Incidence Of Contrast-induced Acute Kidney Injury Research Articles

The Incidence of Contrast-induced Acute Kidney Injury in Patients on Dapagliflozin Undergoing Percutaneous Coronary Interventions

Background: Sodium glucose cotransporter 2 receptor inhibitor (SGLT2i) dapagliflozin protects the renal function of individuals with coronary artery disease (CAD) and reduces incidence of contrast-induced acute kidney injury (CI-AKI) among individuals having percutaneous coronary interventions (PCI). The purpose of this work was to assess the CI-AKI incidence across individuals on dapagliflozin underwent PCI. Methods: This single-center, prospective observational work had been conducted on 200 diabetic individuals ranging in age between 25 and 80 years old, both genders, with CAD were going to have elective coronary angiogram and PCI. We identified CI-AKI by the ESUR and KDIGO definition. Patients were divided into two equal groups: Group I: Type 2 diabetes mellitus (T2DM) were on dapagliflozin (SGLT2i) and group II: T2DM were on non SGLT2i glucose-lowering drugs. Results: CI AKI according to European society of urogenital radiology (ESUR) and kidney disease improving global outcome score were significantly higher among group II contrasted to group I (P<0.05). no significant correlations existed between contrast volume and creatinine post-PCI, estimated glomerular filtration rate (eGFR) post-PCI, high-density lipoprotein, total cholesterol, and hemoglobin A1c in both groups. Dapagliflozin use was significantly correlated with 76.2% risk reduction of AKI. Dapagliflozin usage had been correlated with a 72.6% risk reduction of AKI but with borderline significance (P = 0.064). eGFR post-PCI was significantly greater among group I cootrasted to group II (P <0.05). Conclusions: Regarding the predictors of AKI according to ESUR criteria, multivariate logistic regression analysis and demonstrated that using dapagliflozin was substantially correlated with 76.2% risk reduction of AKI controlling for age, sex, hypertension, smoking, and dyslipidemia.

Abstract 4137708: Implementation of a Standard Hydration Protocol Improves Compliance of Pre-procedural Hydration, Reducing the Incidence of Contrast-Induced Acute Kidney Injury (CI-AKI) After Percutaneous Coronary Intervention (PCI)

Introduction: Intravenous hydration and contrast media volume reduction are the most important preventive factors against CI-AKI after PCI. Multiple studies have demonstrated the effectiveness of intravenous hydration before PCI, however, varied hydration protocols have rather complicated standardization. Doctors’ preferences and local institutional factors further hinder protocol implementation, resulting in reduced compliance. Hypothesis: Standardizing hydration protocol increases the compliance rate of preprocedural hydration orders and administration, reducing the incidence of CI-AKI. Methods: A team at Memorial Hermann The Woodlands Medical Center, comprising a cardiovascular nurse coordinator, catheterization laboratory director, pharmacist, information technologist, and hospital administrators, was formed to improve PCI outcomes through a multi-faceted approach. This involved a standardized hydration protocol with direct education, continuous monitoring, and repeated internal feedback, reviewed monthly. The new protocol included normal saline pre- and post-procedure maintenance fluids, with a 250 ml normal saline bolus pre-operatively. Maintenance fluids were set at 75 ml/hr, and 20 ml/hr for patients with congestive heart failure and an ejection fraction ≤ 40%. The team reviewed 233 patients under the old protocol and 281 under the new protocol. Compliance rates of pre-procedural intravenous hydration were compared and CI-AKI incidence, defined as a >50% increase or a 0.3 mg/dL increase in creatinine levels within 5 days post-procedure, was assessed. Chi square tests and t-tests were used to compare cohorts on 12 parameters and CI-AKI incidence assessment, with a p-value of 0.05. Results: Compliance with pre-procedural hydration significantly increased under the new protocol (86.1% vs 55.4%, p<0.05). CI-AKI incidence was lower in the new protocol group (7.5% vs 9.9%, p=0.33). Although statistically insignificant in this preliminary analysis, the results were still promising due to a relative CI-AKI reduction of 24.3%. A sample size of 352 patients per group is needed to achieve a power of 0.8. Conclusion: The new standardized hydration protocol, coupled with education, increased compliance with pre-procedural hydration and showed a promising trend towards reducing CI-AKI among PCI patients. The final report will be presented upon study completion.

A new hydration strategy can reduce contrast-induced acute kidney injury after PCI in patients with chronic heart failure and chronic kidney disease: a two-center randomized controlled trial

Abstract Backgrounds Adequate hydration is crucial for preventing contrast-induced acute kidney injury (CI-AKI), particularly in patients with chronic kidney disease (CKD). The current guidelines recommend half-volume hydration for patients with chronic heart failure (CHF) to prevent pulmonary edema. Thus, it is challenging to administer hydration therapy in patients with CHF and CKD. This study was aimed to compare different hydration strategies in this subset of patients. Methods This two-center, open-label, randomized clinical trial enrolled 303 CHF (patients with elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion) patients with CKD (estimated glomerular filtration rate [eGFR] of 15-60 mL/min/1.73m2) undergoing selective coronary angiography (CAG) from two tertiary hospitals from October 2020 to December 2023. Patients were randomized into three groups: half-volume hydration group (HH group, 0.5 mL/Kg/h hydration), standard hydration group (SH group, 1 mL/Kg/h hydration), and standard hydration with diuretic group (SH+D group, 1 mL/Kg/h hydration + immediate postoperative intravenous injection of furosemide 20 mg). All patients received hydration from 6 to 12 hours before to 24 hours after the procedure. The primary endpoint was CI-AKI, defined as a serum creatinine (SCr) increase of more than 0.3 mg/dL or 1.5-1.9 times greater than the baseline 48-72 hours after CAG. Safety endpoints included pulmonary edema during hydration, perioperative mortality, and the need for dialysis. Results A total of 101 patients were included in each group. Baseline characteristics (mean age, proportion of males, left ventricular ejection fraction and eGFR) were similar among groups. SCr, cystatin C levels, and SCr level changes between 48 and 72 hours after procedure did not significantly differ among groups (P > 0.05). The incidence of CI-AKI was highest in the HH group (22.8%), lowest in the SH+D group (11.9%), and intermediate in the SH group (17.8%) (P = 0.041). Regarding safety endpoints, there were 2 patients in the HH group, 3 patients in the SH group and 1 patient in the SH+D group experienced heart failure or pulmonary edema during hydration, with no statistically significant differences among the groups (P = 0.874). Perioperative mortality occurred in 1 patient in the HH group and 2 patients in the SH+D group, with no statistically significant differences (P = 0.776). No patient required renal replacement therapy. Conclusions In CHF patients with CKD, the half-volume hydration regimen recommended by guidelines was associated with a higher incidence of CI-AKI compared to standard hydration. However, standard hydration combine with diuretic fails to reduce the risk of heart failure during hydration or perioperative mortality, even if this novel strategy does not increase the risk of CI-AKI compared to standard hydration therapy.

Efficacy of Chronic Use of Sodium-Glucose Co-transporter 2 Inhibitors on the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Type 2 Diabetes Mellitus Following Coronary Procedures: A Systematic Review and Meta-Analysis.

Contrast-induced acute kidney injury (CI-AKI) is a common complication of iodinated contrast administration during coronary procedures, especially in patients with diabetes mellitus (DM). Besides periprocedural hydration and statins, there are no other pharmacological strategies with consistent results to prevent CI-AKI up to date. This study aims to evaluate the efficacy of chronic use of sodium-glucose co-transporter 2 (SGLT2) inhibitors on the prevention of CI-AKI in patients with type 2 DM following coronary procedures. A systematic literature search of MEDLINE, Google Scholar, Embase, and Cochrane Library was performed. Relevant observational studies and randomized controlled studies (RCTs) were identified. Results were pooled using a random-effect model meta-analysis. Subgroup analyses were performed to evaluate the potential benefit of SGLT2 inhibitors on the prevention of CI-AKI in patients undergoing urgent or elective coronary angiography/percutaneous coronary interventions (CAG/PCI). Seven observational studies and one randomized controlled trial with 2740 patients were included. Chronic treatment (minimum duration 2 weeks to 6 months) with an SGLT2 inhibitor was associated with a significantly reduced risk of CI-AKI in diabetic patients undergoing coronary procedures compared with the control group [risk ratio (RR) 0.48; 95% confidence interval (CI) 0.39-0.59; p < 0.001). Results of subsequent subgroup analysis showed a significant reduction in the incidence of CI-AKI in diabetic patients undergoing both elective CAG/PCI (RR 0.49; 95% CI 0.35-0.68; p<0.001) and urgent CAG/PCI (RR 0.48; 95% Cl 0.35-0.66; p < 0.001). Chronic use of SGLT2 inhibitors may be preventative against the incidence of CI-AKI in patients with type 2 DM undergoing coronary interventions. Further RCTs are needed to confirm our findings.

Non-invasive remote ischemic preconditioning for patients with heart failure undergoing cardiac catheterization: a network meta-analysis of randomized controlled trials

ObjectiveThis study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.MethodsA comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.ResultsFour trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.ConclusionAlthough Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.

The High-Sensitivity C-Reactive Protein to High-Density Lipoprotein Cholesterol Ratio and the Risk of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention.

The high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) is a novel biomarker associated with coronary artery disease (CAD) risk. This study aimed to analyze the relationship between CHR and contrast-induced acute kidney injury (CI-AKI). This retrospective cross-sectional research included 10,917 individuals who underwent PCI. CI-AKI was diagnosed using the Kidney Disease: Improving Global Outcomes (KIDIGO) standard. Univariate and multivariable logistic regression analyses were conducted to examine the association between CHR and CI-AKI, followed by a receiver operating characteristic (ROC) curve of participants to assess the clinical diagnostic performance of CHR on CI-AKI. A total of 1037 patients (9.50%) developed CI-AKI after PCI. The age of individuals averaged 64.1 ± 11.1 years old, with 2511 females (23.0%). A multivariate logistic regression study revealed that higher CHR levels were linked to higher CI-AKI incidence rates ([Q4 vs. Q1]: odds ratio (OR) = 1.89, 95% confidence interval (CI) [1.42 to 2.54], p < 0.001). A restricted cubic spline analysis revealed a linear association between CHR and CI-AKI. ROC analysis indicated that CHR was an excellent predictor of CI-AKI (area under ROC curve = 0.606, 95% CI [0.588 to 0.624]). A high CHR level is strongly associated with increased CI-AKI incidence, suggesting that CHR may be an independent risk factor for CI-AKI. NCT05050877. https://clinicaltrials.gov/study/NCT05050877?tab=results.

Soluble suppression of tumorigenicity 2 associated with contrast-induced acute kidney injury in patients with STEMI.

Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Soluble suppression of tumorigenicity 2 (sST2) is associated with AKI. However, the relationship between sST2 and CI-AKI is unclear. This study aimed to investigate the relationship between sST2 and CI-AKI in patients with STEMI. This was a single-center retrospective observational study. Patients diagnosed with STEMI in the Yichun People's Hospital from February 2020 to May 2024 were continuously included. CI-AKI was defined as an increase in serum creatinine of at least 50% or 0.3mg/dL from baseline within 48-72h after contrast exposure. The incidence of CI-AKI after PCI was 12.4% (98/791). Univariate analysis showed that age, fasting plasma glucose, diabetes mellitus, Killip class, left ventricular ejection fraction, estimated glomerular filtration rate, high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and sST2 were associated with CI-AKI. The above factors were included in a multivariate analysis, which showed that sST2 was an independent factor for CI-AKI after PCI. The restricted cubic splines showed a nonlinear dose-response relationship between sST2 and CI-AKI (P < 0.001). The integration of the sST2 could significantly improve the ability of the model to identify CI-AKI (NRI 0.681, 95% CI 0.474-0.887; IDI 0.063, 95% CI 0.038-0.099). Elevated sST2 is an independent risk factor for CI-AKI after PCI in patients with STEMI. Integration of sST2 can significantly improve the risk model for CI-AKI.

Assessing the risk of contrast induced-acute kidney injury (CI-AKI) after enhanced CT scan: Single-centre experience.

Objective: This study was conducted to assess the risk of contrast-induced AKI (CI-AKI), among Saudi patients who underwent enhanced CT scans at a tertiary care hospital; to understand the incidence and the underlying associated factors of CI-AKI. Methods: We conducted a retrospective review of patients who underwent CT scans with IV contrast from 2016 to 2021, at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All authors had no access to information that could identify individual participants during or after data collection. The occurrence of AKI was defined using the “Kidney Disease: Improving Global Outcomes” (KDIGO) consensus definition. The exclusion criteria comprised age &lt;18 years and records with missing key clinical information. Statistical Package for the Social Sciences (SPSS) software, version 21 was used for statistical analysis. The prevalence is presented as a percentage with a 95% confidence level. A P-value &lt;0.05 was considered statistically significant. Results: We reviewed 2000 patient files, of which 1430 met the inclusion criteria. According to the KDIGO definition of AKI, the overall incidence CI-AKI in our study cohort was 8.7%. The incidence of CI-AKI varied across baseline CKD stages, with significantly higher occurrences observed in individuals with CKD Stage5 at 24.3% and Stage4 at 15.9%. Statistical analysis confirmed that the likelihood of CI-AKI is significantly influenced by the baseline eGFR levels. This retrospective analysis found that individuals with hypertension have significantly higher odds of CI-AKI (OR = 2.02, p=0.001) compared to those without hypertension. Moreover, individuals with hyperuricemia have significantly higher odds of CI-AKI (OR = 2.78, p&lt;0.001), compared to those without. The association remains significant after adjusting for other variables (OR = 2.40, p&lt;0.001). The presence of diabetes, malignancy, anaemia, and ischemic heart disease did not show a significant association with CI-AKI. Conclusions: Based on the results of this retrospective study, the overall incidence of CI-AKI is around 8.7 %, among patients undergoing enhanced CT scan. The risk is low and highly influenced by patients’ baseline kidney function. Hypertension and Hyperuricemia are risk factors found to be associated with CI-AKI after enhanced CT scan. Diagnostic and clinically relevant enhanced CT scans should not be deferred based on the potential risk of CI-AKI. Furthermore, pre and peri-scan prevention protocols can significantly mitigate the risk of CI-AKI, even among high-risk patients.

Contrast-Induced Acute Kidney Injury in Patients with Heart Failure on Sodium-Glucose Cotransporter-2 Inhibitors Undergoing Radiocontrast Agent Invasive Procedures: A Propensity-Matched Analysis.

(1) Background: This single-center retrospective study aimed to evaluate whether sodium-glucose cotransporter-2 inhibitors (SGLT2-i) therapy may have a nephroprotective effect to prevent contrast-induced acute kidney injury (CI-AKI) in patients with heart failure (HF) undergoing iodinated contrast medium (ICM) invasive procedures. (2) Methods: The population was stratified into SGLT2-i users and SGLT2-i non-users according to the chronic treatment with gliflozins. The primary endpoint was CI-AKI incidence during hospitalization. Secondary endpoints were all-cause mortality and the need for continuous renal replacement therapy (CRRT). (3) Results: In total, 86 patients on SGLT2-i and 179 patients not on SGLT2-i were enrolled. The incidence of CI-AKI in the gliflozin group was lower than in the non-user group (9.3 vs. 27.3%, p < 0.001), and these results were confirmed after propensity matching analysis. Multivariable logistic regression showed that only SGLT2-i treatment was an independent preventive factor for CI-AKI (OR: 0.41, 95% CI: 0.16-0.90, p = 0.045). The need for CRRT was reported only in five patients in the non-SGLT2-i-user group compared to zero patients in the gliflozin group (p = 0.05). (4) Conclusions: SGLT2-i therapy was associated with a lower risk of CI-AKI in patients with HF undergoing ICM invasive procedures.

An Investigation of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study From Pakistan.

Background and objective Contrast-induced acute kidney injury (CIAKI) is a complicationobserved among individuals undergoing primary percutaneous coronary intervention (PCI) and is associated with high morbidity and mortality rates. It is characterized by an elevation in serum creatinine (SCr) levels >0.5 mg/dl or a 50% relative increase in SCrfrom the baseline value following exposure to contrast within a 48- to 72-hour timeframe, in the absence of any alternative causes foracute kidney injury (AKI). This study aimed to assess the incidence of CIAKI in patients following PCI. Methods This prospective study was conducted from July to December 2022, after obtaining ethical approval from the institutional ethics committee (reference no: 147/LRH/MTI). A total of 159 consecutive patients who met the selection criteria were enrolled. A detailed patient and family history was obtained, and a thorough physical examination was conducted. Baseline tests, including SCr, were performed, with SCr repeated 72 hours post-PCI. All investigations were performed in the affiliated hospital's main laboratory and conducted by the same biochemist. Results The study included 159 patients presenting with myocardial infarction, angina pectoris, or ischemic features on EKG, exercise tolerance test (ETT), or echocardiogram and underwent PCI. The patients had a mean age of 51 ± 9 years, baseline SCr of 0.77 ± 0.41 mg/dl, SCr 72 hours post-procedure of 0.83 ± 0.41 mg/dl, and an average contrast volume of 128.6 ± 63 ml; 87 (55%) patients were male, and 72 (45%) were female. CIAKI was observed in 15 (9.4%) patients. Hypertensionand diabetes mellitus were the most prevalent comorbidities. Male gender, diabetes mellitus, and hypertension had a clinically significant association with the development of CIAKI (p<0.05). ST-elevation myocardial infarction (STEMI) was the predominant clinical presentation in 81 (50.9%) cases. Conclusions This study examines the frequency, risk factors, and associations of CIAKI following PCI at a tertiary care hospital in a low-middle-income country. We believe our findings provide future directions for identifying and minimizing the risk of CIAKI in this patient population.

Association between fasting stress hyperglycemia ratio and contrast-induced acute kidney injury in coronary angiography patients: a cross-sectional study.

Stress hyperglycemia ratio (SHR), an emerging indicator of critical illness, exhibits a significant association with adverse cardiovascular outcomes. The primary aim of this research endeavor is to evaluate the association between fasting SHR and contrast-induced acute kidney injury (CI-AKI). This cross-sectional study comprised 3,137 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI). The calculation of fasting SHR involved dividing the admission fasting blood glucose by the estimated mean glucose obtained from glycosylated hemoglobin. CI-AKI was assessed based on elevated serum creatinine (Scr) levels. To investigate the relationship between fasting SHR and the proportion of SCr elevation, piecewise linear regression analysis was conducted. Modified Poisson's regression analysis was implemented to evaluate the correlation between fasting SHR and CI-AKI. Subgroup analysis and sensitivity analysis were conducted to explore result stability. Among the total population, 482 (15.4%) patients experienced CI-AKI. Piecewise linear regression analysis revealed significant associations between the proportion of SCr elevation and fasting SHR on both sides (≤ 0.8 and > 0.8) [β = -12.651, 95% CI (-23.281 to -2.022), P = 0.020; β = 8.274, 95% CI (4.176 to 12.372), P < 0.001]. The Modified Poisson's regression analysis demonstrated a statistically significant correlation between both the lowest and highest levels of fasting SHR and an increased incidence of CI-AKI [(SHR < 0.7 vs. 0.7 ≤ SHR < 0.9) β = 1.828, 95% CI (1.345 to 2.486), P < 0.001; (SHR ≥ 1.3 vs. 0.7 ≤ SHR < 0.9) β = 2.896, 95% CI (2.087 to 4.019), P < 0.001], which was further validated through subgroup and sensitivity analyses. In populations undergoing CAG or PCI, both lowest and highest levels of fasting SHR were significantly associated with an increased occurrence of CI-AKI.

High-sensitivity c-reactive protein to high-density lipoprotein cholesterol ratio and the risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention

Abstract Background High-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) is a new biomarker, which is related to the incidence rate of coronary artery disease (CAD). The purpose of this study was to investigate the association between CHR and contrast-induced acute kidney injury (CI-AKI). Methods In this retrospective cross-sectional study, 10,917 patients underwent PCI. Diagnose CI-AKI according to KIDIGO standard. Univariate and multivariable logistic regression analysis were used to determine the relationship between CHR and CI-AKI, and further draw the receiver operating characteristic (ROC) curve of subjects to evaluate the clinical diagnostic performance of CHR on CI-AKI. Results 1,037 patients (9.50%) developed CI-AKI after PCI. The subjects were 64.1 ± 11.1 years old, 2,511 were females (23.0%). Multivariate logistic regression analysis showed that the increase of CHR level was associated with the increase of CI-AKI incidence rate ([Q4 vs. Q1]: odds ratio (OR) = 1.89, 95% confidence interval (CI) [1.42 to 2.54], P &amp;lt; 0.001). Restrictive cubic spline analysis showed that CHR and CI-AKI were linear relationship. ROC analysis confirmed that CHR was a good predictor of CI-AKI (area under ROC curve =0.606, 95% CI [0.588 to 0.624]). Conclusions High CHR level is closely related to the increase of CI-AKI incidence, indicating that CHR may be an independent risk factor of CI-AKI.

Prognostic Nutritional Index Combined with Triglyceride-Glucose Index to Contrast a Nomogram for Predicting Contrast-Induced Kidney Injury in Type 2 Diabetes Mellitus Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention.

Our objective was to develop and validate a nomogram model aiming at predicting the risk of contrast-induced acute kidney injury (CI-AKI) following percutaneous coronary intervention (PCI) in patients suffering fromtype 2 diabetes mellitus (T2DM) and also diagnosed with acute coronary syndrome (ACS). The study gathered data from 722 T2DM patients with ACS who received PCI treatment at the Affiliated Hospital of Xuzhou Medical University between February 2019 and December 2022, serving as the training set. Considering the validation set, the study included 217 patients who received PCI at the East Affiliated Hospital of Xuzhou Medical University. The patients were classified into CI-AKI and non-CI-AKI groups. The study employed univariate and multivariate logistic analysis for identifying independent risk factors for CI-AKI, followed by developing a predictive nomogram model for CI-AKI risk using R software. The predictive performance and clinical utility of the nomogram were assessed through internal and external validation, utilizing the areas under the receiver operating characteristic curve (AUC-ROC), the Hosmer-Lemeshow test and calibration correction curve, and decision curve analysis (DCA). The nomogram comprised four variables: age, estimated glomerular filtration rate (eGFR), triglyceride-glucose (TyG) index, and prognostic nutritional index (PNI). The AUC-ROC were 0.785 (95% confidence interval (CI) 0.729-0.841) and 0.802 (95% CI 0.699-0.905) for the training and validation cohorts, respectively, indicating a high discriminative ability of the nomogram. The calibration assessment and decision curve analysis have substantiated the strong concordance and clinical usefulness of the aforementioned. The nomogram exhibits favorable discrimination and accuracy, enabling it to visually and individually identify pre-procedure high-risk patients, and possesses a predictive capacity regarding CI-AKI incidence after PCI in patients diagnosed with both T2DM and ACS.

Clinical Outcomes of Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions with a Novel Dynamic Coronary Roadmap System.

Dynamic coronary roadmap (DCR) is a novel technology that creates a real-time overlay of the coronary arteries in percutaneous coronary intervention (PCI) and has the potential to reduce the contrast volume. However, the efficacy of DCR in terms of clinical outcomes in patients with chronic kidney disease (CKD) remains to be fully elucidated.This single center retrospective study enrolled 275 patients with CKD who underwent PCI, and divided them into a DCR group (n = 124) and Non-DCR group (n = 151). Propensity score matching was performed to minimize the differences in baseline characteristics in 113 patient pairs. The primary endpoint was a composite outcome of all-cause death, hospitalization for heart failure, nonfatal myocardial infarction, or the introductory rate of dialysis within 2 years. The secondary endpoints were contrast medium volume, the incidence of contrast-induced acute kidney injury (CI-AKI), and the introductory rate of dialysis within 2 years.Although there was no significant difference in the success rate (DCR group: 99.1% versus Non-DCR group: 98.2%; P = 0.561), contrast volume (92.20 mL versus 115.97 mL; P = 0.002) was significantly lower in the DCR group. CI-AKI incidence was 0.9% versus 6.2% in the DCR and Non-DCR groups, respectively (P = 0.031). The composite outcome defined as primary endpoint occurred in 10 patients in the DCR group and 20 patients in the Non-DCR group (8.8% versus 17.7%; P = 0.049).From the perspective of acute and long-term clinical outcomes, DCR use may be effective for patients with CKD.

Predictive value of systemic immune-inflammation index combined with N-terminal pro-brain natriuretic peptide for contrast-induced acute kidney injury in patients with STEMI after primary PCI.

To investigate the relationship between the incidence of contrast-induced acute kidney injury (CI-AKI) after emergency percutaneous coronary intervention (PCI) and preoperative systemic immune-inflammation index (SII) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with acute ST-segment elevation myocardial infarction (STEMI), and to further analyze the predictive value of the combination of SII and NT-proBNP for CI-AKI. The clinical data of 1543 patients with STEMI who underwent emergency PCI in our hospital from February 2019 to December 2022 were retrospectively analyzed. All patients were divided into training cohort (n = 1085) and validation cohort (n = 287) according to chronological order. The training cohort was divided into CI-AKI (n = 95) and non-CI-AKI (n = 990) groups according to the 2018 European Society of Urogenital Radiology definition of CI-AKI. Multivariate Logistic regression analysis was used to determine the independent risk factors for CI-AKI. Restricted cubic spline (RCS) was used to explore the relationship between SII, NT-proBNP, and the risk of CI-AKI. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SII, NT-proBNP, and their combination in CI-AKI. The incidence of CI-AKI was 8.8% (95/1085). Multivariate logistic regression analysis showed that SII, NT-proBNP, age, baseline creatinine, fasting blood glucose, and diuretics were independent risk factors for CI-AKI. RCS analysis showed that SII > 1084.97 × 109/L and NT-proBNP > 296.12pg/mL were positively associated with the incidence of CI-AKI. ROC curve analysis showed that the area under the curve of SII and NT-proBNP combined detection in predicting CI-AKI was 0.726 (95% CI 0.698-0.752, P < 0.001), the sensitivity was 60.0%, and the specificity was 77.7%, which were superior to the detection of SII or NT-proBNP alone. Preprocedural high SII and NT-proBNP are independent risk factors for CI-AKI after emergency PCI in patients with STEMI. The combined detection of SII and NT-proBNP can more accurately predict CI-AKI risk than the single detection.

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography: Evaluation of a Practice Change.

Development of contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity, mortality, hospital length of stay, and overall health care costs. The purpose of this project was to evaluate a clinical practice change-the addition of high-dose statin therapy to standard renal protection measures-in adults undergoing acute cardiac catheterization procedures and assessing its effect on CI-AKI. The evaluation was a pretest/posttest descriptive design. Adult patients undergoing acute cardiac catheterization procedures were evaluated for the rate of CI-AKI before (10 months preimplementation, N = 283) and after (10 months postimplementation, N = 286) a recent practice change that added high-dose statin therapy (within 24 hours of dye exposure) to a standard renal protection bundle (intravenous fluids, maximum dye calculations, and avoidance of nephrotoxic medications). Outcomes included the rate of CI-AKI, stage of acute kidney injury, need for new hemodialysis, discharge disposition (alive or died in the hospital), and hospital length of stay. Patients in the postintervention group that received renal protection bundle with high-dose statin had significantly lower incidence of CI-AKI (10.1% pre vs 3.2% post; P < .001). There were no significant differences in hospital length of stay, need for new hemodialysis, or mortality. Administration of high-dose statin within 24 hours of the cardiac catheterization procedure improved significantly (19.4% pre vs 74.1% post; P < .001). Adherence to all 5 components of the renal bundle improved post intervention (17% pre vs 73.4% post; P < .001). The addition of a high-dose statin in addition to existing renal protective measures in patients with acute cardiac procedures is associated with a decreased incidence of CI-AKI.

The effect of perioperative diuretic administration on acute kidney injury in patients with acute myocardial infarction after percutaneous coronary intervention: a real-world retrospective study.

The relationship between diuretic use and contrast-induced acute kidney injury (CI-AKI) after contrast exposure remains unclear. In this study, we conducted a retrospective analysis using propensity score matching (PSM) to investigate the effect of perioperative diuretic administration on contrast-induced acute kidney injury (CI-AKI) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). A total of 1894 patients with AMI who underwent PCI were retrospectively analyzed using PSM and multivariate models. Depending on whether diuretics were used, the patients were divided into two groups: the perioperative diuretic group (497 patients, 26.2%) and the non-diuretic group (1397 patients, 73.8%). And the relationship between perioperative diuretic administration and CI-AKI was evaluated by multiple regression models. Furthermore, Kaplan Meier survival curve ratio was used to evaluate and compare overall postoperative survival between the two groups. Most patients who received diuretics were older (67 vs. 60years, respectively, p < 0.001) and women (22.5% vs. 15.2%, p < 0.001) and had combined hypertension (62.8% vs. 47%, p < 0.001), atrial fibrillation (5.4% vs. 1.8%, p < 0.001), stroke (9.3% vs. 4.9%, p < 0.001), and diabetes mellitus (33.4% vs. 23.6%, p < 0.001) compared to those who did not. After the baseline characteristics were balanced using the PSM model, no significant difference was observed in the incidence of postoperative CI-AKI (22.7% vs. 19.5%, p = 0.356) and major cardiovascular adverse events (21.5% vs. 18.7%, p = 0.398). Multiple regression analysis showed no association between perioperative diuretic administration and postoperative CI-AKI occurrence (odds ratio: 1.14, 95% confidence interval: 0.86-1.51, p = 0.371). Further subgroup analysis and sensitivity analysis confirmed the above findings. We found no significant association between perioperative diuretic administration and postoperative CI-AKI in patients with AMI who underwent PCI.

Effect of Serum Bilirubin Levels on Contrast-induced Acute Kidney Injury: A Systematic Evaluation and Meta-analysis.

Contrast-induced acute kidney injury (CI-AKI) is an important complication following the use of iodinated contrast media. Bilirubin has a protective effect but may also aggravate CI-AKI. The purpose of this systematic review was to assess whether bilirubin is a risk factor for CI-AKI. We searched the databases PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid Medline, CNKI (China National Knowledge Infrastructure), VPCS (Vip Paper Check System), Wanfang, and CBM (Chinese BioMedical Literature Database) from the initial date to May 6, 2023. We summarized the results by directly combining the effect-size odds ratio (OR) and 95% confidence interval (CI) and identified sources of heterogeneity through subgroup analysis, sensitivity analysis, and meta-regression analysis. A total of 10 studies (14 data sets) were included: 7 retrospective studies (10 data sets) and 3 prospective studies (4 data sets), involving 12776 participants. The incidence of CI-AKI of 16% (95% CI: 14-19%). Total bilirubin was positively associated with the occurrence of CI-AKI (OR = 1.80; 95% CI: 1.36-2.38). Both low and high bilirubin concentrations were risk factors for CI-AKI. The incidence of CI-AKI was higher in the low bilirubin group than in the high bilirubin group.

Predictive value of systemic immune-inflammatory index combined with CHA2DS2-VASC score for contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

To investigate the value of systemic immune-inflammation index (SII) combined with CHA2DS2-VASC score in predicting the risk of contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) treatment. 1531 consecutive patients with ACS and undergoing PCI were recruited from January 2019 to December 2021. All patients were divided into CI-AKI and non-CI-AKI groups according to the pre-procedure and post-procedure creatinine changes, and the baseline data were compared between the two groups. Binary logistic regression analysis was used to investigate the factors influencing CI-AKI in ACS patients after PCI. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of SII, CHA2DS2-VASC, and their combined levels on CI-AKI after PCI. Patients with high SII and high CHA2DS2-VASC score had a higher incidence of CI-AKI. For SII, the area under the ROC curve (AUC) for predicting CI-AKI was 0.686. The optimal cut-off value was 736.08 with a sensitivity of 66.8% and a specificity of 66.3% [95% confidence interval (CI) 0.662-0.709; P < 0.001]. For CHA2DS2-VASC score, the AUC was 0.795, the optimal cut-off value was 2.50 with a sensitivity of 80.3% and a specificity of 62.7% (95% CI 0.774-0.815; P < 0.001). When combining SII and CHA2DS2-VASC score, the AUC was 0.830, the optimal cut-off value was 0.148 with a diagnostic sensitivity of 76.1% and a specificity of 75.2% (95% CI 0.810-0.849; P < 0.001). The results showed that SII combined with CHA2DS2-VASC score resulted in improved predictive accuracy of CI-AKI. Multifactorial logistic regression analysis showed that albumin level (OR = 0.967, 95% CI 0.936-1.000; P = 0.047), lnSII level (OR = 1.596, 95% CI 1.010-1.905; P < 0.001), and CHA2DS2-VASC score level (OR = 1.425, 95% CI 1.318-1.541; P < 0.001) were independent risk factors for CI-AKI in patients with ACS treated with PCI. High SII and high CHA2DS2-VASC score are risk factors for the development of CI-AKI, and the combination of the two improves the accuracy of predicting the occurrence of CI-AKI in patients with ACS undergoing PCI.

Preventing contrast-induced acute kidney injury with probucol and hydration in patients with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials.

Preventing contrast-induced acute kidney injury (CI-AKI) is critical because of its association with poor clinical outcomes, including extended hospital stays and increased mortality. The effects of probucol on preventing CI-AKI have been controversial. Therefore, this systematic review and meta-analysis evaluated the influence of probucol combined with hydration on the CI-AKI risk in patients with coronary heart disease undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). We retrieved data from the following databases from their inception to May 29, 2022: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database (Sinomed), Wanfang Database, and Chinese Scientific Journal Database. The methodological quality of the trials was assessed following the Cochrane Handbook guidelines, and Review Manager 5.3 and Stata 14.0 software were used for the data analysis. We included 14 trials comprising 3306 patients in the analysis. All included trials reported the CI-AKI incidence rate (the primary outcome). Probucol with hydration significantly reduced the CI-AKI incidence compared to hydration alone (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.25-0.44, P < .001). Subgroup analyses were performed based on the contrast medium type (iso-osmolality vs low-osmolality contrast medium [LOCM]) and volume (less than or more than 200 mL); the effects of probucol with hydration versus hydration-only on CI-AKI were comparable within each subgroup. Additionally, the serum creatinine (Scr) concentration 24 hours, 48 hours, and 72 hours and the estimated glomerular filtration rate (eGFR) 72 hours after contrast exposure were better in the probucol with hydration group than the hydration-only group. Finally, major clinical adverse events and adverse drug reactions were comparable between the probucol with hydration and hydration-only groups. Probucol with hydration decreases the CI-AKI incidence compared to hydration only in patients with coronary heart disease undergoing CAG or PCI. However, more high-quality, large-sample, multicenter randomized trials are needed to confirm this conclusion.