High Risk Of Contrast-induced Nephropathy Research Articles

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.

Association Between Remnant Cholesterol and Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and/or Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is an acute renal complication that can occur after the use of iodinated contrast media. Remnant cholesterol (RC) is one of the markers of atherosclerotic cardiovascular disease risk. We evaluated the impact of RC on CIN and clinical outcomes after coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Consecutive patients (n = 3332) undergoing CAG and/or PCI were assessed in this retrospective study. Patients were divided into four groups based on baseline RC levels. In the quartile analysis, RC were associated with a higher risk of CIN, especially when RC ≤0.20 or ≥0.38mmol/L (P < .05). However, after adjustment, the association of RC with CIN was not significant. There was a significant correlation between RC and repeated revascularization in patients undergoing PCI (P < .001) and driven primarily by the highest quartile level. After adjustment, this remained statistically significant (adjusted odds ratio (aOR) 4.06; 95% CI 2.10-7.87; P < .001). This is the first large study to show a possible association between RC and the risk of CIN after CAG and/or PCI; however, this finding was not further confirmed after adjustment. The complex clinical risk profile of patients, rather than RC itself, may contribute to the risk of CIN in this high-risk subgroup.

Prevention of Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury has varying definitions, but in general, increased serum creatinine level by ≥ 0.3 mg/dL (26.5 µmol/L) or 1.5x of baseline value or urine output <0.5 mL/kg/h within 1-7 days after contrast media (CM) administration can be considered as CIN. CIN is one of the most common complications and is associated with increased mortality in patients undergoing percutaneous coronary intervention (PCI). Thus, risk stratification for CIN should be made and preventive strategies should be employed in which the intensity of the approach must be tailored to patient's risk profile. In all patients, adequate hydration is required, nephrotoxic medications should be discontinued, and pre-procedural high-intensity statin is recommended. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, IV hydration should be started 12 hours pre-procedure up until 12-24 hours after the procedure. Remote ischemic preconditioning may be performed pre-procedurally. Radial first approach for vascular access is recommended. During the procedure, low or iso-osmolar CM should be used and its volume should be limited to eGFR x 3.7. In patients at high risk for CIN, additional contrast-sparing strategies may be applied, such as using a contrast reduction system, 5 Fr catheter with no sideholes, CM dilution, limiting test injection, confirming placement using guidewire, use of stent enhancing imaging technology, using metallic/software roadmap to guide PCI, use of IVUS or dextran-based OCT, and coronary aspiration. A more advanced hydration technique based on central venous pressure, left ventricular end-diastolic pressure, or using furosemide-matched hydration, might be considered.

Рrevention of contrast-induced nephropathy during interventional treatment of acute coronary syndrome

The aim of the work was to determine the risk factors of contrast-induced nephropathy in patients with acute coronary syndrome and to evaluate the effectiveness of methods of its prevention. There were examined 62 patients admitted to the interventional cardiology department during 9 months of routine practice with a diagnosis of acute coronary syndrome and concomitant chronic kidney disease. Among them, 56.45% have diabetic nephropathy, 21% – hypertensive nephro­pathy, 19.35% – chronic pyelonephritis, 3.2% – gouty nephropathy. According to the stages of chronic kidney disease: I stage – 8.1%, II stage – 46.8%, III A stage – 30.6%, III B stage – 14.5% of patients. The control group consisted of 32 patients with acute coronary syndrome without kidney pathology. All patients underwent urgent percutaneous coronary intervention using a water-soluble low-osmolarity radiocontrast medium. The risk of contrast-induced nephropathy was determined according to the Mehran scale. Contrast-induced nephropathy was diagnosed by an increase in serum creatinine over 24-48 hours by &gt;25%. Prevention of contrast-induced nephropathy according to existing recommendations was carried out by prescribing early statin therapy and diuresis-controlled combined hydration in 22 patients with concomitant chronic kidney disease. Mathematical processing was performed using Statistica 8.0 software (StatSoft Inc, USA). Patients with chronic kidney disease had a high and very high risk of contrast-induced nephropathy in 19.4% and 3.2% of cases, among them in 91.6% of high and in 100% very high-risk contrast-induced nephropathy developed. Patients in the control group had a low to moderate risk, none of them developed contrast-induced nephropathy. It has been shown that the risk of contrast-induced nephropathy depends on the stage of chronic kidney disease and is associated with a decrease in the ejection fraction of the left ventricle (≤40%), acute left ventricle failure of the III and IV classes according to Killip, a decrease in diuresis in the first 12-24 hours after urgent percutaneous coronary intervention up to ≤0.6 ml/h/kg; in patients with diabetic nephropathy taking metformin 6-12 hours before the administration of the X-ray contrast medium and the glomerular filtration rate ≤45 ml/min./1.73 m2. In patients who underwent prevention of contrast-induced nephropathy in its entirety, its development was not registered.

Clinical Case of IVUS-Guided Coronary Artery Stenting in a Patient with Chronic Renal Failure

Introduction. An expanding number of indications for PCI in patients with coronary heart disease and severe concomitant pathology are accompanied by a growing number of patients with chronic renal failure. Contrast-induced nephropathy (CIN) is recognized as a severe complication, aggravating the course of the underlying disease, and, moreover, reducing the life expectancy of the patients. Modern intravascular imaging technologies are widely implemented in real clinical practice of endovascular surgery. In the context of increasing number of PCI performed in patients with severe concomitant pathology, the IVUS-guidance will improve the quality of stenting, and, importantly, lessen the risks of CIN due to the reduction in contrast volume. Materials and methods. The paper presents a clinical case of IVUSguided stenting of the right coronary artery without contrast agent in a patient with chronic kidney disease and the following diagnosis: “Coronary heart disease. Effort angina, class III (dyspnea as anginal equivalent). Balloon angioplasty and stenting of circumflex artery and LAD. Hyperlipidemia 2a. Atherosclerosis of the aorta, brachiocephalic and coronary arteries. Stage 3 hypertension. Controlled Hypertension. Level IV CVD risk. Type 2 diabetes mellitus. Target glycated hemoglobin is less than 7.5%. Grade 2 obesity, exogenous-constitutional. Renal microlithiasis. CKD stage 4 (GFR 29 ml/min/1.73m2). Cerebrovascular disease. Chronic cerebral ischemia.” Results and discussion. In the described clinical case, a complete myocardial revascularization was achieved using IVUS-guidance and minimal amount of contrast agent in a patient with severe CKD. The advantage of minimally invasive endovascular interventions in a complex category of patients, demonstrated by the case, implies expanded possibilities for providing high-tech care to patients with significant limitations in the use of contrast agents due to severe CKD with a high risk of CIN. Conclusion. Today, an increasing number of X-ray operating rooms in Russia are equipped with intravascular technologies, ensuring their wider use. The skills and knowledge in using IVUS imply rare application of contrast agents, thereby lessening the risk of CKD and, as a consequence, improving the prognosis of patients with reduced renal function and high risk of CKD.

Carbon Dioxide Guided Endovascular Aortic Aneurysm Repair in Impaired Renal Function: Propensity Score Matched Study

Carbon dioxide (CO2) is the preferred contrast agent in patients with impaired renal function and or contrast allergy and, particularly, in patients who require large volumes of contrast for complex endovascular procedures. In this study, the aim was to clarify the possible protective effects of CO2 guided endovascular aneurysm repair (EVAR) for patients with impaired renal function by propensity score matching. A retrospective analysis of the database was performed for 324 patients having EVAR between January 2019 and January 2022. A total of 34 patients treated with CO2 guided EVAR were evaluated. This cohort was matched for age, sex, pre-operative serum creatinine levels and glomerular filtration rate (GFR) levels and specific comorbidities to obtain homogeneous groups that included only patients with impaired renal function (eGFR < 60 mL/min/1.73m2). The primary endpoint was to compare the decrease in eGFR from baseline and development of contrast induced nephropathy (CIN) using propensity score matching. Secondary endpoints were the need for renal replacement therapy, other peri-procedural morbidity and mortality. Thirty-one patients (9.6%) of the total population developed CIN. There was no difference in the rate of CIN development between the standard EVAR group and the CO2 guided EVAR group in the unmatched population (10% vs. 3%, p= .15). After matching, the decrease in eGFR values after the procedure was more pronounced for the standard EVAR group (from 44 to 40 mL/min/1.73m2, interaction p= .034). Meanwhile, CIN development was more frequent for the standard EVAR group (24% vs. 3%, p= .027). In matched patients, early death did not differ between the groups (5.9% vs. 0, p= .15) CONCLUSION: Patients with impaired renal function are at higher risk of CIN after an endovascular procedure. CO2 guided EVAR is a safe, effective, and feasible treatment option, especially for patients with impaired renal function. CO2 guided EVAR may be a protective measure for contrast induced nephropathy.

Risk factors of contrast-induced nephropathy in patients with acute coronary syndrome

Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed. We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment. A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value. Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P < 0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P < 0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN. Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation, and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.

SIGNIFICANCE OF CANADA ACUTE CORONARY SYNDROME RISK SCORE IN EMERGENCY PERCUTANEOUS REVASCULARIZATION FOR THE PREDICTION OF CONTRAST INDUCED NEPHROPATHY

Objectives: This study was conducted to compare the accuracy of Canada Acute Coronary Syndrome (C-ACS) score against Mehran risk score (MRS) in primary percutaneous coronary intervention (PCI) patients for risk stratification of contrast induced nephropathy (CIN) at a tertiary care cardiac hospital. Methodology: In this study we included adult patients presented with chief presenting complaint of typical chest pain to emergency department within 12 hours of onset of symptoms, diagnosed with ST-segment elevation myocardial infarction (STEMI) and taken to the catheterization laboratory for primary PCI. Two scores MRS and C-ACS were computed and CIN was defined based on the variations in creatinine level, absolute 0.5 mg/dL or relative 25% increase at 48-72 hours. Results: Study included a total of 593 patients with mean age of 52.22±11.1 years and 488(82.3%) were male patients. A total of 53(8.9%) patients developed CIN after primary PCI. The area under the curve (AUC) was 0.745 [0.675-0.815] and 0. 647 [0.560-0.733] for MRS and C-ACS score respectively. The threshold value C-ACS ≥ 1 has sensitivity of 47.2% [33.3%-61.4%] and specificity of 80.2% [76.6%-83.5%]. Similarly, MRS ≥6.5 has sensitivity of 64.2% [49.8%-76.9%] and specificity of 75% [71.1%-78.6%]. Conclusion: C-ACS score is found to be less sensitive but more specific in identifying patients at high risk of CIN. Predictive value of C-ACS was observed to be lower than that of MRS. In the tradeoff of simplicity and accuracy, clinicians may consider accuracy and prefer MRS over C-ACS for the risk stratification of CIN.

Abstract No. 287 An interpretable machine-learning-based risk model of contrast-induced nephropathy in patients undergoing lower-extremity endovascular interventions

Identification of patient cohorts at higher risk of contrast-induced nephropathy (CIN) may allow targeted interventions to reduce the incidence of renal injury, a postprocedural complication which may prolong hospital stay and contribute to increased morbidity and mortality. We aimed to develop an interpretable machine learning model to stratify individual risk for acute renal failure in patients undergoing lower extremity endovascular interventions for peripheral artery disease (PAD).

Contrast Induced Nephropathy in Very Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

Contrast-Induced Nephropathy (CIN) is associated with significant morbidity and mortality after Percutaneous Coronary Intervention (PCI). Very elderly patients undergoing PCI are at higher risk of CIN because of age and associated multiple comorbidities. The purpose of our study was to asses factors associated with CIN in very elderly patients. We retrospectively studied 128 very elderly patients who underwent PCI for ACS between January 2018 and December 2019 at our hospital. CIN was defined as 25% rise in the baseline creatinine level, within 48 to 72 hours of intravenous contrast administration. CIN occurred in 27 patients (26.7%). The mean age of patients with CIN was 80.63 ± 5.52 years and those without CIN, the mean age was 79.33± 4.1 years ( P -value 0.181). Of the 34 patients with baseline GFR < 60 mL/min/1.73 m 2 , 9 patients (26.5%) developed CIN and of the 94 patients with baseline GFR above 60 mL/min/1.73 m 2 , 18 patients (19.1%) developed CIN ( P -value 0.370). The factors associated with CIN were: STEMI compared to NSTEMI (30.4% vs. 15.9%, P -value 0.05), history of coronary events (35% vs. 14.8%, P -value 0.009), heart failure at admission (35.7% vs. 17% P -value 0.06), and no reflow post PCI (66.7% vs. 21.3%, P -value 0.013). At a median follow-up of 12 months, major cardiovascular events including cardiovascular death, reinfarction, and stroke were more frequents in patients with CIN (36% vs. 14%, P -value 0.011). CIN frequently complicate PCI in very elderly patients, especially those with STEMI and heart failure at admission. It is associated with prolongation of hospital stay and increased rate of cardio-vascular complications at medium and long term follow-up.

The role of remote ischemic preconditioning in preventing contrast-induced nephropathy following invasive coronary angiography; a randomized controlled trial

Introduction: Remote ischemic preconditioning (RIPC) is now proposed as an effective approach for preventing contrast-induced nephropathy (CIN); however, the results on its efficacy have already remained uncertain. Objectives: We aimed to assess the beneficial effects of RIPC in preventing CIN in patients undergoing coronary angiography (CA) followed by angioplasty. Patients and Methods: One hundred patients candidate for elective CA and coronary angioplasty, moderate to high risk for CIN were randomized into two groups including the group which planned for RIPC, and the control group. The overall prevalence rate of CIN was assessed and compared across the two groups. Results: The two groups were matched for demographics, cardiovascular risk profiles and laboratory parameters. The prevalence of CIN in RIPC group was 14.0% and in the control group was 26.0% indicating no statistical difference between the two groups (P = 0.105). Requiring dialysis was also planned for 0.0% and 2.0% respectively with no difference (P = 0.500). Conclusion: RIPC may not prevent CIN in patients who are candidate for invasive CA. Trial Registration: The study was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20171230038144N1; https://www.irct.ir/trial/28715, ethical code: IR.IUMS. FMD.REC 1396.9311171014).

The Predictive Value of Myeloperoxidase for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction.

BackgroundHigher serum myeloperoxidase (MPO) in patients with acute coronary syndrome is associated with adverse cardiovascular outcomes. Contrast-induced nephropathy (CIN) is associated with worse prognosis in patients with coronary artery disease following angiography. We have no idea whether patients with higher serum myeloperoxidase have a higher risk of CIN in acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).MethodsThis study involved 436 consecutive patients with AMI who had received PCI. Serum MPO levels were determined using enzyme-linked immunosorbent assay before administration of contrast media. Multivariate logistic regression analysis was used to analyze the independent risk factors for CIN after univariate analysis. The receiver operator characteristic (ROC) analysis was performed to evaluate the predictive value of MPO for CIN.ResultsAmong the 436 patients, 79 individuals (18.1%) suffered CIN after the PCI procedure. Patients who developed CIN had significantly higher MPO levels compared to those who did not ([203.8 (150.6–276.2)] versus [138.5 (129.9–149.2)]; p<0.001). Multivariate logistic regression analysis revealed that MPO level (OR 1.023, 95% CI: 1.017–1.029, p<0.001) was an independent risk factor for the incidence of CIN after adjusting for the baseline information, blood indicators and angiography procedural parameters. The area under the ROC curve for predicting CIN of MPO was 0.848, and the optimum cutoff point of MPO was 147.38ug/L; the sensitivity and specificity were 82.3% and 72.3%, respectively.ConclusionThe results show that MPO is independently associated with an increased risk of CIN with AMI patients undergoing PCI. Further studies are needed to verify these results.

Abstract 13433: Predictors of Contrast Induced Nephropathy in Patients With Acute Coronary Syndromes and Normal Baseline Glomerular Filtration Rate

Background: The incidence and predictors of contrast-induced nephropathy (CIN) in patients with normal glomerular filtration rate (GFR) are not well ascertained. We aim to determine the incidence and predictors for CIN after coronary catheterization (CATH) for acute coronary syndromes (ACS). Methods: We combined the datasets of two studies. The AMI-QUEBEC was an observational cohort of patients with ST-segment elevation myocardial infarctions in 2003. The AMI-OPTIMA was a study of patients hospitalized with ACS in 2009 and 2012. For this analysis, we retained only patients with GFR &gt; 60 ml/min who underwent CATH. We defined “hyperfiltrators” as patients with GFR above the 95th percentile age and sex-adjusted value. CIN was defined as an increase in serum creatinine &gt;0.5 mg/dL (44.2 μmols/L) or &gt; 50% from baseline serum creatinine. Results: There were 3,188 patients with GFR &gt; 60 ml/min : 39 hyperfiltrators and 3,149 without hyperfiltration. The mean age was similar between the two groups of patients (62 years); 21% and 27% females in hyperfiltrators and non-hyperfiltrators (p&lt;0.0001). The prevalences of diabetes mellitus and hypertension were 36% and 64%, respectively in hyperfiltrators compared to 20% and 46%, respectively in non-hyperfiltrators. The mean baseline GFR and creatinine were 112 ml/min and 50 μmols/L, respectively in hyperfiltrators; 84.2 ml/min and 80 μmols/L in non-hyperfiltrators. There were 225 CIN following CATH; 7.1% of the whole cohort with 35.9% in the hyperfiltrators and 6.7% in non-hyperfiltrators. Hyperfiltration was independently associated with a 13-fold increase in the risk of CIN (Table 1). Each year of increase in age was associated with a 5% increase in the risk of CIN. Shock was also associated with an 11-fold increase in the risk of CIN. Conclusion: Hyperfiltrators may be at high risk of CIN following CATH in ACS. The risk of CIN associated with hyperfiltration should be evaluated in other populations.

Monosit/yüksek-dansiteli lipoprotein oranının st elevasyonu olmayan miyokard enfarktüslü hastalarda kontrasta bağlı nefropatiyle ilişkisi

Aim: Contrast-induced nephropathy (CIN) is associated with worse prognosis in patients with non-ST-elevation myocardial infarction (NSTEMI). Early identification patients with a high risk of CIN are very crucial to improve outcomes. The monocyte to high-density lipoprotein ratio (MHR) is a novel inflammatory marker. We aimed to investigate the MHR had a predictive role for CIN development in patients with NSTEMI. Material and Methods: NSTEMI who underwent percutaneous coronary intervention (PCI) were included in the study. MHR was calculated and CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48- 72 hours. Results: A total of 370(200, 54.1% men) patients were included in this study and 104 (28.1%) of them had DM. 25 (6.7%) of patients had CIN. MHR was significantly higher in patients with CIN (0.014± 0.004 vs 0.011± 0.006-respectively, p: 0.017). MHR was also significantly correlated with creatinine levels after PCI (r:0,104, p: 0.047). CIN group also experienced a more complicated in-hospital clinical course. Additionally; weight and MHR were detected as independent risk factors of CIN in logistic regression analysis.Conclusion: Preprocedural MHR may be used as cheap, easy and simple marker of CIN. It may help with the early identification of patients with NSTEMI who are at high risk of CIN.

Remote ischemic preconditioning for prevention of contrast-induced nephropathy – A randomized control trial

BackgroundThere is a lack of sufficient data regarding the protective effects of remote ischemic preconditioning (RIPC) in patients at risk of developing contrast-induced nephropathy (CIN). Thus, this study was conducted to determine whether RIPC as an adjunct to standard therapy prevents CIN in high-risk patients undergoing coronary intervention. MethodsIn a single-center, double-blinded, randomized controlled trial, 162 patients who were at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was accomplished by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary endpoint was a rise in serum creatinine (>0.5 mg/dL or >25%) from baseline to serum creatinine 48–72 h after contrast administration. ResultsOf the 162 patients, 81 were randomly allocated to receive sham preconditioning and 81 to receive RIPC. Significantly reduced serum creatinine levels were observed in patients with a Mehran moderate risk allocated to sham group compared to the RIPC group (0.070 ± 0.16 mg/dL vs. 0.107 ± 0.13 mg/dL, p = 0.001). With regards to the primary endpoint, a significantly higher change in serum creatinine from baseline to 48–72 h was observed in the sham group compared to the RIPC group (0.023 ± 0.2 μmol/L vs −0.064 ± 0.1 μmol/L, p < 0.001). ConclusionRIPC as an alternative to standard therapy, improved serum creatinine levels after contrast administration in patients at risk of CIN. However, present data indicate that RIPC might have beneficial effects in patients with a moderate or high risk of CIN.

Transfemoral transcatheter aortic valve replacement without contrast medium using the Medtronic CoreValve system: a single center experience.

Transcatheter aortic valve replacement (TAVR) in patients with chronic kidney disease (CKD) is challenging due to the high risk of contrast-induced nephropathy (CIN) and acute kidney injury (AKI). AKI dramatically reduces the clinical benefit of TAVR and is one of the strongest predictors of 30-day mortality as well as long-term adverse outcomes after TAVR. The aim of this study was to evaluate a protocol specifically designed to reduce the incidence of contrast-induced nephropathy (CIN) in advanced CKD patients screened for and undergoing TAVR. Twelve consecutive patients with severe aortic valve stenosis suffering from at least stage 4 CKD underwent both screening with pre-procedural computed tomography scan (CT scan) and bioprosthetic valve implantation without contrast medium. All the TAVR procedures were performed using the CoreValve Evolut R/PRO transcatheter aortic valve (Medtronic Inc, Minneapolis, MN, USA). The annulus and the optimal implantation projection were identified on the non-contrast medium CT scans with the aid of calcifications as a reference. The implant projection was confirmed immediately before the valve implantation by placing two pigtail catheters alternately inside each sinus of Valsalva (SOV). We enrolled 12 patients: mean age 83.42 4.50 years, number of male 5 (41.7%), mean STS 10.33±6.16, mean EuroScore II 13.75±9.07, mean serum creatinine 2.01±0.63 mg/dL, mean eGFR 23.00±5.69 mL/min/1.7m2. All TAVR procedures were successful, leading to a drop in transaortic mean gradient (mean gradient 33.5±14.09 mmHg; postoperative mean gradient 6.08±mmHg). No patient had more than a mild paravalvular leak. Only two patients underwent permanent pacemaker implantation due to advanced atrioventricular block (AV block). Mean change in eGFR 48 hours after the procedure was 1.3 mL/min. None of the patients developed AKI, according to Valve Academic Research Consortium-2 (VARC-2) definition. In patients with advanced CKD, a strategy of "zero contrast" TAVR, preceded by accurate CT scan analysis and procedural planning, appears to be safe and feasible permitting to preserve renal function. The avoidance of contrast medium during preprocedural analysis and TAVR implantation could reduce the incidence of AKI and consequently could improve outcomes in this complex patient cohort.

Elevated red blood cell distribution width as a marker of higher risk for contrast-induced nephropathy: A systematic review and meta-analysis

Elevated red blood cell distribution width as a marker of higher risk for contrast-induced nephropathy: A systematic review and meta-analysis

Elevated high-sensitivity C-reactive protein combined with procalcitonin predicts high risk of contrast-induced nephropathy after percutaneous coronary intervention

BackgroundContrast-induced nephropathy (CIN) is common after percutaneous coronary intervention (PCI) and always leads to a poor prognosis. Compared with conventional detection methods, either high-sensitivity C-reactive protein (hs-CRP) or procalcitonin have higher sensitivity and specificity for predicting CIN, but their combination has not been explored. This prospective study investigated the value of hs-CRP combined with procalcitonin for predicting CIN after PCI.MethodsAll patients undergoing PCI admitted to our hospital during the year 2016 were consecutively enrolled (n = 343). The patients received adequate hydration before PCI and 20 mg furosemide after the procedure. CIN was diagnosed by a 25% elevation in serum creatinine or ≥ 44.2 μmol/L (0.5 mg/dL) serum creatinine within 48 to 72 h after intravenous injection of contrast media.ResultsPatients with high hs-CRP or procalcitonin had higher rates of CIN relative to those patients with low values. For predicting CIN, hs-CRP combined with procalcitonin showed an area under the receiver operating characteristic curve of 0.67, with optimal cut-off value 0.0643610, and the sensitivity and specificity were higher than hs-CRP or procalcitonin alone. The logistic regression analysis showed that high-risk factors of CIN were acute myocardial infarction and highly elevated hsCRP and procalcitonin.ConclusionsPrior to PCI, an elevation of the inflammatory biomarkers hsCRP and procalcitonin are a risk factor for postoperative CIN. This study suggests that the combination of hsCRP and procalcitonin is a better predictor of CIN after PCI then either hsCRP or procalcitonin alone.Trial registration numberChiCTR-IOR-14005250. Date of registration 2014-09-24.

Intravenous N-acetylcysteine versus intravenous theophylline in the prevention of contrast-induced nephropathy in critically ill patients: a prospective randomized clinical trial

Aim Despite the use of several agents for prophylactic agents, contrast-induced nephropathy (CIN) remains a crucial clinical problem. The aim was to compare the efficacy of intravenous N-acetylcysteine (NAC) and intravenous theophylline in the prevention of CIN in critically ill patients. Patients and methods A total of 90 patients were admitted to the ICU with at least one risk factor for CIN and randomly divided into three groups. All patients received the regular management of renal protection with good hydration, to maintain adequate intravenous volume expansion with isotonic crystalloids (normal saline: 1–1.5 ml/kg/h) 3–12 h before the procedure, and it was continued for 6–24 h afterward. In the first group, patients received 6 mg theophylline intravenously over 30 min as a loading dose, followed by a maintenance dose of 0.5 mg/kg/h intravenously, to be started after the loading dose (group T). In the second group, patients received the full course of treatment with NAC (group A), which comprised three consecutive intravenous infusions: first infusion as initial loading dose of 150 mg/kg body weight infused in 200 ml over 1 h, followed by the second infusion of 50 mg/kg in 500 ml over the next 4 h, followed by the third infusion of 100 mg/kg in 1 l over the next 16 h (to be completed on the day of the examination). Control group: in this group, 30 patients received no additional drug before administration of radiocontrast medium. They only received the regular management of renal protection with good hydration. Results Despite the inclusion of ICU patients at high risk for CIN, we found a significant lower incidence of CIN and a lower incidence of patients requiring dialysis among patients under prophylaxis of intravenous NAC and intravenous aminophylline, as creatinine concentration was elevated by 25% in only four patients in the NAC group and only in three patients in the aminophylline group, and the incidence of CIN and patients requiring dialysis were significantly lower (P Conclusion We concluded that the administration of intravenous NAC or intravenous theophylline around the time of contrast administration prevents renal injury in equal efficacy compared with patients receiving no additional drugs at the time of contrast administration as regards incidence of nephropathy and incidence of dialysis among study patients.

A Randomized Double Blind Placebo Controlled Trial Examining the Effects of Pentoxifylline on Contrast Induced Nephropathy Reduction after Percutaneous Coronary Intervention in High Risk Candidates.

Contrast-induced nephropathy (CIN) (known as contrast-induced acute kidney injury) occurs as a result of acute worsening of renal function following a procedure with administration of iodine contrasts agent and remains a substantial concern in clinical practices. The purpose of this study is to investigate the preventive effect of Pentoxifylline supplementation on reduction of CIN occurrence after percutaneous coronary intervention among patients who were high risk of CIN according to Mehran score. In randomized, double-blind clinical trial patients who undergo coronary angiography with Mehran Score ≥ 11 consisted of our population. Patients in a ratio 1:1, divided into two groups received saline 0.9% plus N-acetyl cysteine and Pentoxifylline 400 mg three times per day 24 h before angiography until 48 h after angiography. In control group, the patients received placebo instead of PTX in a same manner as the control group. The endpoint was the incidence of CIN defined as creatinine increase of 0.5 mg/dL within 2 days after contrast. There were no significant differences in baseline characteristics. CIN occurred in 3 (5.5%) and 4 (7.3%) patients of the both groups (Pentoxifylline and control), respectively (p = 0.69; incidence odds ratio 1.36; 95% CI 0.29-6.38). No significant differences were seen in secondary outcome measures and changes in the level of creatinine (p = 0.54). In high-risk patients undergoing coronary angiography pentoxifylline supplementation had protection effect against contrast-induced nephropathy greater than placebo based hydration, but, not supported by our data.