Contrast-induced Nephropathy In Diabetic Patients Research Articles

The Effect of SGLT2 Inhibitors on the Development of Contrast-Induced Nephropathy in Diabetic Patients with Non-ST Segment Elevation Myocardial Infarction.

Background and Objectives: Percutaneous procedures using contrast agents are modern diagnosis and treatment methods for cardiovascular diseases. Contrast use may cause nephropathy, especially in diabetic patients. SGLT2 inhibitors have strong cardioprotective and renal protective effects. In our study, we investigated the effectiveness of this drug group in preventing the development of Contrast-Induced Nephropathy (CIN). Materials and Methods: The results of 312 diabetic patients who underwent CAG were analyzed. The study group included 104 DM patients using SGLT2 and the control group did not use SGLT2. These groups were compared with each other in terms of clinical, demographic, and laboratory parameters. Results: The groups were similar characteristics. However, post-CAG creatinine values compared with before the procedure, the development of CIN was observed to be significantly less in the group using SGLT2 inhibitor (p = 0.03). When the results of the multivariate analysis were examined, it was seen that the use of SGLT2 inhibitors significantly reduced the risk of CIN (odds ratio (OR): 0.41, 95% confidence interval (CI): 0,142-0.966, p = 0.004). Conclusions: Our study showed that SGLT2 inhibitors may be protective against the development of CIN, especially in patients with comorbid conditions such as diabetes.

Effect of Serum C-Peptide Levels on the Development of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary Angiography.

Contrast-induced nephropathy (CIN) is an important cause of morbidity and mortality, in patients with diabetes who undergo coronary angiography (CAG). It is known that serum C-peptide has renoprotective effects in diabetic nephropathy. Patients with diabetes (n = 552) who underwent CAG in our center between January 2020 and December 2021 were included, retrospectively. The patients were divided into 2 groups: not-developing CIN (group 1) and developing CIN (group 2). CIN developed in 128 (23.1%) of the patients with diabetes who underwent CAG. C-peptide, albumin, hemoglobin, hematocrit, initial creatinine, ejection fraction (EF), were significantly lower in the group that developed CIN compared with the group that did not (P < .05, for all). In correlation analysis, creatinine increase rate (ΔCr) was negatively correlated with C-peptide, hematocrit, and ejection fraction (r = -.241, P < .001; r = -.135, P < .001; r = -.194, P = .001; respectively). In logistic regression analysis, C-peptide level (Odds Ratio: .404, 95% Confidence Interval: .286-.571, P < .001) was an independent predictor of CIN. In the present study, C-peptide level was an independent predictor of CIN in patients with diabetes. This study suggests that low levels of C-peptide are associated with a greater risk of CIN.

Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention

BackgroundsDiabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN.MethodsWe reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN.ResultsPatients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829).ConclusionsStudies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.

High-Dose Atorvastatin Raises Threshold of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Elective Coronary Intervention: A Randomized Controlled Study

Background. Contrast-induced nephropathy (CIN) is a significant complication of angiographic procedures resulting from injection of iodinated contrast media (CM). Patients with diabetes mellitus (DM) are at the highest risk of CIN. Statins have recently been proposed for protection against CIN due to their antioxidant and anti-inflammatory properties. Aim of Work. To investigate the potential benefit of acute pretreatment with high-dose atorvastatin (80 mg) in reduction of the incidence of CIN in diabetic patients indicated for elective coronary intervention. Patients and Methods. 200 diabetic patients with indication for coronary intervention were enrolled in the study. 100 patients will be randomly assigned to receive atorvastatin (80 mg) just before coronary intervention (statin group) and 100 patients received placebo (control group). CIN was defined as a rise of serum creatinine of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 hours of the angiography. After the procedure, Thrombolysis in Myocardial Infarction (TIMI) flow of the culprit vessel was reported, as well as the volume of used contrast media and time of X-ray exposure. Results. Our study reported a CIN incidence of 12, 18, and 6% among the whole study, placebo, and statin groups, respectively, P value of 0.001. Among the placebo group, CIN is likely to develop after a 13.5-minute X-ray exposure time with a specificity of 73.2% and sensitivity of 77.8%, area under the curve (AUC) of 0.879 (CI: 0.798–0.960), and P value of 0.001, while in the statin group, CIN is likely to develop after 14.5-minute X-ray exposure time with a specificity of 74.5% and sensitivity of 83.3%, AUC of 0.818 (CI: 0.727–0.910), and P value of 0.009. In the placebo group, CIN is likely to develop after injection of 145 ml of contrast media with a specificity of 75.6% and sensitivity of 77.8%, AUC of 0.855 (CI: 0.757–0.952), and P value of 0.001, while in the statin group, CIN is likely to develop after injection of 165 ml of contrast media with a specificity of 84% and sensitivity of 83.3%, AUC of 0.878 (CI: 0.811–0.944), and P value of 0.002. Conclusions. Acute pretreatment with high-dose atorvastatin can effectively protect against CIN and was associated with a marked decrease in the prevalence of CIN in diabetic patients undergoing coronary interventions. Moreover, pretreatment with high-dose atorvastatin raises the threshold of X-ray exposure time and the amount of contrast media beyond which CIN is likely to develop. The trial is registered with NCT04375787.

The Relation between Pre-Procedural Increase in Urinary Albumin Excretion and Changes in Estimated Glomerular Filtration Rate after Coronary Angiography in Diabetic Patients

Background: Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a iodinated contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality. Adult patients with diabetes have a higher risk than the general population for developing contrast-induced nephropathy. Objective: To assess the significance of preprocedural microalbuminuria on renal function changes post coronary angiography. Patients and methods: The current study included 40 patients all over the age of 18 years, with diabetes mellitus type 1 or type 2, scheduled for coronary angiography with estimated GFR > 60 ml/min. Results: incidence of contrast-induced nephropathy in this study was 40 % (n=16) of patients while 60% (n = 24) did not fit the definition of CIN. There was no statistically significant difference in the age, gender distribution and use of angiotension converting enzyme inhibitors (ACEIs) or diuretics between the cases who developed and who did not develop CIN. The mean albumin creatinine ratio (ACR) in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared to the cases with contrast-induced nephropathy (420.43 ± 348.52) (p = 0.033). The mean HbA1c in no contrast-induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66, which was significantly higher (P > 0.001). With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN. Conclusion: An increase in urinary albumin creatinine ratio in itself maybe be a risk factor for development of contrast-induced nephropathy in diabetic patients.

Glycemic variability as predictor of contrast-induced nephropathy in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention.

BackgroundContrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI). Diabetes mellitus (DM) and acute myocardial infarction (AMI) are associated with an increased risk of CIN. However, it remains unclear whether glycemic variability (GV) has the important prognostic significance of CIN in diabetic patients with AMI undergoing PCI. We conducted this study to investigate the independent prognostic value of the in-hospital GV in diabetic patients who presented with AMI and were treated with PCI.MethodsThe study group comprised 252 diabetic patients with AMI who underwent PCI and were assigned to CINand non-CIN groups. A continuous glucose monitoring system (CGMS) was used to determine the mean amplitude of glycemic excursion (MAGE), a representative index of GV. Independent risk factors for CIN were determined by multivariate logistic regression analysis (MLRA), and receiver-operating characteristic (ROC) analysis was used to measure the prognostic potential of GV.ResultsA total of 55 patients had CIN and they showed markedly elevated MAGE compared with the non-CIN group. MLRA revealed that MAGE had potential to independently predict CIN. The area under the ROC curve, optimal cut-point value, sensitivity and specificity for MAGE were 0.739, 2.95, 70.91% and 61.42%, respectively.ConclusionsIn diabetic AMI patients undergoing PCI, high GV is associated with increased risk of CIN.

Pentoxifylline for the prevention of contrast-induced nephropathy in diabetic patients undergoing angioplasty: a randomized controlled trial.

Contrast-induced nephropathy (CIN) is one of the most important complications of contrast media. We aimed to evaluate the preventive effects of pentoxifylline (PTX) on CIN in diabetic patients undergoing angioplastyusing cystatin C. The present study was a randomized clinical trial, which was investigated the impact of PTX in the prevention of CIN among 90 diabetic patients undergoing the angioplasty using cystatin C as a novel biomarker of renal injury. The patients randomly were allocated 1:1 into the intervention and the control groups. The intervention group received a total of 1200mg PTX orally before the angioplasty. The serum level of cystatin C and creatinine was measured at baseline and 24h after the procedure. The incidence of CIN was 8.9% in the PTX group vs. 6.7% in the control group (p = 1.00). The baseline level of cystatin C was 1.31 ± 0.39mg/L in the PTX group and 1.24 ± 0.42mg/L in the control group (p = 0.561). After angioplasty, the level of cystatin C was increased to 1.33 ± 0.61 in PTX group and to 1.31 ± 0.47 in the control group but was not statistically significant. The similar pattern was also seen in the level of serum creatinine. The results of this study did not support the potential benefit of PTX in the prevention of CIN in diabetic patients undergoing angioplasty.

Effect of trimetazidine on preventing contrast-induced nephropathy in diabetic patients with renal insufficiency.

BackgroundOur study sought to assess the effect of trimetazidine (TMZ) on preventing contrast-induced nephropathy (CIN) in diabetic patients with renal insufficiency.Materials and Methods106 diabetic patients with renal insufficiency who were undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) were enrolled in this study. Standard hydration was administered to both groups (the TMZ group and the control group). In the TMZ group, patients were orally administered TMZ for 48 hours before and 24 hours after CAG and/or PCI. Serum creatinine (Scr), cystatin C and the glomerular filtration rate (eGFR) were measured before as well as 24 hours, 48 hours and 72 hours after contrast media injection. The incidence of CIN and major cardiovascular events (MACE) was also evaluated in both groups.ResultsScr, cystatin C and the eGRF in the TMZ group were better than those in the control group after 24 hours (OR: 0.78, 95% CI: 0.54–0.82; OR: 0.66, 95% CI: 0.62–0.73; OR: 1.2, 95% CI: 1.02–1.53, respectively), 48 hours (OR: 0.69, 95% CI: 0.52–0.73; OR: 0.76, 95% CI: 0.69–0.84; OR: 1.5, 95% CI: 1.25–1.68, respectively) and 72 hours (OR: 0.82, 95% CI: 0.77–0.91; OR: 0.85, 95% CI: 0.71–0.92; OR: 1.67, 95% CI: 1.33–1.72, respectively). The incidence of CIN (9.26% vs 16.67%) and MACE (7.41% vs 18.51%) in the TMZ group was significantly lower than that in the control group (P < 0.05).ConclusionsOur study suggests that TMZ could reduce the incidence of CIN and MACE in diabetic patients with renal insufficiency who are undergoing CAG and/or PCI.

GW26-e4543 Hyperhomocysteinemia and contrast-induced nephropathy in diabetic patients with renal dysfunction who underwent percutaneous coronary intervention

GW26-e4543 Hyperhomocysteinemia and contrast-induced nephropathy in diabetic patients with renal dysfunction who underwent percutaneous coronary intervention

Impact of high loading dose of atorvastatin in diabetic patients with renal dysfunction undergoing elective percutaneous coronary intervention: a randomized controlled trial.

The effectiveness of statin pretreatment in reducing the incidence of contrast-induced nephropathy (CIN) has been examined in some observational and randomized studies, yielding controversial results. This study sought to evaluate the role of atorvastatin in prevention of CIN in diabetic patients with mild-to-moderate chronic kidney disease (CKD), undergoing elective percutaneous coronary intervention (PCI). 130 patients with mean glomerular filtration rate of 48.5±16mL/min/1.73m were prospectively enrolled, then randomly (double blind) assigned in 1:1 ratio to receive atorvastatin (80mg daily for 48h) or placebo. Serum creatinine and glomerular filtration rate were measured preintervention, 72h and 10days thereafter. An increase in serum creatinine by >0.5mg/dL (44.2μmol/L) or >25% of baseline value was considered as CIN. Mean age of the study cohort was 56±5years (males: 62%). Mean serum creatinine level in the placebo group increased significantly 3days after coronary intervention and declined on the 10th day to a level that did not differ significantly from the baseline level, but still higher. However, in atorvastatin group, mean serum creatinine level showed a nonsignificant rise on the third day and then decreased to a level close to the baseline one, on the 10th day. Incidence of CIN was 7.7% in atorvastatin group and 20% in the placebo group (P<0.05). Atorvastatin dose of 80mg per day for 48h is associated with decreased incidence of CIN in diabetic patients with CKD undergoing PCI.

0116: Metformin and contrast-induced nephropathy in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction: a multicentre study

Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI), associated with increased mortality. The impact of metformin, which has potential interactions with renal function, on CIN remains to be investigated. To analyze the association between chronic metformin treatment and the development of CIN after primary PCI for ST segment elevation myocardial infarction (STEMI). 372 patients with diabetes mellitus (DM) treated with PCI <24H in 2 coronary care units (Paris-Bichat and Dijon Hospital, France) were included. Serum creatinine (Cr) was measured before and 48H after PCI. CIN was defined as an increase in Cr of 44µmol/L (0.5 mg/dL) or 25% over baseline after PCI. Since PCI was urgent, metformin could not be withheld prior to PCI but was usually stopped after PCI. Mean age was 66±11 y, and 25% were women. 64% had hypertension, 56% had DM duration >5 year, and 26% had prior coronary artery disease. Metformin and sulfonylurea were the most frequently used antidiabetic chronic treatments (40% for both), and 27% were on insulin therapy. The other antidiabetic medications, including glinide, glitazone, and acarbose were rarely used (3%, 2%, and 5%, respectively). Mean baseline and post PCI Cr levels were 102±52 and 122±81µmol/L. Rate of CIN was similar in patients with or without metformin (21 vs 20%, respectively, p= 0.87). Logistic regression for the risk of CIN taking into account classical risk factors showed no impact of chronic metformin therapy, even in stratified analysis in patients with chronic kidney disease. Hospital mortality was similar between groups (7 vs 6%, respectively, p=0.69). Moreover, no case of lactic acidosis was reported during the hospital stay. In this multicentre study reflecting current clinical practice, metformin treatment prior to primary PCI had no significant impact on CIN. Larger studies are needed to confirm these findings.

Impact of Trimetazidine on Incidence of Myocardial Injury and Contrast-Induced Nephropathy in Diabetic Patients With Renal Dysfunction Undergoing Elective Percutaneous Coronary Intervention

Trimetazidine is an anti-ischemic agent with antioxidant activity. This study evaluated the effect of periprocedural administration of trimetazidine on the incidence of percutaneous coronary intervention (PCI)-induced myocardial injury and contrast-induced nephropathy (CIN) in diabetic patients with mild-to-moderate renal dysfunction. One hundred patients with a mean glomerular filtration rate of 48 ± 16 (ml/min/1.73m(2)) were prospectively enrolled, then randomly assigned to receive (50 patients; trimetazidine group) or not receive (50 patients; control group) periprocedural trimetazidine (70mg/day) for 72hours. The serum creatinine level was measured pre-PCI, 72hours, and 10days thereafter. An increase in the serum creatinine level by >0.5mg/dl or 0.25% of the baseline value is considered as CIN. Cardiac troponin I levels were measured before and 6, 12, and 24hours after PCI. Mean age of the study cohort was 59 ± 6years (men 68%). The serum creatinine level in the control group increased significantly 3days after PCI and decreased on the tenth day. However, it showed no significant change in the trimetazidine group. Incidence of CIN was 12% in the trimetazidine group and 28% in the control group (p <0.05). Cardiac troponin I levels were significantly reduced in the trimetazidine group (6hours: 8 ± 0.3 vs 16 ± 0.2 pg/ml, 12hours: 13 ± 0.9 vs 24 ± 0.8 pg/ml, 24hours: 7 ± 0.7 vs 14 ± 0.3 pg/ml, p <0.001). Inconclusion, trimetazidine intake before elective PCI in diabetic patients with mild-to-moderate renal dysfunction is associated with decreased incidence of CIN and myocardial injury.

Frequency and risk factors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients: a study among Egyptian patients

Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury (AKI) in hospitalized patients. Diabetes mellitus remains a consistent independent predictor of contrast nephropathy. Aim: To determine frequency and predictors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients. Patients and methods: The study included 200 type II diabetic patients who underwent cardiac catheterization; serial measurement of serum creatinine and creatinine clearance (Before contrast exposure and 48 h), creatinine clearance was calculated using Cockcroft–Gault formula. Contrast-induced nephropathy was defined as rise in serum creatinine 48 h after contrast exposure of ≥0.5 mg/dL or increased >25% compared to base line creatinine. Results: incidence of CIN in type II diabetic patients was 21.5%; incidence of CIN in diabetic patients with microalbuminuria was 17%, while incidence of CIN in patients with macroalbuminuria levels was 26%. There was a statistically significant difference between the patients who suffered from CIN post-procedure and patients who did not suffer from CIN regarding the ejection fraction and age with low ejection fraction and older patients in CIN group. Multiple logistic regression analysis for CIN predictors showed that pre-contrast serum creatinine to be the strongest predictor for being at risk of contrast-related, followed by age, and lastly albumin/creatinine ratio. Conclusion: Our findings suggest that diabetic patients, despite having a normal baseline creatinine are at an increased risk of developing CIN post-coronary angiography, patients at risk of CIN are older patients with high pre-contrast serum creatinine and high urine albumin/creatinine ratio.

Comparison of the effects of nebivolol and N-acetylcysteine which are added to hydration theraphy in the prevention of contrast induced nephropathy

Aim: Contrast-induced nephropathy (CIN) is a serious complication occurring after the administration of contrast materials to patients at risk of acute renal injury. Nebivolol is a third generation beta blocker which has anti-apoptotic and anti-oxidant properties. In addition, it has vasodilatator effect via increasing nitric oxide level. So, the aim of the study was to compare the effectiveness of prophylactic nebivolol use versus pretreatment with N-Acetylcysteine (NAC) for prevention of CIN after coronary angiography. Patients and methods: We prospectively enrolled 99 patients who were scheduled for elective coronary angiography procedure and whose baseline creatinin levels between 1.2 and 1.7 mg/dl. Patients were divided into three groups. Group I (NAC group) consisted of the patients received NAC plus hydration, group II (nebivolol group) nebivolol plus hydration and, group III (hydration group) only hydration. In group II, patients received oral nebivolol (5 mg/dose, n = 33) once a day for total 3 doses before coronary angiography, starting two days before angiography and continuing at the morning of angiography day. CIN was defined as an increase of ≥0.5 mg/dl or an increase of >25% in serum creatinine over baseline at 2-day or 5-day after coronary angiography in the first definition. Results: Treatment groups were similar with respect to baseline clinical characteristics. Serum creatinine levels at 2-day and 5-day were not significantly different in the three groups (p=0.96 and p=0.79, respectively). CIN occurred in 18.2% (6/33) of patients in group I, 24.2% (8/33) in group II, and 24.2% (8/33) in group III (p=0.79). Also, the incidence of CIN in diabetic patients was not different in the three treatment groups (p=0.16). Although the incidence of CIN was not different in the three groups (p=0.30), in the diabetic subgroup, CIN occurred in 20% (2/10) of patients taking nebivolol, none of patients taking NAC and 55.6% (5/9) of patients administered only hydration (p=0.01). Conclusion: Both nebivolol and NAC which was added to hydration theraphy didn't reduced the risk of CIN in patients with reduced renal function undergoing elective coronary angiography. This study demonstrated the protective effect of NAC on CIN in only diabetic patients.

Nefrotoxicidad por contrastes yodados en estudios de tomografía computarizada a pacientes ambulatorios diabéticos en tratamiento con metformina

To determine the incidence of contrast-induced nephropathy (CIN) among diabetic patients treated with Metformin who underwent computerized tomography (CT) scan with iodinated contrast media. Prospective study of diabetic patients enrolled in a lactic acidosis prevention protocol in whom clinical and analytical follow up after CT scan with intravenous contrast was performed. In this study, 98 cases were collected. The incidence of CIN in diabetic patients without prior renal failure was 0%. In patients with previous renal failure the incidence of CIN was 4.7%. The risk of CIN in diabetic patients with no renal failure undergoing intravenous contrast administration is minimal. Recommendations to stop Metformin to avoid lactic acidosis in patients undergoing intravenous contrast administration may be restricted to patients with abnormal renal function.

Prevention of contrast-induced nephropathy in diabetic patients with impaired renal function: A randomized, double blind trial of sodium bicarbonate versus sodium chloride-based hydration

AimsDiabetes mellitus and decreased renal function are important risk factors for contrast-induced nephropathy (CIN) in which oxidative stress damage may play a role. Alkalinization with sodium bicarbonate (NaHCO3) has been proposed as a means of reducing free-radical mediated renal injury; however, the effectiveness of NaHCO3 treatment to prevent CIN in high-risk patients remains uncertain. MethodsWe performed a prospective, randomized, double blind, sodium chloride (NaCl) hydration-controlled study of NaHCO3 in 120 diabetic patients with impaired renal function (serum creatinine ≥100μmol/L) undergoing an elective procedure with use of low-osmolar contrast media. The primary endpoint was the incidence of CIN defined as creatinine increase of ≥25% and/or ≥44μmol/L within 2 days after contrast. Secondary end-points were maximal changes in serum creatinine and estimated glomerular filtration rate. Urine F2-isoprostane levels were also assessed as measure of oxidative stress. ResultsThere were no significant group differences in baseline characteristics except for the marginally lower age of the NaHCO3 treated patients (63±11 vs. 67±10 years; p=0.05). CIN occurred in 7 (11.5%) and 5 (8.5%) patients of the NaHCO3 and NaCl groups, respectively (p=0.76; incidence rate ratio 1.35; 95% CI 0.37–5.41). No significant differences were seen in secondary outcome measures and changes in the parameter of oxidative stress. ConclusionsIn diabetic patients with renal function impairment sodium bicarbonate does not confer protection against contrast-induced nephropathy greater than sodium chloride-based hydration. Its specific role in mitigating oxidative stress damage in CIN is also not supported by our data.

Use of Alpha-Lipoic Acid in Prevention of Contrast-Induced Nephropathy in Diabetic Patients

In this prospective study, we aimed to determine the protective antioxidant role of alpha-lipoic acid (ALA) on development of contrast-induced nephropathy (CIN) in diabetic patients undergoing coronary angiography. Seventy-eight diabetic patients undergoing coronary angiography were included. Thirty-nine patients were randomized to control group and 39 patients to ALA group. Both groups were hydrated on the day of angiography, and the ALA group had also received three doses of “Thioctacid 600 mg HR, MEDA Manufacturing GmbH” in pill form. Serum creatinine clearance, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL) were studied before and after angiography. We defined CIN as either ≥25% or ≥0.5 mg/dL increase in serum creatinine at 48th hour after angiography. Baseline clinical characteristics were similar in both groups. Mehran risk score and creatinine clearance were comparable in control and therapy groups (5.59 ± 1.96 vs. 5.49 ± 1.73, p = 0.54 and 89 ± 21 vs. 96 ± 24, p = 0.13, respectively). The volumes of contrast media (median values of 80 mL vs. 75 mL) and hydration with saline (2862 ± 447 mL vs. 2637 ± 592 mL) were also similar (p > 0.05). The incidence of CIN was the same (8%) in both the groups. Alterations in serum creatinine, cystatin C, and urinary NGAL levels before and after the procedure were comparable between the ALA and control groups (group p-values were >0.05 in two-way repeated measures analysis of variance). We presented for the first time that ALA therapy added to hydration does not decrease the risk of CIN development in diabetic patients undergoing coronary angiography.

Impacto na função renal de uma dose de reforço de rosuvastatina prévia a intervenção coronária percutânea eletiva nos pacientes em uso crônico de estatina

INTRODUCAO: A nefropatia induzida pelo contraste (NIC) e uma complicacao potencial apos a intervencao coronaria percutânea (ICP). A patogenese esta associada a mecanismos inflamatorios, disfuncao endotelial e estresse oxidativo, e as estatinas, por seus efeitos pleiotropicos, vem sendo analisadas nesse cenario. Avaliamos se uma dose de reforco de rosuvastatina pre-ICP eletiva, em pacientes em uso cronico de estatina, reduz a ocorrencia de NIC. METODOS: Estudo prospectivo, randomizado, aberto, realizado em unico centro. Os pacientes foram divididos de acordo com a utilizacao (grupo 1) ou nao (grupo 2) de 40 mg de rosuvastatina, 2 a 6 horas pre-ICP. A frequencia de NIC foi comparada entre os dois grupos e nos subgrupos de diabeticos e com disfuncao renal previa. RESULTADOS: Foram incluidos 135 pacientes, com idade de 60,7 + 9,3 anos, randomizados para o grupo 1 (n = 67) ou para o grupo 2 (n = 68). A prevalencia de diabetes foi de 31,1% e de clearance de creatinina < 60 ml/min, de 13,3%. A incidencia de NIC foi de 8,1% e nao mostrou diferenca entre os grupos (9% vs. 7,4%; P = 0,89). A incidencia de NIC nos diabeticos foi de 15% vs. 13,6% (P = 0,75) e nos portadores de disfuncao renal previa foi de 12,5% vs. 0 (P = 0,93). CONCLUSOES: O uso de uma dose de reforco de rosuvastatina em sua posologia maxima nao exerceu efeito protetor renal nos pacientes em uso cronico de estatina submetidos a ICP eletiva.

Comparison of Iodixanol and Ioversol for the Prevention of Contrast-Induced Nephropathy in Diabetic Patients After Coronary Angiography or Angioplasty

This study was designed to compare differences in the incidence of contrast-induced nephropathy (CIN) and changes in serum creatinine (SCr) level following iso-osmolar iodixanol or low-osmolar ioversol administration in diabetic patients undergoing coronary angiography, with or without percutaneous coronary intervention (PCI). A number of studies have indicated that iodixanol reduces the risk of CIN in patients with renal impairment, with or without diabetes. Diabetic patients may have some degree of renal dysfunction despite having a normal SCr level. The study included 250 consecutive diabetic patients undergoing coronary angiography with or without PCI. Those enrolled during the first 7 months of the study received ioversol and those enrolled during the following 11 months received iodixanol. The primary study endpoint was the incidence of CIN. Secondary objectives were to identify independent predictors of CIN and to determine the mean increase in SCr 72 hours after contrast injection. The overall incidence of CIN was 5.6%. The incidence of CIN was significantly lower with iodixanol than with ioversol (2.5% vs. 8.3%, respectively; odds ratio [OR]=0.255; 95% confidence interval [CI], 0.068-0.952; P=.047). A low estimated glomerular filtration rate (60.8+/-29 mL/min per 1.73 m2 in those with CIN vs. 75.3+/-25 mL/min per 1.73 m2 in those without; OR=0.975; 95% CI, 0.952-0.997; P=.03) and ioversol use were independent predictors of CIN. In diabetic patients undergoing diagnostic coronary angiography with or without PCI, the iso-osmolar contrast medium iodixanol was associated with a lower incidence of CIN than low-osmolar ioversol.

Hidratação com bicarbonato de sódio na prevenção de nefropatia induzida por contraste em pacientes diabéticos: subanálise de ensaio clínico multicêntrico

SUMMARY Sodium-Bicarbonate to Prevent Contrast-InducedNephropathy in Diabetic Patients: a Sub-Analysisof a Multicenter Clinical Trial Background: Contrast-induced nephropathy (CIN) isassociated with worse clinical outcomes both at short andlong-term follow-up. Recent evidence indicates thatintravenous hydration with sodium-bicarbonate may reducethe incidence of CIN. However, this strategy has not beenreported in diabetic patients. Methods: Sub-analysis of amulticenter study involving 301 patients with serumcreatinine ≥ 1,2 mg/dL or creatinine clearance < 50 mL/minsubmitted to coronary angiography or percutaneous coronaryintervention and randomized to intravenous hydration withsodium-bicarbonate or normal saline. All patients receivedlow-osmolar contrast media. We assessed the incidence ofCIN (defined as creatinine increase ≥ 0,5 mg/dL), and theaverage change in creatinine and creatinine clearance48 hours after the procedure. A total of 87 diabetic patientswere analyzed. Results: There was no difference betweengroups regarding baseline characteristics, contrast volu-me used, baseline creatinine levels and creatinine clearance.Eight patients presented CIN: 4 (9.8%) in the bicarbonategroup and 4 (8.9%) in the saline group (p = 0.9). The