygen tension in the renal cortico-medullary region of pigs. Clin Hemorheol Microcirc 2020; 73:261-270. [PMID: 31322554 DOI: 10.3233/ch-199009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Repeated injections of iodinated contrast media (CM) can lead to a deterioration of the renal blood flow, can redistribute blood from the renal cortex to other parts of the kidney and can cause small decreases of the blood flow in cortical capillaries, a significant reduction in blood flow in peritubular capillaries and a significant reduction in blood flow in the vasa recta. Therefore, a study in pigs was designed, to show whether the repeated injection of CM boli, alone, can cause a reduction of oxygenation in the cortico-medullar renal tissue - the region with the highest oxygen demand in the kidney - of pigs.While the mean pO2-value had only decreased by 0.3 mmHg from 29.9±4.3 mmHg to 29.6±4.3 mmHg (p = 0.8799) after the tenth Iodixanol bolus, it decreased by 5.9 mmHg from 34.0±4.3 mmHg to 28.1±4.3 mmHg after the tenth Iopromide bolus (p = 0.044). This revealed a remarkable difference in the influence of these CM on the oxygen partial pressure in the kidney.Repeated applications of CM had a significant influence on the renal oxygen partial pressure. In line with earlier studies showing a redistribution of blood from the cortex to other renal areas, this study revealed that Iodixanol - in contrast to Iopromide - induced no changes in the pO2 in the cortico-medullar region which confirms that Iodixanol did not hinder the flow of blood through the renal micro-vessels. These results are in favor of a hypothesis from Brezis that a microcirculatory disorder might be the basis for the development of CI-AKI.
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Affiliation(s)
- P Lamby
- Department of Plastic and Hand Surgery, University Hospital Regensburg, Germany
| | - A Krüger-Genge
- Department of Anaesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - R P Franke
- Central Institute for Biomedical Engineering, Department of Biomaterials, University of Ulm, Ulm, Germany
| | - C Mrowietz
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour and Virtual Center for Replacement - Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, Hannover, Germany
| | - J Falter
- Department of Plastic and Hand Surgery, University Hospital Regensburg, Germany
| | - S Graf
- Department of Plastic and Hand Surgery, University Hospital Regensburg, Germany
| | - E L Schellenberg
- Department of Anesthesiology, University Hospital Regensburg, Germany
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - L Prantl
- Department of Plastic and Hand Surgery, University Hospital Regensburg, Germany
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11
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Azzalini L, Laricchia A, Regazzoli D, Mitomo S, Hachinohe D, Bellini B, Demir OM, Poletti E, Maccagni D, Colombo A. Ultra-Low Contrast Percutaneous Coronary Intervention to Minimize the Risk for Contrast-Induced Acute Kidney Injury in Patients With Severe Chronic Kidney Disease. J Invasive Cardiol 2019; 31:176-182. [PMID: 30865912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The incidence of contrast-induced acute kidney injury (CI-AKI) is particularly high in patients with severe chronic kidney disease (CKD). Novel contrast-sparing strategies are warranted to guarantee the benefit of revascularization in this challenging and growing patient population. We aimed to evaluate the feasibility of an ultra-low contrast volume percutaneous coronary intervention (ULC-PCI) protocol in patients with severe CKD. METHODS The ULC-PCI protocol is based on the prespecification of the maximum contrast volume to be administered, extensive intravascular ultrasound (IVUS) and/or dextran-based optical coherence tomography (OCT) guidance, and use of diluted contrast media. We created a retrospective registry to compare the outcomes of the ULC-PCI protocol vs conventional angiography-based PCI in patients with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m², applying no angiographic or procedural restriction criteria. RESULTS We included 111 patients (ULC-PCI group, n = 8; conventional group, n = 103). Baseline clinical and angiographic characteristics were similar between groups. Contrast volume (8.8 mL [interquartile range, 1.3-18.5] vs 90 mL [interquartile range, 58-140 mL]; P<.001) was markedly lower in the ULC-PCI group. Technical success was achieved in all ULC-PCI procedures; in 7 of the 8 cases (88%), the ULC-PCI protocol was also successful (contrast-volume-to-eGFR ratio <1). The incidence of CI-AKI was 0% vs 15.5% in the ULC-PCI and conventional groups, respectively (P=.28). Procedures in the ULC-PCI group included the use of rotational atherectomy, two-stent bifurcation PCI, and mechanically supported chronic total occlusion PCI. CONCLUSIONS An ULC-PCI protocol in patients with advanced CKD is feasible, appears to be safe, and has the potential to decrease the incidence of CI-AKI, compared with angiographic guidance alone.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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12
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Cheng W, Li XW, Xiao YQ, Duan SB. Non-coding RNA-Associated ceRNA Networks in a New Contrast-Induced Acute Kidney Injury Rat Model. Mol Ther Nucleic Acids 2019; 17:102-12. [PMID: 31234008 DOI: 10.1016/j.omtn.2019.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a severe complication of intravascular applied radial contrast media, and recent progress in interventional therapy and angiography has revived interest in explaining detailed mechanisms and developing effective treatment. Recent studies have indicated a potential link between CI-AKI and microRNA (miRNA). However, the potential non-coding RNA-associated-competing endogenous RNA (ceRNA) pairs involved in CI-AKI still remain unclear. In this study, we systematically explored the circRNA or lncRNA-associated-ceRNA mechanism in a new rat model of CI-AKI through deep RNA sequencing. The results revealed that the expression of 38 circRNAs, 12 lncRNAs, 13 miRNAs and 127 mRNAs were significantly dysregulated. We performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses for mRNAs with significantly different expression and then constructed comprehensive circRNA or lncRNA-associated ceRNA networks in kidney of CI-AKI rats. Thereafter, two constructed ceRNA regulatory pathways in this CI-AKI rat model—novel_circ_0004153/rno-miR-144-3p/Gpnmb or Naglu and LNC_000343/rno-miR-1956-5p/KCP—were validated by real-time qPCR. This study is the first one to provide a systematic dissection of non-coding RNA-associated ceRNA profiling in kidney of CI-AKI rats. The selected non-coding RNA-associated ceRNA networks provide new insight for the underlying mechanism and may profoundly affect the diagnosis and therapy of CI-AKI.
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13
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Kronbichler A, Shin JI, Windpessl M. What is left to prevent contrast-induced acute kidney injury? No difference between low and iso-osmolar contrast media. Int J Cardiol 2018; 273:94-95. [PMID: 30236501 DOI: 10.1016/j.ijcard.2018.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea; Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Martin Windpessl
- Department of Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
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14
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Scharnweber T, Alhilali L, Fakhran S. Contrast-Induced Acute Kidney Injury: Pathophysiology, Manifestations, Prevention, and Management. Magn Reson Imaging Clin N Am 2017; 25:743-753. [PMID: 28964464 DOI: 10.1016/j.mric.2017.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Contrast-induced acute kidney injury is a phenomenon that has been extensively studied throughout the years. There is a large volume of literature documenting this risk, and most radiology departments and radiologists use this information when making decisions regarding contrast administration. A review of the current information on the topic of contrast-induced acute kidney injury is necessary to ensure that the risks of intravenous contrast are properly weighed against the benefits of a contrast-enhanced computed tomography scan.
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Affiliation(s)
- Travis Scharnweber
- Department of Neuroradiology, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, USA.
| | - Lea Alhilali
- Department of Neuroradiology, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, USA
| | - Saeed Fakhran
- Department of Neuroradiology, East Valley Diagnostic Imaging, Banner Health and Hospital System, 1201 S Alma School Road, Suite 14000, Mesa, AZ 85210, USA
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15
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Wybraniec MT, Bożentowicz-Wikarek M, Chudek J, Mizia-Stec K. Pre-procedural renal resistive index accurately predicts contrast-induced acute kidney injury in patients with preserved renal function submitted to coronary angiography. Int J Cardiovasc Imaging 2017; 33:595-604. [PMID: 27995343 DOI: 10.1007/s10554-016-1039-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 12/07/2016] [Indexed: 01/06/2023]
Abstract
The study aimed to evaluate the clinical utility of ultrasonographic intra-renal blood flow parameters, together with the wide range of different risk factors, for the prediction of contrast-induced acute kidney injury (CI-AKI) in patients with preserved renal function, referred for coronary angiography or percutaneous coronary interventions (CA/PCI). This prospective study covered 95 consecutive patients (69.5% men; median age 65 years) subject to elective or urgent CA/PCI. Data regarding 128 peri-procedural variables were collected. Ultrasonographic intra-renal blood flow parameters, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before the procedure. CI-AKI was defined as ≥50% relative or ≥0.3 mg/dL absolute increase of serum creatinine 48 h after procedure. CI-AKI was confirmed in nine patients (9.5%). Patients with CI-AKI had higher SYNTAX score (p = 0.0002), higher rate of left main disease (p < 0.00001), peripheral artery disease (PAD; p = 0.02), coronary artery anomaly (p = 0.017), more frequently underwent surgical revascularization (p = 0.0003), ‘had greater...’ intima-(p = 0.004) and extra-medial thickness (p = 0.001), and received higher contrast media dose (p = 0.049), more often overused non-steroidal anti-inflammatory drugs (p = 0.001), and had substantially higher pre-procedural RRI (0.69 vs. 0.62; p = 0.005) and RPI values (1.54 vs. 1.36; p = 0.017). Logistic regression confirmed age, SYNTAX score, presence of PAD, diabetes mellitus, and pre-procedural RRI independently predicted CI-AKI onset (AUC = 0.95; p < 0.0001). Pre-procedural RRI > 0.69 had 78% sensitivity and 81% specificity in CI-AKI prediction. High pre-procedural RRI seems to be a useful novel risk factor for CI-AKI in patients with preserved renal function. Coronary, peripheral and renal vascular pathology contribute to the development of CI-AKI following CA/PCI.
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16
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Han Y, Zhu G, Han L, Hou F, Huang W, Liu H, Gan J, Jiang T, Li X, Wang W, Ding S, Jia S, Shen W, Wang D, Sun L, Qiu J, Wang X, Li Y, Deng J, Li J, Xu K, Xu B, Mehran R, Huo Y. Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol 2013; 63:62-70. [PMID: 24076297 DOI: 10.1016/j.jacc.2013.09.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 09/03/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and efficacy of rosuvastatin in preventing contrast-induced acute kidney injury (CI-AKI) in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). BACKGROUND CI-AKI is an important complication after contrast medium injection. While small studies have shown positive results with statin therapy, the role of statin therapy in prevention of CI-AKI remains unknown. METHODS We randomized 2,998 patients with type 2 DM and concomitant CKD who were undergoing coronary/peripheral arterial angiography with or without percutaneous intervention to receive rosuvastatin, 10 mg/day (n = 1,498), for 5 days (2 days before, and 3 days after procedure) or standard-of-care (n = 1,500). Patients' renal function was assessed at baseline, 48 h, and 72 h after exposure to contrast medium. The primary endpoint of the study was the development of CI-AKI, which was defined as an increase in serum creatinine concentration ≥0.5 mg/dl (44.2 μmol/l) or 0.25% above baseline at 72 h after exposure to contrast medium. RESULTS Patients randomized to the rosuvastatin group had a significantly lower incidence of CI-AKI than controls (2.3% vs. 3.9%, respectively; p = 0.01). During 30 days' follow-up, the rate of worsening heart failure was significantly lower in the patients treated with rosuvastatin than that in the control group (2.6% vs. 4.3%, respectively; p = 0.02). CONCLUSIONS Rosuvastatin significantly reduced the risk of CI-AKI in patients with DM and CKD undergoing arterial contrast medium injection. (Rosuvastatin Prevent Contrast Induced Acute Kidney Injury in Patients With Diabetes [TRACK-D]; NCT00786136).
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Affiliation(s)
- Yaling Han
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China.
| | - Guoying Zhu
- Department of Cardiology, WuHan Asia Heart Hospital, Wuhan, China
| | - Lixian Han
- Department of Cardiology, CangZhou Central Hospital, CangZhou, China
| | - Fengxia Hou
- Department of Cardiology, Changchun Central Hospital, Changchun, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Huiliang Liu
- Department of Cardiology, General Hospital of Armed Police Forces, Beijing, China
| | - Jihong Gan
- Department of Cardiology, Lanzhou Military WuluMuqi PLA Hospital, Wulumuqi, China
| | - Tiemin Jiang
- Department of Cardiology, Affiliated Hospital of Medical College of Armed Police Forces, Tianjin, China
| | - Xiaoyan Li
- Department of Cardiology, Jinan Military General Hospital, Jinan, China
| | - Wei Wang
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shifang Ding
- Department of Cardiology, Wuhan General Hospital of Guangzhou Military, Wuhan, China
| | - Shaobin Jia
- Department of Cardiology, Affiliated Hospital of Ningxia Medical College, Yinchuan, China
| | - Weifeng Shen
- Department of Cardiology, Ruijin Hospital Affiliated to the Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Dongmei Wang
- Department of Cardiology, Shijiazhuang International Peace Hospital, Shijiazhuang, China
| | - Ling Sun
- Department of Cardiology, Fushun Central Hospital, Fushun, China
| | - Jian Qiu
- Department of Cardiology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| | - Xiaozeng Wang
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Yi Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jie Deng
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jing Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Kai Xu
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Bo Xu
- Cardiac Catheterization Laboratory, Fuwai Hospital, Beijing, China
| | - Roxana Mehran
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yong Huo
- Department of Cardiology, First Hospital of Beijing University, Beijing, China
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Leoncini M, Toso A, Maioli M, Tropeano F, Villani S, Bellandi F. Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome: Results from the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome). J Am Coll Cardiol. 2014;63:71-79. [PMID: 24076283 DOI: 10.1016/j.jacc.2013.04.105] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/19/2013] [Accepted: 04/30/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study sought to determine if in addition to standard preventive measures on-admission, high-dose rosuvastatin exerts a protective effect against contrast-induced acute kidney injury (CI-AKI). BACKGROUND Patients with acute coronary syndrome (ACS) are at high risk for CI-AKI, and the role of statin pre-treatment in preventing renal damage remains uncertain. METHODS Consecutive statin-naïve non-ST elevation ACS patients scheduled to undergo early invasive strategy were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; statin group n = 252) or no statin treatment (control group n = 252). CI-AKI was defined as an increase in creatinine concentration of ≥0.5 mg/dl or ≥25% above baseline within 72 h after contrast administration. RESULTS The incidence of CI-AKI was significantly lower in the statin group than in controls (6.7% vs. 15.1%; adjusted odds ratio: 0.38; 95% confidence interval [CI]: 0.20 to 0.71; p = 0.003). The benefits against CI-AKI were consistent, even applying different CI-AKI definition criteria and in all the pre-specified risk categories. The 30-day incidence of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) was significantly lower in the statin group (3.6% vs. 7.9%, respectively; p = 0.036). Moreover, statin treatment given on admission was associated with a lower rate of death or nonfatal myocardial infarction at 6 month follow-up (3.6% vs. 7.2%, respectively; p = 0.07). CONCLUSIONS High-dose rosuvastatin given on admission to statin-naïve patients with ACS who are scheduled for an early invasive procedure can prevent CI-AKI and improve short-term clinical outcome. (Statin Contrast Induced Nephropathy Prevention [PRATO-ACS]; NCT01185938).
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Sadat U, Usman A, Gillard JH, Boyle JR. Does ascorbic acid protect against contrast-induced acute kidney injury in patients undergoing coronary angiography: a systematic review with meta-analysis of randomized, controlled trials. J Am Coll Cardiol 2013; 62:2167-75. [PMID: 23994417 DOI: 10.1016/j.jacc.2013.07.065] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/16/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to perform a systematic review with meta-analysis of randomized controlled trials comparing the use of ascorbic acid with placebo or other treatment options for the treatment of contrast induced-acute kidney injury (CI-AKI) in patients undergoing coronary angiography. BACKGROUND CI-AKI remains the most widely discussed and debated topic in cardiovascular medicine, with its incidence increasing due to an increasing number of contrast media-enhanced radiological procedures being performed. METHODS MEDLINE, Embase, and Cochrane central databases were searched from inception to May 2013, without language restrictions. For a study to be selected, it had to report the incidence of CI-AKI as an outcome measure. Studies were excluded if at least 1 study arm did not have ascorbic acid administered alone or with saline solution hydration. Data were extracted by 1 author, and random checks were made by another author. RESULTS Nine randomized, controlled trials reported data on the incidence of CI-AKI in 1,536 patients who had completed the trial and were included in the final analysis. Patients receiving ascorbic acid had 33% less risk of CI-AKI compared with patients receiving placebo or an alternate pharmacological treatment (risk ratio by random-effects model: 0.672; 95% confidence interval, 0.466 to 0.969; p = 0.034). CONCLUSIONS Ascorbic acid provides effective nephroprotection against CI-AKI and may form a part of effective prophylactic pharmacological regimens.
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Affiliation(s)
- Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
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Ohno Y, Maekawa Y, Miyata H, Inoue S, Ishikawa S, Sueyoshi K, Noma S, Kawamura A, Kohsaka S, Fukuda K. Impact of periprocedural bleeding on incidence of contrast-induced acute kidney injury in patients treated with percutaneous coronary intervention. J Am Coll Cardiol. 2013;62:1260-1266. [PMID: 23770181 DOI: 10.1016/j.jacc.2013.03.086] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/25/2013] [Accepted: 03/13/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement. BACKGROUND The relationship between CI-AKI and bleeding in contemporary practice remains controversial. METHODS In a retrospective analysis of the prospectively maintained Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies (JCD-KICS) multicenter registry, we divided 2,646 consecutive patients into 5 groups according to the change of Hb level after compared with before percutaneous coronary intervention: patients without a decrease in Hb level (group A) and patients with a decreased Hb level: <1 g/dl (group B); 1 to <2 g/dl (group C); 2 to <3g/dl (group D); and >3 g/dl (group E). CI-AKI was defined as an increase in serum creatinine level ≥ 0.5 mg/dl or ≥ 25% above baseline values at 48 h after administration of contrast media. Procedure and outcome variables were compared. RESULTS The mean patient age was 67 ± 11 years. Of the 2,646 patients, CI-AKI developed in 315 (11.9%). The CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (p < 0.01), whereas the incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (p < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, p < 0.01) and of composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, p < 0.01). CONCLUSIONS Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.
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