Occurrence Of Contrast-induced Acute Kidney Injury Research Articles

Non-invasive remote ischemic preconditioning for patients with heart failure undergoing cardiac catheterization: a network meta-analysis of randomized controlled trials

ObjectiveThis study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.MethodsA comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.ResultsFour trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.ConclusionAlthough Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.

Association between fasting stress hyperglycemia ratio and contrast-induced acute kidney injury in coronary angiography patients: a cross-sectional study.

Stress hyperglycemia ratio (SHR), an emerging indicator of critical illness, exhibits a significant association with adverse cardiovascular outcomes. The primary aim of this research endeavor is to evaluate the association between fasting SHR and contrast-induced acute kidney injury (CI-AKI). This cross-sectional study comprised 3,137 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI). The calculation of fasting SHR involved dividing the admission fasting blood glucose by the estimated mean glucose obtained from glycosylated hemoglobin. CI-AKI was assessed based on elevated serum creatinine (Scr) levels. To investigate the relationship between fasting SHR and the proportion of SCr elevation, piecewise linear regression analysis was conducted. Modified Poisson's regression analysis was implemented to evaluate the correlation between fasting SHR and CI-AKI. Subgroup analysis and sensitivity analysis were conducted to explore result stability. Among the total population, 482 (15.4%) patients experienced CI-AKI. Piecewise linear regression analysis revealed significant associations between the proportion of SCr elevation and fasting SHR on both sides (≤ 0.8 and > 0.8) [β = -12.651, 95% CI (-23.281 to -2.022), P = 0.020; β = 8.274, 95% CI (4.176 to 12.372), P < 0.001]. The Modified Poisson's regression analysis demonstrated a statistically significant correlation between both the lowest and highest levels of fasting SHR and an increased incidence of CI-AKI [(SHR < 0.7 vs. 0.7 ≤ SHR < 0.9) β = 1.828, 95% CI (1.345 to 2.486), P < 0.001; (SHR ≥ 1.3 vs. 0.7 ≤ SHR < 0.9) β = 2.896, 95% CI (2.087 to 4.019), P < 0.001], which was further validated through subgroup and sensitivity analyses. In populations undergoing CAG or PCI, both lowest and highest levels of fasting SHR were significantly associated with an increased occurrence of CI-AKI.

Correlation between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury and the establishment of machine-learning-based predictive models

Objective To explore the correlation between neutrophil-to-lymphocyte ratio (NLR) and contrast-induced acute kidney injury (CI-AKI). To develop machine-learning (ML) methods based on NLR and other relevant high-risk factors to establish new and effective predictive models of CI-AKI. Methods: The data of 2230 patients, who underwent elective vascular intervention, coronary angiography and percutaneous coronary intervention were retrospectively collected. The patients were divided into a CI-AKI group and a non-CI-AKI group. Logistic regression was used to analyze the correlation of NLR with CI-AKI and high-risk factors for CI-AKI, and logistic regression (LR), random forest (RF), gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and naïve Bayes (NB) models based on NLR and the high-risk factors were established. Results A high NLR(>2.844) was an independent risk factor for CI-AKI (odds ratio = 2.304, p < 0.001). The area under the ROC curve (AUC) of the NB model was the largest (0.774), indicating that it had the best performance. NLR, serum creatinine concentration, fasting plasma glucose concentration, and use of β-blocker all accounted for a large proportion of the predictive performance of each model and were the four most important factors affecting the occurrence of CI-AKI. Conclusions There was a significant correlation between NLR and CI-AKI The NB model exhibited the best predictive performance out of the five ML models based on NLR exhibited the best predictive performance out of the five ML models.

The effect of perioperative diuretic administration on acute kidney injury in patients with acute myocardial infarction after percutaneous coronary intervention: a real-world retrospective study.

The relationship between diuretic use and contrast-induced acute kidney injury (CI-AKI) after contrast exposure remains unclear. In this study, we conducted a retrospective analysis using propensity score matching (PSM) to investigate the effect of perioperative diuretic administration on contrast-induced acute kidney injury (CI-AKI) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). A total of 1894 patients with AMI who underwent PCI were retrospectively analyzed using PSM and multivariate models. Depending on whether diuretics were used, the patients were divided into two groups: the perioperative diuretic group (497 patients, 26.2%) and the non-diuretic group (1397 patients, 73.8%). And the relationship between perioperative diuretic administration and CI-AKI was evaluated by multiple regression models. Furthermore, Kaplan Meier survival curve ratio was used to evaluate and compare overall postoperative survival between the two groups. Most patients who received diuretics were older (67 vs. 60years, respectively, p < 0.001) and women (22.5% vs. 15.2%, p < 0.001) and had combined hypertension (62.8% vs. 47%, p < 0.001), atrial fibrillation (5.4% vs. 1.8%, p < 0.001), stroke (9.3% vs. 4.9%, p < 0.001), and diabetes mellitus (33.4% vs. 23.6%, p < 0.001) compared to those who did not. After the baseline characteristics were balanced using the PSM model, no significant difference was observed in the incidence of postoperative CI-AKI (22.7% vs. 19.5%, p = 0.356) and major cardiovascular adverse events (21.5% vs. 18.7%, p = 0.398). Multiple regression analysis showed no association between perioperative diuretic administration and postoperative CI-AKI occurrence (odds ratio: 1.14, 95% confidence interval: 0.86-1.51, p = 0.371). Further subgroup analysis and sensitivity analysis confirmed the above findings. We found no significant association between perioperative diuretic administration and postoperative CI-AKI in patients with AMI who underwent PCI.

Effect of Serum Bilirubin Levels on Contrast-induced Acute Kidney Injury: A Systematic Evaluation and Meta-analysis.

Contrast-induced acute kidney injury (CI-AKI) is an important complication following the use of iodinated contrast media. Bilirubin has a protective effect but may also aggravate CI-AKI. The purpose of this systematic review was to assess whether bilirubin is a risk factor for CI-AKI. We searched the databases PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid Medline, CNKI (China National Knowledge Infrastructure), VPCS (Vip Paper Check System), Wanfang, and CBM (Chinese BioMedical Literature Database) from the initial date to May 6, 2023. We summarized the results by directly combining the effect-size odds ratio (OR) and 95% confidence interval (CI) and identified sources of heterogeneity through subgroup analysis, sensitivity analysis, and meta-regression analysis. A total of 10 studies (14 data sets) were included: 7 retrospective studies (10 data sets) and 3 prospective studies (4 data sets), involving 12776 participants. The incidence of CI-AKI of 16% (95% CI: 14-19%). Total bilirubin was positively associated with the occurrence of CI-AKI (OR = 1.80; 95% CI: 1.36-2.38). Both low and high bilirubin concentrations were risk factors for CI-AKI. The incidence of CI-AKI was higher in the low bilirubin group than in the high bilirubin group.

The Potential Biotherapeutic Targets of Contrast-Induced Acute Kidney Injury.

Contrast-induced acute kidney injury (CI-AKI) is manifested by an abrupt decline in kidney function as a consequence of intravascular exposure to contrast media. With the increased applicability of medical imaging and interventional procedures that utilize contrast media for clinical diagnosis, CI-AKI is becoming the leading cause of renal dysfunction. The pathophysiological mechanism associated with CI-AKI involves renal medullary hypoxia, the direct toxicity of contrast agents, oxidative stress, apoptosis, inflammation, and epigenetic regulation. To date, there is no effective therapy for CI-AKI, except for the development of strategies that could reduce the toxicity profiles of contrast media. While most of these strategies have failed, evidence has shown that the proper use of personalized hydration, contrast medium, and high-dose statins may reduce the occurrence of CI-AKI. However, adequate risk predication and attempts to develop preventive strategies can be considered as the key determinants that can help eliminate CI-AKI. Additionally, a deeper understanding of the pathophysiological mechanism of CI-AKI is crucial to uncover molecular targets for the prevention of CI-AKI. This review has taken a step further to solidify the current known molecular mechanisms of CI-AKI and elaborate the biomarkers that are used to detect early-stage CI-AKI. On this foundation, this review will analyze the molecular targets relating to apoptosis, inflammation, oxidative stress, and epigenetics, and, thus, provide a strong rationale for therapeutic intervention in the prevention of CI-AKI.

Predictive value of systemic immune-inflammatory index combined with CHA2DS2-VASC score for contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

To investigate the value of systemic immune-inflammation index (SII) combined with CHA2DS2-VASC score in predicting the risk of contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) treatment. 1531 consecutive patients with ACS and undergoing PCI were recruited from January 2019 to December 2021. All patients were divided into CI-AKI and non-CI-AKI groups according to the pre-procedure and post-procedure creatinine changes, and the baseline data were compared between the two groups. Binary logistic regression analysis was used to investigate the factors influencing CI-AKI in ACS patients after PCI. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of SII, CHA2DS2-VASC, and their combined levels on CI-AKI after PCI. Patients with high SII and high CHA2DS2-VASC score had a higher incidence of CI-AKI. For SII, the area under the ROC curve (AUC) for predicting CI-AKI was 0.686. The optimal cut-off value was 736.08 with a sensitivity of 66.8% and a specificity of 66.3% [95% confidence interval (CI) 0.662-0.709; P < 0.001]. For CHA2DS2-VASC score, the AUC was 0.795, the optimal cut-off value was 2.50 with a sensitivity of 80.3% and a specificity of 62.7% (95% CI 0.774-0.815; P < 0.001). When combining SII and CHA2DS2-VASC score, the AUC was 0.830, the optimal cut-off value was 0.148 with a diagnostic sensitivity of 76.1% and a specificity of 75.2% (95% CI 0.810-0.849; P < 0.001). The results showed that SII combined with CHA2DS2-VASC score resulted in improved predictive accuracy of CI-AKI. Multifactorial logistic regression analysis showed that albumin level (OR = 0.967, 95% CI 0.936-1.000; P = 0.047), lnSII level (OR = 1.596, 95% CI 1.010-1.905; P < 0.001), and CHA2DS2-VASC score level (OR = 1.425, 95% CI 1.318-1.541; P < 0.001) were independent risk factors for CI-AKI in patients with ACS treated with PCI. High SII and high CHA2DS2-VASC score are risk factors for the development of CI-AKI, and the combination of the two improves the accuracy of predicting the occurrence of CI-AKI in patients with ACS undergoing PCI.

Protective Effect of Nicorandil on Contrast-Induced Acute Kidney Injury After Emergency Percutaneous Coronary Intervention.

Objective: To investigate the protective effect of nicorandil on contrast-induced acute kidney injury (CIAKI) in patients with acute ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). Methods: This is a single-center, retrospective control study. A total of 156 patients with STEMI were divided into the nicorandil group (n = 55) and the control group (n = 101). The incidence of CIAKI, defined as an increase of >25% or absolute values > 44.2 μmol/L in serum creatinine (Scr) from baseline within 72 h of exposure to a contrast agent after exclusion of other causes, was the primary endpoint. The secondary endpoints were: (1) changes of Scr, estimated glomerular filtration rate (eGFR), uric acid, and β2-microglobulin at 24/48/72 h and 5 to 7 days after PCI; (2) the peak value difference of creatine kinase isoenzymes (CK-MB) after PCI; (3) adverse events within 6 months after PCI. Results: The overall incidence of CIAKI was 21.8%; the incidence of CIAKI in the nicorandil group was significantly lower (12.7% [7/55]) than in the control group (26.7% [27/101]) (P = .043). Compared with the control group, Scr, uric acid, and β2-microglobulin levels were lower, and the level of eGFR was higher in nicorandil group (P all < .05). The peak value of CK-MB in the nicorandil group was lower than that in the control group (105.30 [56.61, 232.04] vs 178.00 [77.08, 271.91]U/L, P = .042). There was no significant difference in adverse events between the 2 groups within 6 months after PCI. Moreover, multivariate logistic regression analysis showed that hypertension and diabetes were independent risk factors for CIAKI, while nicorandil treatment was a protective factor. Conclusion: Our data suggest that intravenous nicorandil after emergency PCI has a protective effect on the occurrence of CIAKI in STEMI patients.

528 OUTCOMES IN DIABETIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH SGLT2-I: THE SGLT2-I AMI PROTECT REGISTRY

Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) receive intense clinical interest in patients with and without type 2 diabetes mellitus (T2DM) for their pleiotropic beneficial effects. Objectives To investigate in-hospital and long-term prognosis in a cohort of T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-I versus other oral anti-diabetic (OAD) agents (non-SGLT2-I users). Methods In this multicenter international registry all consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled and, based on the admission anti-diabetic therapy, divided into SGLT-I users versus non-SGLT2-I users. In-hospital outcomes included cardiovascular death, recurrent AMI, occurrence of arrhythmias, and contrast-induced acute kidney injury (CI-AKI). Long-term outcomes were cardiovascular mortality, recurrent AMI, heart failure (HF) hospitalization, and their composite (MACE). Results The study population consisted of 646 AMI patients (with or without ST-segment elevation): 111 SGLT2-I users and 535 non-SGLT-I users. The use of SGLT2-I was associated with a significantly lower in-hospital cardiovascular death, arrhythmic burden, and occurrence of CI-AKI (all p&amp;lt;0.05). During a median follow-up of 24±13 months, cardiovascular mortality, HF hospitalization and the composite endpoint were lower for SGLT2-I users compared to non-SGLT2-I patients (p&amp;lt;0.04 for all). After adjusting for confounding factors, the use of SGLT2-I was identified as independent predictor of HF hospitalization (HR=0.46; 95%CI:0.21-0.98; p=0.041) and MACE occurrence (HR=0.57; 95%CI:0.33-0.99; p=0.039). Conclusions In T2DM AMI patients, the use of SGLT2-I was associated with a lower risk of adverse cardiovascular outcomes during index hospitalization and long-term follow-up. Our findings provide new insights into the cardioprotective effects of SGLT2-I in the setting of AMI.

Outcomes in diabetic patients treated with SGLT2-Inhibitors with acute myocardial infarction undergoing PCI: The SGLT2-I AMI PROTECT Registry

AimsTo investigate in-hospital and long-term prognosis in T2DM patients presenting with acute myocardial infarction (AMI) treated with SGLT2-I versus other oral anti-diabetic agents (non-SGLT2-I users). MethodsIn this multicenter international registry all consecutive diabetic AMI patients undergoing percutaneous coronary intervention between 2018 and 2021 were enrolled and, based on the admission anti-diabetic therapy, divided into SGLT-I users versus non-SGLT2-I users. The primary endpoint was defined as a composite of cardiovascular death, recurrent AMI, and hospitalization for HF (MACE). Secondary outcomes included i) in-hospital cardiovascular death, recurrent AMI, occurrence of arrhythmias, and contrast-induced acute kidney injury (CI-AKI); ii) long-term cardiovascular mortality, recurrent AMI, heart failure (HF) hospitalization. ResultsThe study population consisted of 646 AMI patients (with or without ST-segment elevation): 111 SGLT2-I users and 535 non-SGLT-I users. The use of SGLT2-I was associated with a significantly lower in-hospital cardiovascular death, arrhythmic burden, and occurrence of CI-AKI (all p < 0.05). During a median follow-up of 24 ± 13 months, the primary composite endpoint, as well as cardiovascular mortality and HF hospitalization were lower for SGLT2-I users compared to non-SGLT2-I patients (p < 0.04 for all). After adjusting for confounding factors, the use of SGLT2-I was identified as independent predictor of reduced MACE occurrence (HR=0.57; 95%CI:0.33–0.99; p = 0.039) and HF hospitalization (HR=0.46; 95%CI:0.21–0.98; p = 0.041). ConclusionsIn T2DM AMI patients, the use of SGLT2-I was associated with a lower risk of adverse cardiovascular outcomes during index hospitalization and long-term follow-up. Our findings provide new insights into the cardioprotective effects of SGLT2-I in the setting of AMI. RegistrationData are part of the observational international registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov Identifier: NCT05261867.

Effect of PCSK9 Inhibitor on Contrast-Induced Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Intervention Therapy.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to inhibit pyroptosis and apoptosis, which play important roles in the development and progression of contrast-induced acute kidney injury (CI-AKI). However, to the best of our knowledge, no studies have investigated the potential effect of PCSK9 inhibitors on the prevalence of CI-AKI after percutaneous coronary intervention (PCI). This study aimed to determine whether PCSK9 inhibitors are associated with the prevalence of CI-AKI. The medical records of 309 (mean age, 63.35 years; 71.84% male) patients with acute myocardial infarction who underwent PCI at our institution were retrospectively analyzed. Overall, 149 and 160 patients were assigned to the evolocumab and control groups, respectively. Serum creatinine levels were examined preoperatively and 24–72 h postoperatively and compared between groups. Data were grouped according to the occurrence of CI-AKI, and a univariate analysis was conducted to exclude suspected influencing factors that led to CI-AKI occurrence. After adjusting for confounding factors, a logistic regression analysis was performed to assess the association between evolocumab administration (independent variable) and CI-AKI occurrence (dependent variable). The prevalence of CI-AKI was significantly lower in the evolocumab group (6.7%) than in the control group (20.0%; p < 0.01).We further evaluated the correlation between exposure factor and outcome. The relative risk(RR) between the use of evolocumab and the occurrence of CI-AKI was 0.34(95% CI 0.17-0.66,p<0.01).This result indicate a significant association between the use of evolocumab and a reduction in the incidence of CI-AKI.The logistic regression analysis results revealed that evolocumab was significantly associated with CI-AKI. The use of PCSK9 inhibitors, hydration therapy, and statin administration appears promising for preventing CI-AKI in patients with acute myocardial infarction undergoing PCI.

Risk factors for acute renal injury caused by contrast media after percutaneous coronary intervention and coronary angiography: A protocol for systematic review and meta-analysis.

Background:Contrast-induced acute kidney injury (CI-AKI) caused by contrast medium is one of the common complications of percutaneous coronary intervention (PCI)/coronary angiography (CAG). Early identification of the risk factors of CI-AKI in patients with PCI/CAG and help clinical staff to prevent and intervene as soon as possible is very important to improve the clinical outcome of patients. Although domestic and foreign scholars have studied and summarized the risk factors of CI-AKI in PCI/CAG, the conclusions are not the same. Therefore, in this study, meta-analysis was used to summarize the risk factors of CI-AKI in patients with PCI/CAG, and to explore the characteristics of high-risk groups of CI-AKI, to provide reference for early identification and prevention of clinical doctors and nurses.Methods:We will search related literature of PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Eligible studies will be screened based on inclusion criteria, and data extraction, risk of bias assessment, publication bias assessment, subgroup analysis, and quality assessment will be performed. Review Manager version 5.3 software will be used for data analysis. Each process is independently conducted by 2 researchers, and if there is any objection, it will be submitted to the third researcher for resolution.Results:We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Conclusions:The results of this analysis can be used to generate a risk prediction model and provide an intervention strategy for the occurrence of CI-AKI in PCI/CAG.

Development and Validation of a Risk Nomogram Model for Predicting Contrast-Induced Acute Kidney Injury in Patients with Non-ST-Elevation Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention.

ObjectiveTo establish a nomogram model to predict the risk of contrast-induced acute kidney injury (CI-AKI) by analyzing the risk factors of CI-AKI and to evaluate its effectiveness.MethodsRetrospectively analyze the clinical data of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI) in our cardiology department from September 2018 to June 2021. Of these, patients who underwent PCI in an earlier period formed the training cohort (70%; n = 809) for nomogram development, and those who underwent PCI thereafter formed the validation cohort (30%; n = 347) to confirm the model’s performance. The independent risk factors of CI-AKI were determined by LASSO regression and multivariable logistic regression analysis. By using R software from which nomogram models were subsequently generated. The nomogram was developed and evaluated based on discrimination, calibration, and clinical efficacy using the concordance statistic (C-statistic), calibration plot, and decision curve analysis (DCA), respectively.ResultsThe nomogram consisted of six variables: age >75, left ventricular ejection fraction, diabetes mellitus, fibrinogen-to-albumin ratio, high-sensitive C-reactive protein, and lymphocyte count. The C-index of the nomogram is 0.835 (95% CI: 0.800–0.871) in the training cohort and 0.767 (95% CI: 0.711–0.824) in the validation cohort, respectively. The calibration plots exhibited that the nomogram was in good agreement between prediction and observation in the training and validation cohorts. Decision curve analysis and clinical impact curve suggested that the predictive nomogram had clinical utility.ConclusionThe nomogram model established has a good degree of differentiation and accuracy, which is intuitively and individually to screen high-risk groups and has a certain predictive value for the occurrence of CI-AKI in NSTE-ACS patients after PCI.

The Association of Serum Lactate Level with the Occurrence of Contrast-Induced Acute Kidney Injury and Long-Term Prognosis in Patients Undergoing Emergency Percutaneous Coronary Intervention.

ObjectiveThe association of lactate and contrast-induced acute kidney injury (CI-AKI) has not been well established. This prospective study was planned to identify the effects of lactate level on the occurrence of CI-AKI and long-term prognosis with acute myocardial infarction (AMI) patients undergoing emergency percutaneous coronary intervention (PCI).MethodsA total of 280 patients with AMI who underwent emergency PCI were selected from March 2018 to March 2019. A receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off value of lactate on predicting CI-AKI after PCI. A multivariable logistic regression model was used to explore the significant predictors that might affect the occurrence of CI-AKI after univariate analysis. The primary endpoints were clinical outcomes including events: a combined endpoint of major adverse cardiovascular events, re-hospitalization due to heart failure, and worsening renal function. The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.ResultsAmong the 280 patients, 64 patients (22.9%) developed CI-AKI after emergency PCI procedure. Multivariable logistic regression analysis revealed that baseline lactate level was the independent risk factor for the development of CI-AKI (OR, 3.657; 95% CI, 2.237–5.978; p<0.001). The area under the ROC curve for predicting CI-AKI of lactate was 0.786, and the optimum cut-off point of lactate was 3.02 mmol/L, with sensitivity of 65.6% and specificity of 85.2%. The incidence of primary endpoints in the high lactate group (lactate ≥3.02mmol/L) was significantly increased compared with the control group [26.3% (42/160) vs 15.8% (19/120), χ2=4.430, p=0.035]. Cox regression analysis also confirmed high lactate was an independent predictor for primary endpoint outcomes at 1-year follow-up (HR, 1.916; 95% CI, 1.118–3.285; p=0.018).ConclusionOur study demonstrates that baseline high lactate levels may be associated with an increased risk of CI-AKI and are the important predictors of long-term poor cardiorenal outcomes in AMI patients undergoing emergency PCI.

Impact of Radial Access on Contrast-Induced Acute Kidney Injury in Patients With Coronary Artery Bypass Grafts

PurposeWe investigated the impact of radial access on contrast-induced acute kidney injury (CI-AKI) in patients with coronary artery bypass graft (CABG) undergoing cardiac catheterization. MethodsThis retrospective monocenter study included 527 CABG patients undergoing cardiac catheterization via radial (58.1%, N = 306) or femoral access (41.9%, N = 221). Primary outcome measure was CI-AKI defined in accordance with the KDIGO criteria. Independent predictors for CI-AKI were assessed. 1-year mortality was assessed depending on the occurrence of CI-AKI. ResultsIn total, 99 CABG patients (18.8%) developed CI-AKI within 48 h after cardiac catheterization. Compared to patients without CI-AKI, amount of contrast media used (203.1 ± 102.6 ml vs. 204.2 ± 98.2 ml; P = 0.892) as well as procedural times (87.9 ± 44.8 vs. 79.8 ± 37.0; P = 0.190) were similarly. Regarding vascular access, there was no significant difference in the incidence of CI-AKI between radial and femoral approach (19.0% vs. 18.6%; p = 0.907). However, poor left ventricular ejection fraction (odds ratio [OR] = 1.72, P = 0.026), chronic kidney disease (OR = 2.30, P = 0.001) and acute coronary syndrome (OR = 1.64, P = 0.043) were independent predictors for CI-AKI. The occurrence of CI-AKI was significantly associated with an increased 1-year mortality (hazard ratio [HR] = 2.52, P = 0.003). ConclusionsWith 18.8%, CI-AKI is a frequent complication in CABG patients undergoing cardiac catheterization. Radial access did not decrease the risk when compared to the femoral approach.

Effect of Oral Hydration on Contrast-Induced Acute Kidney Injury among Patients after Primary Percutaneous Coronary Intervention

Objectives: The purpose of this study was to evaluate the protective effect of oral hydration volume to weight ratio (OHV/W) on contrast-induced acute kidney injury (CI-AKI) among patients with ST-elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI). Methods: A total of 754 patients with STEMI undergoing PCI were selected. Each patient was encouraged to drink as much water as possible 24 h after PCI. Total volume intake was recorded for all patients. The ratio of OHV/W was calculated. The occurrence of CI-AKI was defined as ≥0.5 mg/dL absolute or ≥25% relative increase in serum creatinine within 48–72 h following PCI. Logistic regression analysis and generalized additive model were performed to evaluate the relationship between OHV/W and CI-AKI. Results: There was a nonlinear relationship between OHV/W and CI-AKI with an inflection point of 15.69 mL/kg. On the right side of the inflection point (OHV/W ≥15.69 mL/kg), a negative relationship was detected between OHV/W and CI-AKI (HR = 0.90, 95% CI: 0.82∼0.98, p = 0.0126). However, no relationship was observed between OHV/W and CI-AKI on the left of inflection point (HR = 1.19, 95% CI: 0.95∼1.49, p = 0.1302). Subgroup analysis showed that significant interactions were observed only for gender difference (p for interaction = 0.0155), male patients had a significantly lower risk of CI-AKI (HR = 0.84, 95% CI: 0.75∼0.93, p = 0.0012). Conclusion: OHV/W ≥15.6 mL/kg for 24 h post-procedure may be an effective preventive strategy of CI-AKI. In addition, male patients may particularly benefit from OHV to prevent CI-AKI.

Predictors and outcome of contrast-induced acute kidney injury in older patients presenting with acute coronary syndrome

Abstract Background The number of older patients presenting with acute coronary syndrome (ACS) is increasing. Routine percutaneous coronary intervention (PCI) is performed in order to improve outcome, but comorbidities associated with aging lead to a higher risk of treatment complications. Contrast-induced acute kidney injury (CI-AKI) represents potential harm in older and frail patients, but its impact on long term prognosis is not clear. Purpose To evaluate occurrence, predictors, and impact on long term outcome of CI-AKI in elderly patients presenting with ACS. Methods A prospective cohort of 392 older (≥70 years) ACS patients who underwent coronary angiography was enrolled. CI-AKI was defined as a serum creatinine increase at least ≥0.3 mg/dl in 48 h or at least ≥50% in 7 days. According to our department protocol, prophylactic hydration was performed to all patients with isotonic saline, given intravenously at a rate of 1 ml/kg body weight/h (0.5 ml/kg for patients with left ventricular ejection fraction &amp;lt;35%) for 12 h before (unless for emergent patients) and 24 h after PCI. Median follow up was 4 [3.0–4.1] years. Long term adverse outcomes include all-cause mortality and any hospitalization for cardiovascular causes (ACS, heart failure, arrhythmia, cerebrovascular accident). Results CI-AKI was observed in 72 patients (18.4%). Among patients who developed or not CI-AKI, no difference was found between clinical presentation (Non-ST segment elevation myocardial infarction (NSTEMI) vs. STEMI), left ventricular ejection fraction and multivessel coronary disease. Estimated glomerular filtration rate (odd ratio (OR) 3.59, confidence interval (CI) 1.79–7.20, p&amp;lt;0.001), contrast media volume (OR 1.006, CI 1.002–1.009, P=0.001), white blood cells (OR 1.18, CI 1.10–1.27, p&amp;lt;0.001), haemoglobin level (OR 0.81, CI 0.70–0.94, p=0.005) and chronic obstructive pulmonary disease (OR=5.37, CI 2.24–12.90, p&amp;lt;0.001) were independent predictors for CI-AKI. Patients with CI-AKI presented increased mortality rate both at 30-days (2.7% vs 0%, p=0.038) and at 4-years follow-up (all cause death 23.6 vs. 11.6%, p=0.013) (Figure 1: long term adverse outcomes). Multivariable Cox proportional hazards analysis revealed that diabetes (hazard ratio, HR 1.99, CI 1.33–2.97, p=0.001), atrial fibrillation (HR 2.49, CI 1.59–3.91, p&amp;lt;0.001), Killip class &amp;gt;1 (HR 2.20, CI 1.32–3.67, p=0.003) and haemoglobin level (HR 0.84, CI 0.76–0.92, p&amp;lt;0.001) were independently associated with adverse outcome, while CI-AKI represent a risk factor only at univariate analysis. Conclusions CI-AKI is a common complication among older adults undergoing coronary angiography for ACS. Patients who developed CI-AKI had worse outcome at long term follow-up. Actually, the occurrence of CI-AKI was not identified as an independent predictor for long-term adverse outcome, while it may represent a marker of severity of comorbidity and consequent poor prognosis, rather than a causal agent itself. Figure 1. Kaplan-Maier Curve Funding Acknowledgement Type of funding source: None

SAT-026 THE PROTECTIVE ROLE OF ROSUVASTATIN AGAINST CONTRAST INDUCED ACUTE KIDNEY INJURY; A RANDOMIZED CLINICAL TRIAL

The risk of contrast-induced acute kidney injury (CI-AKI) as a deteriorating factor of renal function has been well demonstrated previously. While the exact mechanism of CI-AKI in not still understood, but many studies have investigated the effect of various drugs in order to prevention of nephrotoxic mechanisms. One of the drugs' category of recent interest is Statins and especially Atorvastatin. The aim of this study was to evaluate the effect of Rosuvastatin – as a newer member of the statins family – in the prevention of CI-AKI. Patients who were candidate for CT scan with contrast during 2018 to 2019 were randomly divided into two groups. The first group received 20 mg Rosuvastatin 24 hours before receiving the contrast followed by 10 mg Rosuvastatin for two consequent days, while the second group received placebo at the same times. Considering the baseline serum's creatinine, patients were examined for probable onset of CI-AKI for next 72 hours after contrast injection. Gathered data were analyzed using SPSS software version 24 and p-value less than 0.05 was considered significant. There were no significant differences regarding age, sex, diabetes mellitus, hypertension and estimated glomerular filtration rate (eGFR) between Rosuvastatin-received group (204 individuals) and placebo-received group (198 patients) at the onset of study. Although there was a decrease in eGFR in the placebo-received group (p-value:0.02), no similar changes were observed in the Rosuvastatin-received group (p-value:0.20) in three days follow up after receiving contrast for CT scan. CI-AKI occurrence were 1% and 4% in Rosuvastatin-received group and placebo-received group respectively and there was a significant difference between groups (p-value:0.04). Based upon our data and similar previous studies, It's believed that Rosuvastatin could be considered as a protective agent against CI-AKI and can reduce renal injuries and decreased eGFR related to contrast injection.

Efficacy and Safety of a Balanced Salt Solution Versus a 0.9% Saline Infusion for the Prevention of Contrast-Induced Acute Kidney Injury After Contrast-Enhanced Computed Tomography

Rationale & ObjectiveWe aimed to elucidate whether a balanced salt solution decreases the occurrence of contrast-induced acute kidney injury (CI-AKI) after contrast-enhanced computed tomography (CE-CT) as compared to 0.9% saline solution.Study DesignA randomized clinical trial.Setting & ParticipantsThe study was performed in 14 tertiary hospitals in South Korea. Patients with estimated glomerular filtration rates (eGFRs) < 45 or <60 mL/min/1.73 m2 and additional risk factors (age ≥ 60 years or diabetes) who were undergoing scheduled CE-CT were included from December 2016 to December 2018.InterventionAn open-label intervention was performed. The study group received a balanced salt solution and the control group received 0.9% saline solution as prophylactic fluids for CE-CT.OutcomesThe primary outcome was CI-AKI, defined by creatinine level elevation ≥ 0.5 mg/dL or 25% from baseline within 48 to 72 hours after CE-CT. Secondary outcomes included AKI defined based on the KDIGO (Kidney Disease: Improving Global Outcomes) guideline, eGFR changes, death, or requiring dialysis within 6 months after CE-CT.Results493 patients received the study fluids. The control and study groups included 251 and 242 patients, respectively. The occurrence of CI-AKI in the study (10 [4.2%]) and control (17 [6.8%]) groups was not significantly different (P = 0.27). No significant difference was present for the secondary outcomes; AKI by the KDIGO definition (study: 19 [7.9%], control: 27 [10.8%]; P = 0.33), death/dialysis (study: 11 [4.7%], control: 9 [3.7%]; P = 0.74), and eGFR changes (study: 0.1 ± 0.2 mg/dL, control: 0.3 ± 2.8 mg/dL; P = 0.69).LimitationsThis study failed to meet target enrollment.ConclusionsThe risk for CI-AKI was similar after administration of a balanced salt solution and after use of 0.9% saline solution during CE-CT in higher-risk patients.FundingThis study was funded by CJ Healthcare (CS2015_0046).Trial RegistrationRegistered at ClinicalTrials.gov with study number NCT02799368.

Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis.

Aims Many previous studies have examined the effect of different hydration strategies on prevention of contrast-induced acute kidney injury (CI-AKI), but the optimal strategy is unknown. We performed a network meta-analysis (NWM) of these previous studies to identify the optimal strategy. Methods and Results Web of Science, PubMed, OVID Medline, and Cochrane Library were searched from their inception dates to September 30, 2018. Randomized controlled trials (RCTs) were selected based on strict inclusion criteria, and a Bayesian NWM was performed using WinBUGS V.1.4.3. We finally analyzed 60 eligible RCTs, which examined 21,293 patients and 2232 CI-AKI events. Compared to intravenous 0.9% sodium chloride (reference), intravenous sodium bicarbonate (OR [95% CI]: 0.74 [0.57, 0.93]), hemodynamic guided hydration (0.41 [0.18, 0.93]), and RenalGuard guided hydration (0.32 [0.14, 0.70]) significantly reduced the occurrence of CI-AKI. Oral hydration and intravenous 0.9% sodium chloride were each noninferior to no hydration in preventing CI-AKI. Intravenous 0.9% sodium chloride, sodium bicarbonate, and hemodynamic guided hydration were each noninferior to oral hydration in preventing CI-AKI. Based on surface under the cumulative ranking curve values, the RenalGuard system was best (0.974) and hemodynamic guided hydration was second best (0.849). Conclusion There was substantial evidence to support the use of RenalGuard or hemodynamic guided hydration for preventing CI-AKI in high-risk patients, especially those with chronic kidney disease or cardiac dysfunction.