Contrast-induced Nephropathy Research Articles

#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<0.001) and CG (p<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<0.001 compared with both groups of patients with IHD) with a maximum increase in patients of the CIN+ group (p<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<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.

#2432 DNA damage analysis with oxidative stress index in patients developing contrast nephropathy after coronary angiography

Abstract Background and Aims Contrast Nephropathy (KN) is acute kidney injury that occurs after exposure to contrast material. Advanced age, chronic kidney disease, heart failure, anemia, hypertension, diabetes mellitus, and hyperuricemia have been reported in the literature to increase the risk of KN development. In addition, oxygen radicals have an important place in the pathogenesis of contrast nephropathy development. Specific biomarkers are used in clinics to determine oxidative stress and antioxidant status. In particular, measurement of total antioxidant status (TAS) and total oxidant status (TOS) can provide useful information about an individual's overall serum antioxidative status. The ratio of TOS to TAS level gives the oxidative stress index (OSI). One of the most investigated metabolites for DNA damage is 8-hydroxy-2-deoxyguanosine (8-OhdG), which is accepted as a biomarker of oxidative damage to DNA. In our study, we planned to investigate DNA damage and important predisposing factors for contrast nephropathy using oxidative stress markers. Method Between February 2021 and April 2022, blood was taken from 191 patients who underwent coronary angiography (CAG) by the Cardiology Department at ESOGU before CAG and at 72 hours after CAG. Patients who met the criteria for contrast nephropathy development (those with a serum creatinine increase of 25% or more compared to baseline or an increase of 0.5 mg/dl or more) were included as the case group in our study. Our study is a prospective study consisting of 85 cases and 106 controls, totaling 191 participants. TAS, TOS, OSI, and 8-OhDG levels were compared between both groups and before-after procedure. This study was supported by ESOGU BAP project number 1621. Results The mean age of the developing group was calculated as 68.13 ± 10.37, while it was calculated as 61.03 ± 9.97 in the control group (p = 0.00). In the case group, there were 30 (35.3%) without heart failure, while there were 75 (70.8%) without heart failure in the control group (p = 0.00). In univariate analyzes, we found that advanced age and heart failure were the most important indicators for KMN. When we compared those with and without KMN, we saw that TOS values decreased less in the group with post-angiography nephropathy than in those without it. We found a positive correlation between uric acid and TAS. In the KMN group, it was found that there was a statistically significant increase in TAS value after CAG, while there was a decrease in OSI value, and no statistically significant difference was found for TOS and 8-OhDG. In patients who underwent percutaneous intervention, it was found that there was a statistically significant increase in TAS value after CAG, while TOS and OSI decreased, and no significant difference was found for 8-OhDG. Conclusion Although previous studies have shown that oxidative stress plays an important role in contrast nephropathy pathogenesis, a strong relationship between KMN development and oxidative stress could not be found in our study. Our study is the first study to examine DNA damage with 8-OhDG in KMN, and it has been shown that there is no increase in DNA damage with KMN development. It is thought that one of the reasons leading to this result may be that contrast agents used today are selected as less toxic substances used in less volumes during processing, which may prevent DNA damage from occurring. Another result reached in our study is that TAS level increased in patients undergoing percutaneous intervention, while TOS and OSI decreased; that is, revascularization can reduce TOS and ultimately oxidative status.”

#554 Baseline neutrophil gelatinase-associated lipocalin (NGAL) levels for early prediction and ruling out future contrast nephropathy

Abstract Background and aims Neutrophil gelatinase-associated lipocalin (NGAL), is an early marker of acute kidney injury (AKI). There is only limited data, however, on the optimal timing for assessment, the cut-off values and its utilization for ruling out AKI We aimed to investigate the diagnostic utility of sequential NGAL measurements for both prediction and ruling out of AKI among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). Methods We included 133 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (NGAL 0) and 24 hours after PCI (NGAL 24). Optimal threshold for the development of AKI were determined using receiver operating characteristic curves (ROC). Patients were also assessed for the dynamics between NGAL 0 and NGAL 24 levels. Results Mean age was 62 ± 13 years and 78% were men, and a total of 20 (15%) developed AKI. Patients with AKI demonstrated higher plasma NGAL 0 levels (164 ± 42 vs. 95 ± 30 ng/mL; p < 0.001) as well as NGAL 24 levels (142 ± 41 vs. 93 ± 36 ng/mL; p < 0.001). There were no significant changes between NGAL 0 & 24 hours within the 2 groups (Fig. 1). According to the ROC curve analysis NGAL 0 performed better than NGAL 24 for AKI prediction (Fig. 2). The optimal NGAL 0 level for AKI prediction was >125 ng/mL (AUC 0.841, 95% CI 0.801–0.961, p < 0.001), with a sensitivity of and specificity of 70% and 84% respectively, while the negative predictive value of NGAL 0<125 ng/mL was 94%. Conclusions Among STEMI patients, NGAL levels before primary PCI may be utilized both for ruling out and for the prediction of AKI.

#2994 Nephrotoxicity post injection of iodized PDC in patients with renal failure in the emergency room

Abstract Background and Aims Nephropathy following injection of iodinated contrast media (PDC) is the leading cause of iatrogenic acute renal failure. Several associated factors have been identified, including renal function before the procedure. Objective To study the incidence of nephrotoxicity post venous-injection of iodinated PDC in patients with impaired renal function. Method This was a prospective, descriptive, single-center study over a six-month period. Patients aged over 14 years and having undergone an injection of iodinated contrast products for diagnostic or therapeutic purposes were included. We excluded patients with stage IV renal insufficiency (Cl ≤ 29 ml/min) with or without indication for extra-renal purification. Nephropathy in this context was defined by an elevation in baseline plasma creatinine of more than 25% in the 48 to 72 hours following injection. Results During the study period, 135 patients were collected with a mean age of 46 ± 18 years and range of 16 to 97 years. The gender ratio was 3.2 with a male predominance. Thirty-two patients had impaired renal function on admission, of which seven patients (5.2%) were known to have chronic renal failure and twenty-five patients (18.5%) had impaired renal function discovered on admission. The mean renal clearance was 90.9 ± 36.3 ml/min with extremes ranging from 30 ml/min to 176 ml/min. More than half of the patients had normal renal function (Stage G1 according to the KDIGO 2022 classification) (n = 79, 58.5%). The incidence of nephropathy post venous-injection of iodized PDCs was 15.6%. 111 patients (82.8%) benefited from per-procedure hydration protocol. In univariate analysis, chronic renal failure or discovered on admission was associated with the risk of worsening renal function with a statistically significant difference, p respectively at 0.007 and 0.009. Furthermore, the correlation between the worsening of renal function as a function of initial plasma creatinine showed that initial plasma creatinine was higher in patients who developed iodinated contrast nephropathy with a statistically significant difference, p = 0.005, a sensitivity of 57% and a specificity of 78%. ROC curve analysis showed an AUC of 0.691; 95% CI [0.567-0.815], with a discriminant Cut off of plasma creatinine at 90.5 µmol/l. Conclusion The incidence of post-iodized PDC injection nephropathy was high in emergency room. Among the independent associated factors identified, chronic renal insufficiency or discovered on admission which requires special precautions, especially through optimal hydration.

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.

Protective Feature of Anzer Propolis in Contrast-Induced Nephropathy in Rats

Aim: The study aims to ascertain whether Anzer Propolis, a natural antioxidant compound, can protect the kidneys from iopromide. Material and Method: This study was done in 2021. Four groups of 32 adult male Wistar albino rats, weighing between 250 and 300 g, were formed. Control (C) group contained eight rats. Intraperitoneal ethanol was administered to the Ethanol (E) group (n=8), 8 g/kg intraperitoneal iopromide to the contrast-induced nephropathy (CIN) group (n=8), and a 100 mg/kg dose of Anzer Propolis on the date of application to the Anzer Propolis group (AP) (n=8), as well as the prior day, by gastric gavage and then 8 g/kg iopromide was administered intraperitoneally. Termination was carried out at the 48th hour. Histopathological examination was performed for CIN in the right and left kidneys. Results: Following has been examined as a part of the research: serum urea, creatinine, IL6, interleukin (IL)-1β, total oxidant status (TOS), tumor necrosis factor (TNF-α), total antioxidant status (TAS), myeloperoxidase (MPO). TAS had a statistically significant increase in AP, in comparison to CIN, C and E groups (p

Effect of hydration therapy and nursing intervention on preventing contrast-induced nephropathy after interventional treatment of lower extremity arteriosclerosis obliterans.

Endoluminal interventions have become one of the main options for the treatment of arteriosclerosis obliterans (ASO). To explore the effect of hydration therapy and nursing intervention on the prevention of contrast-induced nephropathy (CIN) after interventional treatment of lower extremity ASO. A convenience sampling method was used to select 94 patients who received ASO treatment in our hospital from March 2019 to May 2021 as the study subjects. All patients underwent endovascular interventional therapy and were randomly divided into two groups by the random number table method, with odd numbers entering the observation group (n= 47) and even numbers entering the control group (n= 47). The control group received routine nursing intervention, while the observation group underwent hydration therapy and had a corresponding nursing intervention scheme. The clinical efficacy of the two groups and the incidence of contrast-induced nephropathy after interventional therapy were compared, and an evaluation of satisfaction within the two groups was performed via a questionnaire. The total effective rate of patients in the observation group was higher after hydration treatment (97.87% vs 87.23%, p< 0.05). The blood urea nitrogen, creatinine, and β2 microglobulin levels in the observation group were significantly lower than those in the control group after the intervention (p< 0.05). Patients in the observation group had higher nursing satisfaction after using preventive measures of hydration therapy combined with nursing interventions (100% vs 89.36%, p< 0.05). Hydration therapy and nursing intervention can effectively prevent CIN after interventional treatment of lower extremity ASO. After interventional therapy, patients had better clinical outcomes, lower biochemical indexes and improved satisfaction evaluations. The therapy is worthy of clinical promotion and application.

Neutrophil gelatinase-associated lipocalin (NGAL) levels for early prediction and ruling out future contrast nephropathy in patients undergoing primary coronary intervention

Abstract Funding Acknowledgements None. Background Neutrophil gelatinase-associated lipocalin (NGAL), is an early marker of acute kidney injury(AKI) . We aimed to investigate the diagnostic utility of sequential NGAL measurements for both prediction and ruling out of contrast induced AKI (CI-AKI) among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). Methods We included 133 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (NGAL 0) and 24 hours after PCI (NGAL 24). Optimal threshold for the development of CI-AKI were determined using receiver operating characteristic curves (ROC). Patients were also assessed for the dynamics between NGAL 0 and NGAL 24 levels. Results Mean age was 62 ±13 years and 78% were men, and a total of 20 (15%) developed CI-AKI . Patients with CI-AKI demonstrated higher plasma NGAL 0 levels (164 ± 42 vs. 95 ± 30 ng/mL; p &amp;lt; 0.001) as well as NGAL 24 levels (142 ± 41 vs. 93 ± 36 ng/mL; p &amp;lt; 0.001). There were no significant changes between NGAL 0 &amp; 24 hours within the 2 groups( figure 1). According to the ROC curve analysis (figure 2), the optimal NGAL 0 level for CI-AKI prediction was &amp;gt;125 ng/mL (AUC 0.841, 95% CI 0.801–0.961, p &amp;lt; 0.001), with a sensitivity of and specificity of 70% and 84% respectively, while the negative predictive value of NGAL 0&amp;lt;125 ng/mL was 94%. Conclusions Among STEMI patients, NGAL levels before primary PCI may be utilized both for ruling out and for the prediction of CI-AKI.NGAL 0 vs 24 according to CI-AKINGAL AUC

Abstract 1140: Contrast-induced Nephropathy Among Hospitalized Patients With Chronic Limb Threatening Ischemia Undergoing Percutaneous Transluminal Angioplasty - A Nationwide Analysis

Introduction: Among patients with chronic limb-threatening ischemia (CTLI) who are not responsive to lifestyle changes and pharmacotherapy, surgical or endovascular treatment are indicated. Contrast-induced nephropathy (CIN) is a known complication of endovascular interventions. In this study, we examine the prevalence of CIN among hospitalized patients with CTLI undergoing percutaneous transluminal angioplasty (PTA). Methods: Using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2020 for hospitalizations among patients ≥18 years old with a diagnosis of contrast-induced nephropathy and chronic limb-threatening ischemia and a procedure code for lower extremity PTA. We identified the prevalence of CIN among patients with CTLI undergoing endovascular treatment. Sociodemographic differences were examined among patients with CTLI undergoing PTA with and without CIN. Results: Our study included 500,690 weighted hospitalizations with CTLI, of which 57,020 (11.4%) underwent PTA. CIN was observed among 690 (1.2%) of patients with CTLI and was more common among males compared to females (53.6% vs. 46.4%) Patients with CIN were older compared to those without CIN (mean [SD] age: 70.7 [11.9] vs 68.8 [11.8] years, p=0.06 ). Among hospitalizations for CTLI who underwent PTA, the proportion of patients with CIN was higher than those without CIN for Blacks (28.4% vs. 21.1%) and Hispanics (14.2% vs. 13.2%) but not for Whites (53.0% vs. 60.1%) and Asian/Pacific Islanders (0.8% vs. 1.4%) ( p=0.4 ). CIN was more common among those with Medicaid (65.2%) compared to those with private insurance (17.4%), Medicare (10.1%), and self-pay (2.9%) ( p=0.4 ). Conclusion: Disparities exist in the prevalence of contrast-induced nephropathy among hospitalized patients with chronic limb-threatening ischemia undergoing percutaneous transluminal angioplasty. Results could be used to support future research to examine factors driving these disparities.

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.

Multivariable correlations of estimated glomerular filtration rate in 1020 consecutive PCIs in 16 months from a single center

ABSTRACT Background: Contrast-induced nephropathy can occur post percutaneous coronary intervention (PCIs). Objectives: To establish the multivariable relationships in all post-PCI patients. Methods: Renal function assessed by calculating estimated glomerular filtration rate using the modification of diet in renal disease formula and then indexed to respective BSA in consecutive 1020 post-PCI patients from June 2021 to September 2022. The complete raw data of various variables were segregated and analyzed in Microsoft Excel under various headings. Then studied for their clinical significance and interrelationships. Statistical significance was studied with number, percentages, maximum, minimum, mean, standard deviation etc., and specific statistics (includes: descriptive statistics provides number, %, interquartile range, etc., correlation statistics-provides Pearson ‘r’ correlation and regression statistics-provides the relationships). Finally, all the results were presented in the form of tables and figures from the data visualization technique. Results: The complete analysis of all 1020 PCI patient’s data suggests that age, left ventricular ejection fraction by two-dimensional echocardiography, body mass index, pre-procedural serum creatinine values and volumes of contrast used, and diastolic blood pressure (BP) has directly related to good cardiorenal outcome. Conclusions: Post-PCI acute kidney injury is a known entity. Renal functions were affected by multiple variables. Prerenal assessment and management, adequate (pre and post-PCI) hydration therapy, avoiding or minimizing nephrotoxic agents, BP control, staged PCI, precision PCI with additional procedures will not only reduce the contrast agent burden on kidney and will have good cardiorenal outcome.

The effect of CTCA guided selective invasive graft assessment on coronary angiographic parameters and outcomes: Insights from the BYPASS-CTCA trial

BackgroundComputed tomography cardiac angiography (CTCA) is recommended for the evaluation of patients with prior coronary artery bypass graft (CABG) surgery. The BYPASS-CTCA study demonstrated that CTCA prior to invasive coronary angiography (ICA) in CABG patients leads to significant reductions in procedure time and contrast-induced nephropathy (CIN), alongside improved patient satisfaction. However, whether CTCA information was used to facilitate selective graft cannulation at ICA was not protocol mandated. In this post-hoc analysis we investigated the influence of CTCA facilitated selective graft assessment on angiographic parameters and study endpoints. MethodsBYPASS-CTCA was a randomized controlled trial in which patients with previous CABG referred for ICA were randomized to undergo CTCA prior to ICA, or ICA alone. In this post-hoc analysis we assessed the impact of selective ICA (grafts not invasively cannulated based on the CTCA result) following CTCA versus non-selective ICA (imaging all grafts irrespective of CTCA findings). The primary endpoints were ICA procedural duration, incidence of CIN, and patient satisfaction post-ICA. Secondary endpoints included the incidence of procedural complications and 1-year major adverse cardiac events. ResultsIn the CTCA cohort (n ​= ​343), 214 (62.4%) patients had selective coronary angiography performed, whereas 129 (37.6%) patients had non-selective ICA. Procedure times were significantly reduced in the selective CTCA ​+ ​ICA group compared to the non-selective CTCA ​+ ​ICA group (−5.82min, 95% CI -7.99 to −3.65, p ​< ​0.001) along with reduction of CIN (1.5% vs 5.8%, OR 0.26, 95% CI 0.10 to 0.98). No difference was seen in patient satisfaction with the ICA, however procedural complications (0.9% vs 4.7%, OR 0.21, 95% CI 0.09–0.87) and 1-year major adverse cardiac events (13.1% vs 20.9%, HR 0.55, 95% CI 0.32–0.96) were significantly lower in the selective group. ConclusionsIn patients with prior CABG, CTCA guided selective angiographic assessment of bypass grafts is associated with improved procedural parameters, lower complication rates and better 12-month outcomes. Taken in addition to the main findings of the BYPASS-CTCA trial, these results suggest a synergistic approach between CTCA and ICA should be considered in this patient group. RegistrationClinicalTrials.gov, NCT03736018.

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

Spironolactone for Preventing Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Chronic Kidney Disease.

Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, P < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; P < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; P = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.

Evaluation of contrast induced nephropathy related risk factors and long-term results.

We aimed to evaluate the frequency of contrast induced nephropathy (CIN), its relationship with accepted risk factors and long-term renal outcomes in patients who underwent coronary angiography (CAG). All patients who underwent CAG between April 2020 and April 2021 were retrospectively evaluated. CIN was defined as characteristic increase in serum creatinine after CAG. CIN developed in 50 (5.4%) of 934 patients. The CIN rate was found to be statistically significantly higher in patients with diabetes, hypertension, heart failure and those using diuretics. Pre-procedural hemoglobin, albumin and GFR were found to be independent risk factors for CIN. After discharge, the urea and creatinine values of the patients who developed CIN were significantly higher than those who did not. We concluded that in order to reduce the development of CIN, hemoglobin and albumin levels should be evaluated with renal functions before the procedure and they should be kept within normal limits.

Reply to Letter: A Predictor of Contrast-Induced Nephropathy After Carotid Angiography

Reply to Letter: A Predictor of Contrast-Induced Nephropathy After Carotid Angiography

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.

Incidence of acute kidney injury in patients with acute ischaemic stroke undergoing CT angiography (CTA) and CT perfusion (CTP): a systematic review and meta-analysis

Background and purposeWe conducted a systematic review and meta-analysis to assess the incidence of acute kidney injury (AKI) in patients undergoing CT angiography (CTA) and CT perfusion (CTP) for acute...

Transitioning from Contrast-induced Nephropathy and Contrast-associated Nephropathy to Contrast-associated Acute Kidney Injury

Transitioning from Contrast-induced Nephropathy and Contrast-associated Nephropathy to Contrast-associated Acute Kidney Injury

The application value of a vendor-specific deep learning image reconstruction algorithm in "triple low" head and neck computed tomography angiography.

Head and neck computed tomography angiography (CTA) technology has become the noninvasive imaging method of choice for the diagnosis and long-term follow-up of vascular lesions of the head and neck. However, issues of radiation safety and contrast nephropathy associated with CTA examinations remain concerns. In recent years, deep learning image reconstruction (DLIR) algorithms have been increasingly used in clinical studies, demonstrating their potential for dose optimization. This study aimed to investigate the value of using a DLIR algorithm to reduce radiation and contrast doses in head and neck CTA. A total of 100 patients were prospectively enrolled and randomly divided into two groups. Group A (50 patients) consisted of those who underwent 70-kVp CTA with a low contrast volume and injection rate and who were classified according to the reconstruction algorithm into subgroups A1 [DLIR at high weighting (DLIR-H)], A2 [DLIR at low weighting (DLIR-L)], and A3 [volume-based adaptive statistical iterative reconstruction with 50% weighting (ASIR-V50%)]. Meanwhile, group B (50 patients) consisted of those who underwent standard radiation and contrast doses at 100 kVp with ASIR-V50% reconstruction. The computed tomography (CT) attenuation, background noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality score (SIQS) were statistically compared for several vessels among the four groups. Group A showed significant reductions in contrast dosage, injection rate, and radiation dose of 36.09%, 20.88%, and 47.80%, respectively, compared to group B (all P<0.001). The four groups differed significantly in terms of background noise (all P<0.05) with group A1 having the lowest value. Group A1 also had significantly higher SNR and CNR values compared to group B in all vessels (all P<0.05) except the M1 of the middle cerebral artery for the SNR. Group A1 also had the highest SIQS, followed by the A2, B, and A3 groups. The SIQS showed good agreement between the two reviewers in all groups, with κ values between 0.88 and 1. Compared to the standard-dose protocol using 100 kVp and ASIR-V50%, a protocol of 70 kVp combined with DLIR-H significantly reduces the radiation dose, contrast dose, and injection rate in head and neck CTA while still significantly improving image quality for patients with a standard body size.