Contrast-induced Nephropathy In Patients Research Articles

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 < 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.

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).

#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.

Anisodamine for the prevention of contrast-induced nephropathy in patients with acute coronary syndrome: a pilot systematic review and meta-analysis of randomized controlled trials.

Contrast-induced nephropathy (CIN) is a common post-procedural complication of percutaneous coronary intervention for acute myocardial infarction (AMI). Anisodamine hydrobromide is an alkaloid that has demonstrated efficacy in improving microcirculation. This meta-analysis aims to evaluate the reno-protective effects of Anisodamine in patients undergoing percutaneous coronary intervention (PCI) for AMI. PubMed, Embase, Cochrane Library, Scopus, and clinicaltrials.gov were searched from inception to January 2024 for randomized controlled trials (RCTs) comparing the efficacy of Anisodamine in preventing the development of CIN. Outcomes of interest included the incidence of CIN, serum creatinine levels, and estimated glomerular filtration rate (eGFR). A random-effects model was used for pooling standard mean differences (SMDs) and odds ratios (ORs) with a 95% CI. Statistical significance was considered at a P less than 0.05. Three RCTs involving 563 patients were included. Anisodamine was associated with a reduction in the incidence of CIN [OR: 0.44; 95% CI: 0.28, 0.69; P=0.0003], a reduction in serum creatinine levels at 48 [SMD: -6.78; 95% CI: -10.54,-3.02; P=0.0004] and 72 h [SMD: -6.74; 95% CI: -13.33,-0.15; P=0.03], and a higher eGFR at 24 [SMD: 5.77; 95% CI: 0.39, 11.14; P=0.03], and 48 h [SMD: 4.70; 95% CI: 2.03,7.38; P=0.0006]. The levels of serum creatinine at 24 h and eGFR value at 72 h were comparable between both groups. Anisodamine has demonstrated clinical efficacy in ameliorating the development of CIN post-PCI in AMI patients. Large, multi-centric RCTs are warranted to evaluate the robustness of these findings.

Association between Systolic Pulmonary Artery Pressure and Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction.

The objective of this study was to examine whether there is an elevated risk of developing contrast induced nephropathy (CIN) in patients with high systolic pulmonary artery pressure (SPAP) in ST-segment elevation myocardial infarction (STEMI). A total of 213 patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention were enrolled in the study. The patients were stratified into two groups based on the presence of CIN. Comparisons between these groups included an assessment of demographic characteristics, laboratory findings, and risk factors. SPAP was calculated for each patient upon admission through echocardiography, and subsequent comparisons were performed between the groups. The distribution of the study population was as follows: 33 (15.5%) were CIN(+) and 180 (84.5%) were CIN(-). SPAP [odds ratio (OR) = 1.295, 95% confidence interval (CI): 1.157-1.451, p < 0.001], and diabetes (OR = 1.241, 95% CI: 1.194-1.287, p = 0.013) were identified as independent factors associated with CIN development. In receiver operating characteristic curve analysis, SPAP above a cut-off level of 31.5 mmHg could determine the presence of CIN with a sensitivity of 91.0% and specificity of 90.0% (p < 0.001). SPAP on echocardiography is an independent predictor of the development of CIN in patients with STEMI. Its ease of calculation renders it a valuable tool for predicting CIN among STEMI patients.

A comparison between rosuvastatin and trimetazidine in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization

A comparison between rosuvastatin and trimetazidine in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization

Efficacy of Trimetazidine in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Contrast Coronary Intervention: A Systematic Review and Meta-Analysis (PRISMA).

Objective: The present systematic review assessed the efficacy of peri-procedurally administered trimetazidine in the prevention of contrast-induced nephropathy (CIN) in patients undergoing coronary interventions with contrast agents. Methods: We performed a systematic literature review of articles published in PubMed and Google Scholar by 7 December 2023 and included articles from the last 15 years that evaluated the efficacy of trimetazidine in preventing CIN in cardiac patients undergoing coronary intervention. Results: After title/abstract and full-text screening, this systematic review included 9 randomized controlled trials (N = 2158 patients) with two groups: Trimetazidine (60-70 mg/day 24 to 48 h before and up to 72 h after the procedure) with hydration and the control group with only hydration. A total of 234/2158 patients developed CIN (Incidence rate [IR], 10.8%) as per the CIN definition of the Contrast Media Safety Committee of the European Society of Urogenital Radiology. The incidence of CIN in the trimetazidine vs. control group was 6.4% (69/1083) vs. 15.4% (165/1075), and the odds ratio (95% CI) was 0.3753 (0.279-0.504). Conclusions: In conclusion, the trimetazidine group had a lower incidence of CIN. Trimetazidine offers a reno-protective effect and helps in reducing the CIN incidence in patients undergoing cardiac intervention. Peri-procedure administration of trimetazidine significantly decreases the risk of CIN in patients despite comorbidities.

Contrast-Free Endovascular Aneurysm Repair Combined With Fibrin Sealant Filling for Treating Abdominal Aortic Aneurysm: Technical Note.

Endovascular aneurysm repair using iodinated contrast agents risks contrast-induced nephropathy, especially in high-risk patients. This technical note describes a contrast-free endovascular aneurysm repair (EVAR) protocol using preoperative imaging measurement and fibrin sealant (FS) filling. Preoperative imaging measurement and intraoperative guidewire manipulation facilitated anatomical identification without contrast. After endograft deployment, the aneurysm sac was filled with FS if endoleak was indicated by pressure fluctuations. Between 2017 and 2020, 6 high-risk patients underwent contrast-free EVAR with FS filling. Complete exclusion was achieved in all cases. Over follow-up, no endoleaks, deterioration in renal function, or other complications were observed. Contrast-free EVAR with FS filling shows early feasibility as an alternative technique for contrast-induced nephropathy (CIN) high-risk patients, while larger studies with long-term monitoring are imperative to validate outcomes. This study showcases a contrast-free EVAR technique with fibrin sealant filling for high-risk CIN patients. It offers a safer approach for those with renal challenges, reducing CIN risk. The technique's feasibility in a small cohort suggests its utility in treating AAA without iodinated contrast, crucial for patients with specific health risks. For clinicians, it introduces a method that decreases nephrotoxic risks, potentially changing practice for vulnerable patients.

Contrast-enhanced Computed Tomography Examinations: Discussion of Hydration Protocols for Patients with Altered Creatinine Levels

Computed Tomography (CT) is an imaging diagnostic method that enables the visualization of internal structures in the human body, allowing for the detection of various pathologies that may affect individuals. This examination can be performed with or without contrast, which can be administered orally or intravenously. Patients with altered creatinine due to renal dysfunction may encounter difficulties in eliminating this intravenous contrast through the renal route, requiring a hydration protocol to facilitate the safe and effective completion of the examination. Considering the significance of CT in disease diagnosis, this study aims to analyze hydration protocols used in patients with altered creatinine during the performance of intravenous contrast-enhanced computed tomography. This study is an integrative literature review, where searches were conducted in databases such as PubMed/MEDLINE, BVS (Virtual Health Library), and ScienceDirect, in order to identify and list articles and research studies discussing the aforementioned subject, published between the years 2013 and 2017. The study revealed that both oral and intravenous hydration demonstrate similar efficacy in preventing contrast-induced nephropathy in patients with renal dysfunction, as detected through alterations in serum creatinine. Based on the findings, it is concluded that there is a need to continually advance research efforts to enable a growing number of patients with renal dysfunction to undergo intravenous contrast-enhanced computed tomography safely and effectively, thus enabling early diagnosis of diseases, as well as monitoring pre-existing conditions.

Abstract No. 538 Trimetazidine Reduces Contrast-Induced Nephropathy in Patients with Renal Insufficiency Undergoing Angiography and Angioplasty: A Systematic Review and Meta-Analysis (PRISMA)

Abstract No. 538 Trimetazidine Reduces Contrast-Induced Nephropathy in Patients with Renal Insufficiency Undergoing Angiography and Angioplasty: A Systematic Review and Meta-Analysis (PRISMA)

Efficacy of nicorandil and ranolazine in prevention of contrast-induced nephropathy in patients with mild-to-moderate renal dysfunction: a randomized controlled trial.

Contrast-induced nephropathy (CIN) is a common complication after percutaneous coronary intervention (PCI). There is conflicting evidence regarding efficacy of nicorandil in CIN prevention. With respect to ranolazine, there is physiological possibility as well as data in animal study regarding its protective effect against CIN; there is, however, no human data till date. To assess the efficacy of nicorandil and ranolazine in preventing CIN. The secondary endpoint was to measure difference in postprocedure acute kidney injury (AKI) incidence across groups. Also, patients were followed up till 6 months for major adverse events. This single-center randomized controlled study included 315 patients of coronary artery disease with mild-to-moderate renal dysfunction undergoing elective PCI. Eligible patients were assigned to either nicorandil (n = 105), ranolazine (n = 105) or control group (n = 105) in 1 : 1 : 1 ratio by block randomization. All enrolled patients were given intravenous sodium chloride at rate of 1.0 mL/kg/h (0.5 mL/kg/h for patients with left ventricular ejection fraction <45%) from 6 h before procedure till 12 h after procedure. Iso-osmolar contrast agent (iodixanol) was used for all patients. In addition to hydration, patients in nicorandil group received oral nicorandil (10 mg, 3 times/d) and those in ranolazine group received oral ranolazine (1000 mg, 2 times/d) 1 day before procedure and for 2 days after PCI. Patients in control group received only hydration. Total number of CIN was 34 (10.7%), which included 19 (18.1%) in control, 8 (7.6%) in nicorandil and 7 (6.6%) in ranolazine group. There was significant association of CIN reduction across groups ( P = 0.012). On pairwise comparison also, there was significant benefit across control and ranolazine as well as control and nicorandil ( P < 0.025). There was numerically higher incidence of AKI in controls; the difference, however, did not reach statistical significance after applying Bonferroni correction ( P = 0.044). Over 6-month follow-up, adverse events were similar across groups. While this study adds to existing literature that supports role for nicorandil in CIN prevention, the efficacy of ranolazine in protecting against CIN has been demonstrated in humans for the first time.

The Association and Utility of Left Ventricular End-Diastolic Pressure in Predicting the Development of and in Managing Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography.

Contrast-induced nephropathy (CIN) is a significant complication in patients undergoing coronary angiography, and its development is associated with increased morbidity and mortality. Left ventricular end-diastolic pressure (LVEDP) provides one index of left heart filling status. An elevated LVEDP can reflect volume overload or abnormal diastolic function and indicates a cardiac disorder. Data on the association between an elevated LVEDP and CIN are limited and have had conflicting results. We systematically searched the databases PubMed, Embase, and Scopus for full-text articles from database inception to May 2022. Studies were included if they evaluated the association between a high LVEDP and the incidence of CIN in patients undergoing coronary angiography. The study was registered in the PROSPERO CRD42022334070. A second search in PubMed identified randomized controlled trials using LVEDP to guide fluid administration during coronary procedures. Four studies were identified that used LVEDP to classify patients into groups to determine the association between the level and the development of CIN. In these studies, 240 patients of 2441 patients (9.8%) developed CIN. One study found no association between LVEDP levels and the development of CIN. Two studies found an increased frequency of CIN in patients with elevated levels using 2 cutoff points for LVEDP, ≥20 mm Hg and >30 mm Hg. One study found that lower LVEDP levels (5-14 mm Hg) were associated with the development of CIN. Three randomized control trials used LVDEP levels to manage fluid administration in patients undergoing coronary procedures; only one study found that the use of these levels to guide fluid administration resulted in better outcomes. In patients undergoing coronary angiography, an elevated LVEDP was not consistently associated with increased risk of CIN, and using LVEDP levels to guide fluid administration during these procedures did not always improve outcomes in comparison to other protocols. The use of LVEDP levels can help classify patients with cardiac disorders but does not necessarily provide an adequate description of the hemodynamic patterns in these patients to predict or prevent CIN in patients undergoing angiography.

Value of CHA2DS2-VASC Score as Predictor of Contrast-Induced Nephropathy in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Background: PCI necessitates the usage of iodinated contrast agent which in some cases is accompanied by CIN and the potential for worse outcomes. The current study aimed to use the CHA2DS2-VASc score with its simple and available components as a predictor of risk of developing CIN in NSTEMI cases who will undergo PCI.&#x0D; Methods: This single center observational study was conducted on 200 cases diagnosed with NSTEMI who were subjected to primary PCI. The basic level of serum Cr was detected at time of admission followed by monitoring for 48 h, and seven days following the approach to detect the occurrence of CIN. Electrocardiogram (ECG) and transthoracic echocardiography are assessed to all patients.&#x0D; Results: At cut off ≥2 (area under curve (AUC)=0.649), CHA2DS2-VASc could be used as a predictor for post-PCI CIN with sensitivity and specificity, PPV, NPV and accuracy of 77.6%, 52.3%, 34.5%, 87.8% and 58.5% respectively. There was a statistically significant correlation between occurrence of CIN and all the studied factors (female sex, HTN, DM, anemia, CHF, hemoglobin (HBG), pre-existing renal disease, previous stroke, pre-creatinine, 48hrs and 7 days post-creatinine, pre glomerular filtration rate (GFR) and cha2ds-vasc score and dehydration) with exception of age and vascular disease (p&gt;0.05) being non-significant. Contrast volume, CHA2DS VASC score, metformin use, eGFR after 48h and ACEI /ARB II antagonists ’inhibitor use were significant independent predictors for CIN.&#x0D; Conclusions: In NSTEMI cases who are subjected to PCI, CHADS2 VASC score ≥ 2 is accompanied by a high risk for CIN and in hospital morbidity and mortality. CHA2DS2-VASC score is considered a useful novel, easy, and reliable method to anticipate CIN in NSTEMI cases undergoing urgent P.