CI-AKI In Patients Research Articles

Predictive value of inflammatory factors on contrast-induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention.

Contrast-induced acute kidney injury (CI-AKI) is one of the most serious complications in patients who undergo percutaneous coronary intervention (PCI), especially in those with acute coronary syndrome. It has been shown that inflammation may play an important role in the pathophysiology of CI-AKI. Inflammatory factors may play a predominant role in the prediction of CI-AKI in patients who undergo emergency PCI. Patients who underwent emergency PCI from 2013 to 2015 were consecutively enrolled and were divided into CI-AKI and non-CI-AKI groups. Logistic analysis was used to identify the risk factors of CI-AKI. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve (AUC) and to establish the optimal cutoff. A total of 1061 patients were included, and the CI-AKI rate was 5.47% (58/1061). Logistic analysis showed that the white blood cell (WBC) count (odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.018-1.195, P = 0.016), neutrophil (N) count (OR: 1.134, 95% CI: 1.045-1.232, P = 0.003), neutrophil to lymphocyte ratio (NLR) (OR: 1.105, 95% CI: 1.044-1.169, P = 0.001), C-reactive protein (CRP) level (OR: 1.006, 95% CI: 1.001-1.011, P = 0.020), high-sensitivity C-reactive protein (hs-CRP) level (OR: 1.099, 95% CI: 1.020-1.184, P = 0.013), and big endothelin-1 (ET-1) level (OR: 4.030, 95% CI: 1.989-8.165, P < 0.001) were all significant predictors for CI-AKI, as was the left ventricular ejection fraction and diuretic administration. The AUC of the big ET-1 level was the highest (0.793, 95% CI: 0.733-0.853), followed by the NLR (0.708, 95% CI: 0.641-0.774), hs-CRP level (0.705, 95% CI: 0.627-0.782), CRP level (0.684, 95% CI: 0.607-0.761), N count (0.655, 95% CI: 0.584-0.726), WBC count (0.620, 95% CI: 0.544-0.695), and erythrocyte sedimentation rate (0.611, 95% CI: 0.527-0.695). The WBC count, N count, NLR, CRP level, hs-CRP level, and big ET-1 level are all associated with an increased risk of CI-AKI, and among which, the big ET-1 level, NLR, and the hs-CRP level might have high predictive value for CI-AKI after an emergency PCI.

Short-Term High-Dose Vitamin E to Prevent Contrast Medium-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Elective Coronary Angiography: A Randomized Placebo-Controlled Trial.

BackgroundContrast medium–induced acute kidney injury (CIAKI) is a leading cause of acquired renal impairment. The effects of antioxidants have been conflicting regarding the prevention of CIAKI. We performed a study of vitamin E use to decrease CIAKI in patients undergoing elective coronary angiography.Methods and ResultsIn a placebo‐controlled randomized trial at 2 centers in Iran, 300 patients with chronic kidney disease—defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2—were randomized 1:1 to receive 0.9% saline infusion 12 hours prior to and after intervention combined with 600 mg vitamin E 12 hours before plus 400 mg vitamin E 2 hours before coronary angiography or to receive placebo. The primary end point was the development of CIAKI, defined as an increase ≥0.5 mg/dL or ≥25% in serum creatinine that peaked within 72 hours. Based on an intention‐to‐treat analysis, CIAKI developed in 10 (6.7%) and 21 (14.1%) patients in the vitamin E and placebo groups, respectively (P=0.037). Change in white blood cell count from baseline to peak value was greater in the vitamin E group compared with the placebo group (−500 [−1500 to 200] versus 100 [−900 to 600]×103/mL, P=0.001). In multivariate analysis, vitamin E (odds ratio 0.408, 95% CI 0.170–0.982, P=0.045) and baseline Mehran score (odds ratio 1.257, 95% CI 1.007–1.569; P=0.043) predicted CIAKI.ConclusionsProphylactic short‐term high‐dose vitamin E combined with 0.9% saline infusion is superior to placebo for prevention of CIAKI in patients undergoing elective coronary angiography.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02070679.

Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: A systematic review and trial sequential analysis

BackgroundContrast-induced acute kidney injury (CI-AKI) is a potential complication in coronary angiography (CAG) and percutaneous coronary interventions (PCI). Prior randomized controlled trials (RCTs) have suggested that statins may play a role in reducing rates of CI-AKI, however it is not clear how firm the current evidence is. ObjectivesThe aim of this study was to conduct a meta-analysis and trial sequential analysis to determine the effects of statins in lowering CI-AKI rates in CAG and PCI. MethodsA systematic literature search was performed to include all RCTs comparing statins (treatment arm) versus low-dose statins or placebo (control arm) as pretreatment for CAG and/or PCI. A traditional meta-analysis and several subgroup analyses were conducted using traditional meta-analysis with relative risk (RR), trial sequential analysis, and meta-regression analysis. Results14 RCTs met our inclusion criteria giving a total of 2992 statin treated (49.6%) and 3041 control patients (50.4%). There was a significant reduction in CI-AKI in the statin group compared to controls (3.7% vs 8.3%, RR, 0.46; p=<0.00001). Trial sequential analysis using a relative risk reduction threshold of 20%, power 80% and type 1 error of 5%, indicated that the evidence is firm. A greater risk reduction in CI-AKI in the statin group significantly correlated with higher estimated glomerular filtration rate (eGFR; p=0.003) ConclusionsThe present trial sequential analysis provides support for statins in reducing the incidence of CI-AKI in patients undergoing CAG/PCI. This effect appeared to be greater in patients with higher eGFR.

Additional value of the red blood cell distribution width to the Mehran risk score for predicting contrast-induced acute kidney injury in patients with ST-elevation acute myocardial infarction

BackgroundContrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI) is a common complication associated with worse outcome. Considering the prognostic predictive value of the red cell distribution width (RDW), we aimed to measure the usefulness of RDW for predicting CI-AKI. MethodsAll consecutive STEMI patients without hemodialysis from June 2011 to September 2013 admitted to St. Luke's International Hospital were enrolled. We performed primary percutaneous coronary intervention in all patients. CI-AKI was defined as a >25% increase or an absolute increase in serum creatinine of 0.5mg/dl within 3 days after percutaneous coronary intervention. The potential additional predictive value of RDW with the Mehran risk score (MRS) on admission was estimated. ResultsA total of 102 patients (78.4% males) were analyzed – 10 of the 102 (10%) STEMI patients developed CI-AKI. Multivariate analysis showed that RDW was an independent variable predicting CI-AKI in these patients [odds ratio, 2.029; 95% confidence interval (95% CI), 1.029–3.999; p=0.041]. The areas under the receiver operating characteristic curves for MRS only, RDW only, and the combined model (MRS and RDW) for the prediction of CI-AKI were 0.806 (95% CI, 0.696–0.917), 0.719 (95% CI, 0.536–0.902), and 0.846 (95% CI, 0.744–0.949), respectively. ConclusionWe showed the potential predictive ability of RDW, only if used with MRS, for CI-AKI in STEMI patients. Further evaluation of RDW for predicting CI-AKI in patients with STEMI is needed.

Remote ischemic preconditioning reduces contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction: A randomized controlled trial

BackgroundContrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention. Methods and resultsPatients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n=63) or without (n=62) RIPC (intermittent arm ischemia through three cycles of 5min of inflation and 5min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine >0.5mg/dL or >25% over the baseline value 48–72h after administration of contrast medium. The incidence of CI-AKI was 10% (n=5) in the RIPC group and 36% (n=17) in the control group (p=0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05–0.64; p=0.008). ConclusionsIn patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.

GW25-e2326 Cystatin C combined with creatinine seems to be a better early predictor of CI-AKI in patients undergoing PCI

GW25-e2326 Cystatin C combined with creatinine seems to be a better early predictor of CI-AKI in patients undergoing PCI

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The association between pre-procedural blood glucose levels and CI-AKI risk (regardless of pre-existing diabetes) is unknown. The present study was conducted to evaluate the incidence of CI-AKI in patients with admission hyperglycemia in non-diabetic ACS patients. Methods: This is Prospective, observational study done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Considering inclusion and exclusion criteria, 50 patients were non diabetic with ACS with normal blood glucose (d”7.8 mmol/l or d”140 mg/dl) in (Group I) and 50 patients were non diabetic with ACS with high blood glucose (&gt;7.8 mmol/l or &gt;140 mg/dl) undergoing percutaneous coronary intervention in (Group II). On admission random blood glucose was measured. Non- ionic low osmolar contrast agents (lopamidol) was used in all patients. Serum creatinine, serum electrolytes was measured and creatinine clearance rate was determined within 24 hours before PCI and day 1 and 2 after PCI. Results: The incidence of CIN was 24% in high blood glucose group and 4% in normal blood glucose group (p=0.004). It was also observed that gradual incremental increase in risk of CIN associated with higher admission blood glucose level. There was positive correlation between s. creatinine and admission blood glucose but it showed negative correlation between CCr and admission blood glucose after PCI in ACS patients not known to be diabetic. Conclusion: The present study reveals that index admission high blood glucose in acute coronary syndrome patients not known to be diabetic is associated with increased incidence of contrast induced nephropathy after percutaneous coronary intervention. Cardiovascular Journal Volume 6, No. 1, 2013, Page 23-30 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16111