Contrast-induced Nephropathy In Patients Research Articles

The Role of Magnesium Levels in the Progression of Contrast-Induced Nephropathy in Patients With STEMI Undergoing Primary PCI.

Contrast-induced nephropathy (CIN) poses a significant risk following primary percutaneous coronary intervention (pPCI) in patients with ST-Elevation Myocardial Infarction (STEMI). Magnesium (Mg²⁺) deficiency has been associated with renal dysfunction and cardiovascular diseases, yet its role in CIN development remains unclear. This study represents the first investigation exploring the relationship between Mg²⁺ levels and CIN in this context.We conducted a retrospective study involving 2306 consecutive STEMI patients undergoing pPCI. Serum Mg²⁺ levels were measured on admission. Logistic regression and Receiver Operating Characteristic (ROC) analysis were employed to assess the association between Mg²⁺ levels and CIN development. Of the enrolled patients, 691 (30%) developed CIN post-pPCI. Mg²⁺ levels were significantly lower in the CIN group (P < .001). Multivariate analysis identified Mg²⁺ <2.03 mg/dL, age >68 years, left ventricular Ejection Fraction (EF) <49%, and post-procedure Thrombolysis In Myocardial Infarction (TIMI) flow grade <2 as independent predictors of CIN. ROC analysis revealed an Mg²⁺ cutoff of 2.03 mg/dL, Area Under the Curve (AUC): 0.711, sensitivity: 69%, specificity: 68%). Our study demonstrates a significant correlation between low Mg²⁺ levels and CIN in STEMI patients undergoing pPCI, highlighting Mg²⁺ <2.03 mg/dL as an independent risk factor for CIN.

Prevention of Contrast Induced Nephropathy in Patients Undergoing Coronary Angioplasty by Pretreatment with High Dose Atorvastatin

One potential side effect of coronary angioplasty for the development of acute kidney injury (AKI) is contrast-induced nephropathy (CIN). New data show that atorvastatin, decreases the risk of CIN by its anti-inflammatory and endothelium-stabilizing properties. This paper sought to assess high dose atorvastatin pretreatment in the prevention of CIN in patients who are candidates for coronary angioplasty. This prospective descriptive comparative study was carried out in the department of Cardiology, PAEC Hospital, Islamabad, from 1st August 2024 till 31st December 2024. A total of 214 patients, were equally assigned to two groups: the Atorvastatin Group, comprised of 107 participants and the Control Group comprised of 107 participants. In atorvastatin group, patients took 80mg of orally before 24 hours of angioplasty procedure was done. Routine preoperative IV saline 1 mL/kg/h was given 12 h before and after the procedure. No statin pretreatment was given to patients in control group but they were offered the same level of hydration. Mean age in study group versus control group was (63.2 ± 10.4 years vs. 62.8 ± 11.2, p = 0.685) respectively. The majority of patients (67.3% in the atorvastatin group and 65.4% in the control group) were male. The mean contrast volume employed during the procedure was 180.2 ± 25.0 mL in the atorvastatin group and 185.1 ± 30.2 mL in the control group; p = 0.34. High dose atorvastatin administration before coronary angioplasty decreases the incidence of CIN, suggesting that this is a secure and efficient way to maintain renal function.

Comparative Efficacy of High-Dose Rosuvastatin and Atorvastatin in Preventing Cystatin C-Oriented Contrast-Induced Nephropathy in Patients With Acute Myocardial Infarction: RACCOON-AMI Registry

Comparative Efficacy of High-Dose Rosuvastatin and Atorvastatin in Preventing Cystatin C-Oriented Contrast-Induced Nephropathy in Patients With Acute Myocardial Infarction: RACCOON-AMI Registry

A Comparative Study for Iohexol and Ioversol Effects on Renal Function in Patients with Coronary Artery Intervention Treatment

&amp;lt;i&amp;gt;Objective: &amp;lt;/i&amp;gt;To compare the effects of iohexol and ioversol on the incidence of contrast induced nephropathy (CIN) and renal function in patients who received percutaneous coronary intervention (PCI); to investigate the related risk factors of CIN in patients after PCI; to evaluate the preventative effect of different dose of atorvastatin on the incidence of CIN in the patients after PCI. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;140 patients who received PCI were chosen as research subjects in the Third People&amp;apos;s Hospital of Mianyang from June 2013 to March 2015, which were randomly divided into iohexol group and ioversol group (74 cases for iohexol group, 66 cases for ioversol group). It was recorded that the patients’ general condition, blood routine test, urine examination, renal function, etc before and after PCI. And it was observed after PCI that the dosage of contrast material, the numbers of damaged coronary artery and implanting stent, the exposure time of contrast material, etc. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;The incidences of CIN for iohexol and ioversol were not significantly different (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05). The differences between the two groups in the Serum creatinine (Scr), blood urea nitrogen (BUN), glomerular filtration rate (GFR), urine β2- microglobulin (β2-MG), and cystatin C (Cys C) before and after PCI were not obvious (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05) ; the changes of Scr, β&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;-MG, CysC, GFR of the patients before and after PCI in the two groups were significant (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;&amp;lt;0.05), but the change of BUN was not significant (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05).Through multiple regression analysis, it was found that type 2 diabetes (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt; = 9.560, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.001), two coronary artery implanting stents (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt; = 6.252, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.044), three and above coronary artery implanting stents (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt;=12.499, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.009) were independent risk factors of CIN. It was not significantly different that the effects of 20mg atorvastatin and 40mg atorvastatin on the incidence of CIN, Scr and GFR (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;&amp;gt;0.05). &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; There are no significant differences in the incidence of CIN and renal function for PCI patients with ioversol or iohexol. Moreover, diabetes and two or more coronary artery implanting stents are independent risk factors for CIN in PCI patients. It doesn’t show any benefits for PCI patients to take the large dose of atorvastatin to prevent CIN before operation.

The Agatston score is a predictor of contrast-induced nephropathy in patients with stable coronary artery disease after percutaneous coronary intervention.

Agatston coronary artery calcium (CAC) scoring is the primary scoring method used to determine the summed value of calcium burden. The Agatston CAC score method is a non-invasive, rapid, easily accessible tool that helps identify the weighted sum of the calcium burden in arteries using multi-detector computed tomography. The Agatston CAC score is a significant prognostic indicator for vascular diseases in the long term. To investigate the relationship between the Agatston CAC score and contrast-induced acute kidney injury (C-AKI) in patients with stable coronary artery disease (CAD) following a percutaneous coronary intervention (PCI). This retrospective study included 360 patients with stable CAD who received PCI between January 2023 and December 2023. The Agatston score was measured non-invasively on computed tomography before the coronary angiography. Receiver operating characteristics (ROC) curve analysis was used to determine the sensitivity and specificity of the Agatston CAC score and the optimal cutoff value for predicting C-AKI. The 360 patients included in the study were divided into two groups. 71 patients were classified as C-AKI+ while 289 patients were classified as C-AKI-. There was no significant difference in terms of gender, but the C-AKI+ group was significantly older. The C-AKI+ group was observed to have significantly higher levels of uric acid, Agatston score and Mehran score. Regression analyses showed that age, uric acid, Agatston score and Mehran score were independent risk factors for C-AKI. The Agatston CAC score was found to be an independent risk factor for C-AKI in patients with stable CAD with PCI.

Preventive effects of nitric oxide donors in contrast-induced nephropathy in patients undergoing coronary artery angiography: an updated systematic review and meta-analysis of 13 randomized controlled trials.

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the preventive effects of nitric oxide (NO) donors in CIN patients undergoing CAG/PCI. We conducted a comprehensive systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 5th, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). Our analysis included 13 RCTs encompassing 3,550 patients. NO donors were significantly associated with a decreased incidence of CIN compared to placebo either as an oral administration (RR: 0.33 with 95% CI [0.26, 0.42], P < 0.01) or IV infusions (RR: 0.56 with 95% CI [0.40, 0.78], P < 0.01). Moreover, NO donors were significantly associated with decreased serum creatinine levels compared to placebo either as an oral administration (MD: - 0.07 with 95% CI [- 0.10, - 0.04], P < 0.01) or IV infusions (MD: - 0.07 with 95% CI [- 0.09, - 0.04], P < 0.01). In terms of safety, NO donors were significantly associated with a decreased incidence of major adverse cardiac events (MACE) compared to placebo as an oral administration (RR: 0.64 with 95% CI [0.45, 0.89], P < 0.01). However, there was no significant difference between NO donors as IV infusions and placebo in MACE (RR: 0.68 with 95% CI [0.38, 1.21], P = 0.18). Finally, NO donors were significantly associated with a decreased incidence of all-cause mortality compared to placebo as an oral administration (RR: 0.58 with 95% CI [0.36, 0.94], P = 0.03). Nevertheless, there was no statistically significant difference in all-cause mortality between IV infusions of NO donors and placebo (RR: 1.84 with 95% CI [0.40, 8.52], P = 0.44). NO donors as adjunct therapy are associated with reduced incidence of CIN and decreased serum creatinine levels, either as an oral or IV administration. They were also associated with reduced incidence of MACE, all-cause mortality, and recurrent myocardial infarction as an oral administration, which makes this simple, low-cost intervention an important therapeutic option in patients undergoing CAG/PCI.

Machine learning algorithms using the inflammatory prognostic index for contrast-induced nephropathy in NSTEMI patients.

Aim: Inflammatory prognostic index (IPI), has been shown to be related with poor outcomes in cancer patients. We aimed to investigate the predictive role of IPI for contrast-induced nephropathy (CIN) development in non-ST segment elevation myocardial infarction patients using a nomogram and performing machine learning (ML) algorithms.Materials & methods: A total of 178 patients with CIN (+) and 1511 with CIN (-) were included.Results: CIN (+) patients had higher IPI levels, and IPI was independently associated with CIN. A risk prediction nomogram including IPI had a higher predictive ability and good calibration. Naive Bayes and k-nearest neighbors were the best ML algorithms for the prediction of CIN patients.Conclusion: IPI might be used as an easily obtainable marker for CIN prediction using ML algorithms.

The Incidence of Contrast-Induced Nephropathy in Patients on Sodium-Glucose Cotransporter-2 Inhibitors Following Percutaneous Coronary Intervention: An Observational Analysis.

The purpose of this study is to compare the incidence of contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) in patients on sodium-glucose cotransporter-2 (SGLT-2) inhibitors prior to the procedure with a matched cohort of patients not receiving sodium-glucose cotransporter-2 inhibitor therapy. In this retrospective observational study, patients were eligible for inclusion if they underwent PCI at any of the included study centers within the study time period. Patients were assigned to either the SGLT-2 inhibitor group or control group depending on the documentation of receiving any SGLT-2 inhibitors within 24h prior to PCI. Propensity matching was utilized to determine the final subjects to include for comparison. The primary outcome was the incidence of CIN. A total of 192 patients (96 in each group) were matched after exclusion criteria were applied. The incidence of contrast-induced nephropathy was similar between groups, occurring in 8 (8.3%) patients in the SGLT-2 inhibitor group and 6 (6.3%) patients in the comparator group (p = 0.58). There was also no difference between groups in the change in serum creatinine following PCI. Based on our analysis, we did not identify any risk of CIN associated with SGLT-2 inhibitor use prior to PCI. Based on these results and in conjunction with previously published literature, the use of SGLT-2 inhibitors appears safe prior to PCI. These results still warrant further investigation with prospective adequately powered studies to evaluate the incidence of CIN with SGLT-2 inhibitor use in the setting of PCI.

The use of allopurinol in prophylaxis against contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Abstract Background Contrast-induced nephropathy (CIN) is a serious complication after percutaneous coronary intervention (PCI). Inflammation and development of reactive oxygen species are among the postulated mechanisms of CIN. Allopurinol with anti-inflammatory action could be a preventive method of CI-AKI. Aim of the work To determine the effect of adding allopurinol to hydration in the prevention of CIN in patients undergoing PCI, with or without hyperuricemia. Methods One hundred and seven patients with moderate to high Mehran score undergoing elective PCI were randomly allocated to the allopurinol (n=52) or the control group (n=55). Those in the allopurinol group (hyperuricemic n=25, and normouricemic n= 27) received allopurinol 300 mg one day and one hour before PCI beside intravenous hydration (1 ml/kg/hour) normal saline, a maximum of 100 ml/hour for 12 hours pre and post coronary angiography. Patients in the control group (hyperuricemic n=26 and normouricemic n=29), received the same intravenous hydration only. Serum creatinine and urea were measured before and 48 hours after the procedure while the uric acid level was measured before the procedure only. CIN was defined by a percentage increase in serum creatinine of ≥25% or absolute serum creatinine ≥0.5 mg/dl, 48 hours after PCI. Results The mean age of the studied patients was 59.6 ± 9.1 years old, 59% were male. No difference between both groups regarding baseline characteristics or medications. Average Mehran score was 9.0 ± 1.2. CIN was observed in 5 patients in the allopurinol group (9.6%) and 15 patients in the control group (27.3%) (P = 0.017). There was no significant difference between both groups regarding the contrast volume (179.8 ± 68.1 vs. 153.8 ± 57.9 ml, p: 0.052). Hyperuricemia had no significant effect on increasing the incidence of CI-AKI either in patients with or without CKD (p=0.964). Conclusion Allopurinol on the top of hydration was found to decrease the incidence of CIN following PCI in patients with moderate to high Mehran score for CIN. The anti-inflammatory action of allopurinol could be the mechanism of this favorable effect, as baseline uric acid didn't affect the results. Further multi-center study with a larger sample size is needed to offer more definite results.

INCIDENCE OF CONTRAST-INDUCED NEPHROPATHY FOLLOWING CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION

Contrast-induced nephropathy (CIN) is a potentially serious complication following percutaneous coronary intervention (PCI), particularly in patients with chronic total occlusion (CTO). It is characterized by an acute deterioration in renal function after exposure to contrast media. CIN is associated with increased morbidity, hospital stays, and long-term renal outcomes, making it crucial to identify and mitigate its incidence. This study aimed to evaluate the incidence of CIN in patients undergoing CTO-PCI and its associated complications. Objective: To assess the incidence of contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) and evaluate in-hospital complications, hospital stay duration, and short-term mortality. Methods: This cross-sectional study was conducted with ethical approval at a tertiary care hospital, including 118 patients who underwent PCI for CTO at the Department of Cardiology, Lady Reading Hospital Peshawar, Pakistan from 10th June 2023 to 09th June 2024. Standardized pre- and post-procedural hydration protocols were implemented to reduce the risk of CIN, and non-ionic, iso-osmolar contrast agents were used. CIN was defined as a 25% increase in serum creatinine or an absolute increase of ≥0.5 mg/dL within 48–72 hours post-procedure. Data on demographic characteristics, complications, and mortality were collected and analyzed using SPSS Version 25, with categorical variables expressed as percentages and continuous variables as means. Chi-square tests were used to assess statistical significance, with P-values &lt; 0.05 considered significant. Results: Of the 118 patients included, the mean age was 56.34 years, and 52.5% were male. Age distribution showed that 43.2% were between 51-60 years, while 33.1% were between 61-70 years. CIN was observed in 6.8% of patients, with 9.7% of males and 3.6% of females affected (P=0.188). In-hospital complications included arrhythmias in 4.2% of patients, heart failure in 0.8%, and mortality in 0.8%. Hospital stay averaged 5.94 days, with no significant differences in CIN incidence across age groups (P=0.186). Conclusion: The incidence of contrast-induced nephropathy following PCI for chronic total occlusion is a clinically significant issue, affecting 6.8% of patients despite preventative measures. This emphasizes the need for ongoing risk assessment, monitoring, and the implementation of effective prevention strategies. Further research is warranted to refine risk stratification tools and develop targeted interventions to minimize CIN incidence, particularly in high-risk patient populations.

Reduction in the risk of contrast-induced nephropathy using enhanced external counter-pulsation in patients with chronic kidney disease

Objective To evaluate the efficacy of EECP in the prevention of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). Methods A prospective trial was undertaken in the participants. A total of 280 patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 who underwent percutaneous coronary artery procedures were enrolled and divided into two groups: the control group (n = 100) and the EECP group (n = 180). All patients received extracellular fluid volume expansion therapy with 0.9% normal saline, and patients in the EECP groups were also treated with EECP. The renal function indexes of the two groups were determined 48–72 h after coronary artery procedures. Results In the EECP group, the BUN and serum creatinine (Scr) after coronary artery procedures were significantly lower than those before coronary artery procedures (BUN: 8.4 ± 3.5 vs. 6.6 ± 2.7 mmol/L, p < 0.001; Scr: 151.9 ± 44.7 vs. 144.5 ± 48.3 μmol/L, p < 0.001), while the eGFR was significantly increased (43.6 ± 11.4 vs. 47.1 ± 13.9 ml/min/1.73 m2, p < 0.001). The degree of Scr elevation was lower in the EECP group than in the control group (12.4 ± 15.0 vs. 20.9 ± 24.8 μmol/L, p = 0.026). Additionally, the EECP group had a lower incidence of post-procedures Scr elevation than the control group (36.5 vs. 48.0%, p = 0.042), a higher incidence of post-procedures eGFR elevation (62.2 vs. 48.0%, p = 0.021), and a lower risk of CIN (1.1 vs. 6.0%, p = 0.019). Conclusion EECP therapy has a protective effect on renal function and can reduce the risk of CIN in patients with CKD.

Prognostic value of nutrition for contrast-induced nephropathy in patients undergoing peripheral vascular intervention.

Background: The objective was to examine the predictive value of malnutrition, assessed via the Controlling Nutritional status (CONUT) and Prognostic Nutrition Index (PNI) scores, in the development of contrast-associated acute kidney injury (CA-AKI) following peripheral vascular intervention (PVI).Methods: This retrospective cross-sectional observational study included the enrollment of 243 consecutive patients who underwent PVI. Patients were categorized into two groups based on the occurrence of CA-AKI.Results: Patients with CA-AKI had lower PNI scores and the PNI score was an independent predictor of CA-AKI development (Odds Ratio: 0.518, 95% CI: 2.295-0.908, p=0.021). Nomogram had higher discriminative ability than both PNI and CONUT scores and discriminative abilities were similar for PNI and CONUT scores.Conclusion: Malnutrition, as identified by the CONUT and PNI, was found to be associated with a high risk of CA-AKI development following PVI.

Relationship Between Modified Systemic Immune- inflammatory Index and Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction

Objective: Developing contrast induced nephropathy after primary PCI in patients with ST segment elevation myocardial infarction is a risky condition in terms of mortality and morbidity. Various studies have shown that the systemic inflammatory index predicts (SII) the development of CIN. Mean platelet volume (MPV) is an important indicator known to be associated with the platelet function and activation. Therefore, we revised SII and named it modified SII (mSII) by using NLR multiply MPV. Materials and Methods: This study includes patients who underwent pPCI due to STEMI in our cardiology department between February 2015 and February 2021. Modified SII was obtained by using MPV instead of platelet in the formula (mSII= NLR x MPV). Patients who underwent pPCI with STEMI were divided into two groups, those with CIN and those without CIN, and compared. Results: In the logistic regression analysis, it was observed that the mSII, NLR, GFR and contrast medium amount was independent predictor of CIN. The optimal threshold mSII for predicting CIN was &gt;42.5, with a 78.1% sensitivity and 52.3% specificity ([AUC]: 0.639, 95%CI: 0.602- 0.674, p&lt; 0.001). Pairwise comparison of ROC curves, it was observed that the predictive value of mSII for the development of CIN was better than NLR. (z-test = 3.144, P = 0.001) Conclusion: We think that mSII, which we have shown to be superior to SII in predicting the development of CIN and is very easy to calculate, is a parameter that can be considered in predicting the development of CIN after pPCI in STEMI patients.

Predictive value of combining urinary N-acetyl-β-D-glucosaminidase and serum homocysteine for contrast-induced nephropathy in patients after percutaneous coronary intervention.

Contrast-induced nephropathy (CIN) can lead to serious complications following percutaneous coronary intervention (PCI). Urine N-Acetyl-β-D-glucosaminidase (uNAG) and serum homocysteine (sHCY) are both potential predictors for CIN detection, but their combination has not been explored. We aimed to combine uNAG and sHCY as predictors for the early detection of CIN and for prognosis prediction in patients after PCI. A total of 232 consecutive patients who underwent PCI at a university hospital were recruited for this study. According to the European Society of Urology and Reproduction (ESUR) criterion, CIN is defined as an elevation of serum creatinine (sCr) by ≥25% or ≥0.5 mg/dl from baseline within 48 h. We assessed the use of individual biomarkers (uNAG and sHCY) measured around PCI and their combinations for CIN detection and prognosis prediction. Receiver operating characteristic curves (ROC) and area under the curve (AUC) were used to evaluate the predictive efficiency of potential predictors. In total, 54 (23.28%) patients developed CIN. Concentrations of uNAG and sHCY increased significantly in CIN subjects (p < 0.05) than non-CIN. CIN could be predicted by uNAG and sHCY but not by creatinine at an early stage. At pre-PCI, 0, 12, 24, and 48 h after PCI, the AUC-ROC value of uNAG in calculating total CIN was 0.594, 0.603, 0.685, 0.657, and 0.648, respectively. The AUC-ROC value of sHCY in calculating total CIN was 0.685, 0.726, 0.771, 0.755, and 0.821, respectively. The panel of uNAG plus sHCY detected CIN with significantly higher accuracy than either individual biomarker alone and earlier than sCr. For detecting total CIN, this panel yielded AUC-ROCs of 0.693, 0.754, 0.826, 0.796, and 0.844 at pre-PCI, 0, 12, 24, and 48 h after PCI, respectively, which were superior to those of the individual biomarkers. For predicting the incidence of major adverse cardiovascular events (MACE) within 30 days to 12 months, the AUC-ROC values for uNAG and sHCY measured before discharge were 0.637 and 0.826, respectively. The combined panel yielded an AUC-ROC of 0.832. The combined detection did not significantly enhance the predictive capability for MACE in patients with CIN. The CIN group and the non-CIN group showed no significant difference in the Coronary Heart Disease Intensive Care Unit (CCU) stay time, hospital stay time, demand for renal replacement therapy, CCU mortality rate, and in-hospital mortality rate. The uNAG and sHCY panel demonstrated better sensitivity and specificity for predicting the diagnosis and prognosis of CIN in patients after PCI, earlier than sCr. The combination of these biomarkers revealed a significantly superior discriminative performance for CIN detection and prognosis compared to using uNAG or sHCY alone.

Contrast-induced nephropathy: nursing interventions - a scoping review

Abstract Introduction Contrast-induced nephropathy (CIN) refers to a reduction in renal function following contrast administration, excluding other causes. It is characterized by na increase in creatinine levels of 0.5mg/dl or greater, or a 25% increase over baseline creatinine, occurring 48 to 72 hours post-contrast administration and lasting for 2 to 5 days (Santos et al., 2011). Antunes et al. (2013) refers that the CIN is the 3rd cause of acute renal insufficiency (ARI) and that CIN may develop in up to 55% of patients who receive contrast exposure during coronary angiography and of these may result in 12,6% requiring dialysis among high-risk groups following percutaneous coronary intervention (PCI) (Wu et al., 2022). Objective This review aims to map the available evidence regarding nursing interventions to prevent contrast-induced nephropathy in patients undergoing PCI. Methods The review follows the methodology proposed by the Joanna Briggs Institute guided by the PCC (Population, Concept, Context) strategy. Were identified 44 articles by MEDLINE Complete (via PubMed), CINAHL Complete (via EBSCO) e SciELO, and analyzed/ selected through PRISMA Scr flowchart. Four articles were included. Results These articles revealed that the incidence of CIN varies based on risk factors such as age, hypertension, and pre-existing chronic kidney disease. As there is no specific treatment for contrast-induced nephropathy, prevention strategies are essential. Nursing professionals have a significant and privileged role in the pre-, intra-, and post-procedural phases, and thus, are best positioned to implement prevention strategies for CIN. In general, hospitals that implemented improvement interventions reduced CIN by 21% compared to the pre-intervention phase. Compared to patients with pre-existing CKD, the reduction was 28% (Lambert et al., 2017). Teams also report important successes in implementing improvements, such as changing behavior with greater awareness of CIN prevention strategies, implementing the hydration protocol, standardizing medical prescriptions and minimizing the volume of contrast administered. Conclusions Nursing plays a crucial and privileged role in preventing CIN. Key interventions involve conducting a thorough initial assessment to identify individuals at risk for CIN (considering factors such as age, comorbidities, nephrotoxic medication, and dehydration). Pioli et al. (2023) found that oral hydration can be effective in the process of preventing CIN, before and after elective percutaneous procedures. It concluded that the oral hydration protocol carried out by nurses proved to be as effective as the hospital intravenous hydration protocol in protecting the kidneys of individuals at risk of developing CIN associated with elective coronary interventions (Picture 1). By implementing these strategies, nursing professionals can effectively contribute to reducing the incidence of contrast-induced nephropathy in patients undergoing PCI.

Predictive value of inflammatory prognostic index for contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention

The purpose of this study was to investigate the relationship between Inflammatory Prognostic Index (IPI) levels and Contrast-Induced Nephropathy (CIN) risk and postoperative clinical outcomes in patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). A total of 3,340 consecutive patients who underwent CAG and/or PCI between May 2017 and December 2022 were enrolled in this study. Based on their baseline IPI levels, patients were categorized into four groups. Clinical characteristics and postoperative outcomes were compared among these groups. In-hospital outcomes focused on CIN risk, repeated revascularization, major bleeding, and major adverse cardiovascular events (MACEs), while the long-term outcome examined the all-cause readmission rate. Quartile analysis found a significant link between IPI levels and CIN risk, notably in the highest quartile (P < 0.001). Even after adjusting for baseline factors, this association remained significant, with an adjusted Odds Ratio (aOR) of 2.33 (95%CI 1.50–3.64; P = 0.001). Notably, baseline IPI level emerged as an independent predictor of severe arrhythmia, with aOR of 0.50 (95%CI 0.35–0.69; P < 0.001), particularly driven by the highest quartile. Furthermore, a significant correlation between IPI and acute myocardial infarction was observed (P < 0.001), which remained significant post-adjustment. For patients undergoing CAG and/or PCI, baseline IPI levels can independently predict clinical prognosis. As a comprehensive inflammation indicator, IPI effectively identifies high-risk patients post-procedure. This study underscores IPI's potential to assist medical professionals in making more precise clinical decisions, ultimately reducing mortality and readmission rates linked to cardiovascular disease (CVD).

Contrast-induced Nephropathy: Incidence and Reversibility in Patients Undergoing High-risk Percutaneous Coronary Intervention

Abstract Introduction: There is a paucity of data regarding contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) from this part of the world. The present study was thus planned to find the incidence and reversibility of CIN in patients undergoing high-risk PCI. Materials and Methods: A hospital-based observational study was conducted at the department of cardiology in a tertiary care hospital. The study included 50 consecutive cases undergoing high-risk PCI at the cardiac catheterization laboratory. CIN is characterized as either a relative increase in serum creatinine (S. Cr) of 25% or more or an absolute increase of 0.5 mg/dL or more, occurring within 48 h of exposure to contrast media. This is under the assumption that there are no other factors contributing to the increase in S. Cr. Results: The incidence of CIN in cases undergoing high-risk percutaneous interventions was 18% in the present study. On regression analysis, age above 70 years, hypertension and diabetes were identified as significant predictors of the development of CIN in patients undergoing cardiac procedures in the cardiac catheterization laboratory (P &lt; 0.01). All the cases of CIN had a self-limiting course, and none of the cases required renal replacement therapy. Conclusion: CIN affects one out of every five to six cases undergoing high-risk PCI; however, almost all cases are reversible. Patients with preexisting comorbidities such as diabetes and hypertension have a significantly increased risk of development of CIN.

#731 The role of diabetes mellitus in the development of contrast-induced nephropathy in patients during x-ray endovascular procedures

Abstract Background and Aims To identify the role of diabetes mellitus in the development of contrast-induced nephropathy (CIN) in patients during X-ray endovascular procedures (REP). Method The study included 150 patients with coronary artery disease who underwent X-ray endovascular procedures (REP) using the contrast agent unihexone. The mean age of the patients was 55.69±1.27 years, including 83 men and 67 women, which accounted for 55.3% and 44.7% of the total number of patients, respectively. Diabetes mellitus was detected in 73 patients (49%). To isolate patients whose REP in the postoperative period was complicated by CIN on days 1, 2, 3, 5, 7, and 10, dynamic determination of serum creatinine concentration was carried out with glomerular filtration rate calculation. According to the results, all patients were divided into 2 groups: patients with uncomplicated postoperative REP (CIN- group, 99 patients, 66%) and patients who developed contrast-induced nephropathy (CIN+ group, 51 patients, 34%). As a control group, 20 healthy volunteers were examined. The validity of intergroup comparisons was carried out using the Student's test for paired and unpaired differences. Results In the course of the study, it was revealed that in the group of patients who developed CIN, there were significantly more people who developed CIN against the background of type II diabetes mellitus (p &amp;lt; 0.05), which is probably explained by their tendency to develop diabetic microangiopathy, one of the variants of which is nephropathy. The study of glycemic features in patients with CIN included in the study demonstrated that among patients with diabetes who developed CIN, the level of glycemia was significantly higher than in patients with uncomplicated course of REP (p &amp;lt; 0.05 for fasting and p &amp;lt; 0.001 for postprandial glycemia), that is, the higher level of glycemia in patients with CIN of the CINgroup is explained not only by the large number of patients with diabetes, but also by the large number of patients with diabetes. but also its less control. In parallel with higher glycemia, patients with diabetes of the CIN+ group were also distinguished by more pronounced uricemia (p &amp;lt; 0.01). The increased relative density of urine in patients with diabetes of the CIN+ group compared to patients with CI- (p &amp;lt; 0.05) is explained by the osmotic effect of glycosuria. Conclusion Thus, the presence of background DM, and especially its decompensation, is a risk factor for the development of CIN after REP.

#951 Structural and functional indicators of the left heart in the aspect of contrast-induced nephropathy

Abstract Background and Aims To study the structural and functional features of the left heart in patients with coronary artery disease depending on the development of contrast-induced nephropathy (CIN) against the background of radiopaque endovascular procedures (REP). Method The study included 303 patients with stable forms of coronary artery disease who underwent X-ray endovascular procedures (REP). Patients with eGFR, determined by serum creatinine concentration, less than 60 ml/minute were not included in the study. 20 healthy volunteers were examined as a control group. All patients were divided into 2 groups - patients with an uncomplicated postoperative period of REP (CIN- group, 206 patients, 67.99%) and patients who developed contrast-induced nephropathy (CIN+ group, 97 patients, 32.01%). Subsequently, the CIN+ and CIN- groups were retrospectively compared based on baseline echocardiographic parameters. Results The present study demonstrated that EchoCG predictors of CIN in patients with stable forms of coronary artery disease are dilatation of the left ventricular (LV) cavity more than 136 ml (relative risk 1.65, p &amp;lt; 0.01), an increase in the index of impaired regional contractility of the LV to 1.2 points or higher (relative risk 1.77, p &amp;lt; 0.01) and a decrease in the e/a ratio of tissue Dopplerogram of the lateral edge of the mitral annulus to 0.7 relative units or less (relative risk 1.59, p &amp;lt; 0.01). Conclusion In patients with coronary artery disease after REP, despite the improvement in the index of impaired regional contractility and the index of LV sphericity, in the CIN+ group there is a more significant deterioration in the structural and functional properties of the LV myocardium, which manifested itself in an increase in systolic myocardial stress, a decrease in ejection fraction and an increase in the degree of diastolic dysfunction, which indicates a toxic effect of the radiocontrast drug not only on the kidneys, but also on the myocardium.

#980 Lipid spectrum in patients with coronary artery disease with contrast-induced nephropathy during X-ray endovascular procedures

Abstract Background and Aims Study of the main indicators of the lipid spectrum in patients with coronary artery disease with contrast-induced nephropathy (CIN), which developed during X-ray endovascular procedures (ERP). Method The study included 303 patients with stable forms of coronary artery disease who underwent X-ray endovascular procedures (REP). The average age of the patients was 53.79 ± 1.27 years. Based on the results, all patients were divided into 2 groups - patients with an uncomplicated postoperative period of REP (CIN− group, 206 patients, 67.99%) and patients who developed contrast-induced nephropathy (CIN+ group, 97 patients, 32.01%). Kidney filtration function was assessed by the clearance of endogenous cystatin C with calculation of the glomerular filtration rate (eGFRcys=90.63 × cystatin C – 1.192). Three fractions of lipoproteins were selected as indicators of the lipid spectrum: cholesterol containing LDL and HDL, as an anti-atherogenic factor, and VLDL, the main triglyceride-containing fraction. Results It was found that in patients in the CIN+ group, the LDL level was significantly higher than that characteristic of the CIN− group (p&amp;lt;0.001) and CG (p&amp;lt;0.001). At the same time, in the CIN− and CG groups, the LDL concentration was comparable, despite the use of statins in the groups of patients with coronary artery disease. The concentration of the second studied atherogenic fraction, VLDL, was also increased in patients with IHD compared with the CG (p&amp;lt;0.001 compared with both groups of patients with IHD) with a maximum increase in patients of the CIN+ group (p&amp;lt;0.01 significance of the difference between the CIN+ and KIN−). The concentration of the antiatherogenic fraction of the lipid spectrum—HDL—was significantly and comparable reduced in both groups of patients with coronary artery disease (p&amp;lt;0.001 when comparing both groups of patients with CG). Conclusion In the course of this study, it was found that one of the risk factors for the development of CIN in patients with coronary artery disease after REP is an increased concentration of atherogenic lipoproteins in the peripheral blood. A decrease in the level of anti-atherogenic HDL in the present study was not associated with the risk of developing CIN, but serves as a marker of impaired glomerular function kidney.