Prevalence Of Contrast-induced Nephropathy Research Articles

Prevalence of contrast-induced nephropathy after primary percutaneous coronary intervention at a tertiary referral hospital

ObjectiveThis study aimed to quantify the incidence of Contrast-induced nephropathy (CIN) in patients undergoing primary percutaneous coronary intervention (PPCI) due to acute ST-elevation myocardial infarction (STEMI). MethodsFrom April 2019 to March 2022, a prospective, observational study enrolled 213 consecutive STEMI patients referred to a tertiary hospital for PPCI. Participants were divided into tow groups based on the presence or absence of contrast-induced nephropathy. The chi-square test (χ2) and Student's t-test evaluated the data, with logistic regression identifying CIN's independent predictors. ResultsResults: In this study, the incidence of contrast-induced nephropathy was observed at 13.1% (N = 28). Several factors were more prevalent among patients exhibiting contrast-induced nephropathy. These factors encompassed: radial access for coronary angiography over the femoral method (P = 0.021), elevated contrast volume (P = 0.003), smoking (P = 0.009), diabetes (P = 0.04), heart failure (P = 0.049), a history of coronary artery bypass graft (P = 0.006), diminished left ventricular ejection fraction indicating systolic dysfunction (P = 0.012), cardiogenic shock (P = 0.046), increased BUN at the time of admission (P = 0.043), decreased initial GFR (P = 0.004), and prior consumption of medications such as aspirin (P = 0.002), diuretics (P = 0.046), beta blockers (P = 0.04), angiotensin-converting enzyme inhibitors (P = 0.033), angiotensin receptor blockers (P = 0.02). Other relevant conditions included anemia (P = 0.012), leukocytosis (P = 0.011), hypercholesterolemia (P = 0.034), and reduced HDL levels (P = 0.004).Through logistic regression, key predictors for the onset of contrast-induced nephropathy were determined, which included heart failure (OR: 5.52; 95% CI: 1.08–28.24), radial access (OR: 12.71; 95% CI: 1.45–110.9), hypercholesterolemia (OR: 1.02; 95% CI: 1.004–1.04), increased BUN upon admission (OR: 1.11; 95% CI: 1.006–1.24), and leukocytosis (OR: 2.03; 95% CI: 1.18–3.49). ConclusionsWhile heart failure, radial access, hypercholesterolemia, elevated BUN at admission, and leukocytosis significantly influenced renal filtration deterioration post-PPCI, it's evident that CIN is multifactorial. Further studies are crucial to elucidate the underlying factors.

Contrast-induced Nephropathy among Patients Administered with Contrast Material at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Administration of an intravenous contrast medium, which is used in various routine hospital procedures, can lead to the development of nephropathy in some patients. This contrast-induced nephropathy is one of the most common reasons for hospital-acquired acute kidney injury. This study aimed to find out the prevalence of contrast-induced nephropathy among patients administered with contrast material at a tertiary care centre. This descriptive cross-sectional study was conducted from 4 March 2022 to 23 May 2022 at a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 0812202106). Patients administered with an intravenous contrast medium for diagnostic imaging were included in the study. Data including sociodemographic variables and renal function test results were collected. A convenience sampling method was used. Point estimate was done and 95% Confidence Interval was calculated. Among 174 participants, contrast-induced nephropathy was found in 86 (48.31%) (48.24-48.39, 95% Confidence Interval). The study showed that the prevalence of contrast-induced nephropathy was higher than findings from other studies done in a similar setting. contrast material; kidney disease; prevalence.

Effect of Carvedilol Versus Metoprolol on Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Intervention Therapy.

Carvedilol can inhibit inflammation, vasoconstriction, and oxidative stress, which play important roles in the development and progression of contrast-induced nephropathy (CIN). To the best of our knowledge, no studies have investigated the potential effect of carvedilol on the prevalence of CIN after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The present study aimed to determine whether carvedilol use is associated with the development of CIN. A total of 319 patients (mean age, 59.2 ± 12.4years; 77.7% male) with ACS who underwent urgent PCI at our institution between May 2019 and May 2022 were included prospectively. Overall, 100 and 219 patients were assigned to the carvedilol and metoprolol groups, respectively. The prevalence of CIN was significantly lower in the carvedilol group (6.0%) than in the metoprolol group (18.3%; P = .003). Multivariate analysis revealed that carvedilol use (odds ratio [OR] .250, 95% confidence interval [CI] .092-.677, P = .006), amount of contrast agent (OR 1.004, 95% CI 1.000-1.008, P = .031), and admission estimated glomerular filtration rate (OR .978, 95% CI 0.960-.995, P = .014) were independently associated with the development of CIN. The use of carvedilol may be a promising option for the prevention of CIN in patients with ACS undergoing urgent PCI.

Impact of 719Trp>Arg Polymorphism of KIF 6 Gene on Contrast Induced Nephropathy in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention.

Background:The identification of preventive strategies, such as statin therapy, is crucial for the management of contrast-induced nephropathy (CIN). Several studies showed the association between KIF6 polymorphism (replacement of Trp719 with Arg) and an increased cardiovascular risk, while others showed a correlation between ‘pleiotropic’ effects of statins and a reduction in cardiovascular events in the population with the risk allele due to the documented modulation of response to statin by KIF6 polymorphism. Aim of this study is to assess the impact of KIF6 polymorphism on the development of CIN.Methods:We analysed 1253 consecutive patients undergoing coronary angiography/PCI. Serum creatinine was collected at baseline, 24 and 48 hours after contrast exposure. We identified the different allelic patterns and assessed the incidence of CIN (absolute increase of 0.5mg/dL or relative >25% in creatinine at 24 and 48h).Results:KIF6 Arg mutation was found in 669 patients (heterozygotes n = 525, homozygotes n = 144). The total prevalence of CIN was 12.5% and we did not find any association between KIF6 polymorphism and CIN development (11.3%, 13.7%, 13.2% p = 0.30). At subgroups analysis among statin ‘naïve’ patients we found a higher prevalence of CIN in homozygous patients as compared to wild-type (20.7% vs 11.3%, p = 0.05), while opposite results were observed among patients with statin therapy (8.6% vs 13.2%, p = 0.28).Conclusion:KIF6 homozygous Arg was associated with a significant increase in the risk of CIN only among statin naive patients. Future studies are needed to evaluate the beneficial effects of statin especially in this subset of patients.

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).

Contrast-induced nephropathy after staged balloon pulmonary angioplasty: lower risk compared with left-sided cardiac procedures

Abstract Introduction The risk of contrast-induced nephropathy (CIN) after left-sided cardiac procedures is reported as 10–15%. When the ratio of total contrast volume in ml to glomerular filtration rate (GFR) in mL/min (ratio V/GFR) exceeds 3.7, the risk increases significantly. However, there are few reports regarding the risk of CIN in patients (pts) with right-sided cardiac interventions such as balloon pulmonary angioplasty (BPA) and ratio V/GFR is not validated for use in this procedures. Purpose To assess the prevalence of CIN in pts with chronic thromboembolic pulmonary disease with or without hypertension (CTEPH/CTED) undergoing BPA. Methods Prospective single-centre study that included all BPA sessions performed from 2017 to 2020. Serum creatinine concentration (SC) was measured and the GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) before and 48 hours after each BPA procedure and 6 months after BPA treatment completion. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dL in SC from the baseline value within 48h of contrast administration. Results 76 consecutive BPA sessions were performed in 15 CTEPH/CTED pts: mean age 63.2±14.0 years, 60% female, 86.7% CTEPH, mean of 5.3±1.9 sessions per patient with 4.3±1.9 vessels dilated per session. Mean value of GFR before BPA program was 73.5±26.3 mL/min. All the procedures were performed using low-osmolality contrast agent with a 1:1 dilution ratio with normal saline solution. Pts received 273.0±73.0 mL of contrast per session with a ratio V/GFR 3.7±1.7 mL. SC and GFR did not change significantly within 48h after BPA (+3.1%, p=0.07 and −3.0%, p=0.13, respectively). Ratio V/GFR >3.7 occurred in 44.3% of cases (n=31), but CIN occurred in only 5.3% (n=4) with an increase in SC <0.5 mg/dL but ≥25% in 3 cases (+33% in mean) and ≥0.5 mg/dL in 1 case. None of the pts required renal replacement therapy. Higher SC and lower GFR 48h after BPA were significantly correlated with greater rato V/GFR during procedure (r=0.75, p<0.01 and r=−0.74, p<0.01, respectively) – see figure. But neither higher values of ratio V/GFR (OR 1.43; CI95% 0.84–2.41; p=0.19) nor V/GFR >3.7 (OR 1.28; CI95% 0.17–9.6; p=0.81) were predictors of CIN. GFR before procedure did not influence the contrast volume administered (p=0.901), number of vessels (p=0.63) and segments treated by session (p=0.45). At 6 months follow-up, there was a trend for SC (1.3±0.2 mg/dL vs 1.1±0.2 mg/dL, −15%, p=0.43) and GFR (44.5±8.3 mg/dL vs 53.0±12.6 mg/dL, +16%, p=0.34) improvement in pts with impaired renal function at baseline (GFR<60 mL/min). Conclusions These findings suggested that the occurrence of CIN after BPA was low, raising the hypothesis that the influence of contrast agent on renal function could differ in right-sided cardiac interventions. Although the ratio V/GFR may be correlated with the risk of nephropathy, it is necessary to find a new cut-off to predict CIN in BPA pts. Funding Acknowledgement Type of funding sources: None.

Prevalence of contrast nephropathy following the administration of N-acetyl cysteine; a systematic review and meta-analysis

Introduction: Nephropathy is a serious complication in patients receiving contrast during imaging. N-acetyl cysteine (NAC) can reduce the contrast nephropathy. This review evaluates the prevalence of contrast-induced nephropathy (CIN) following the administration of NAC. Methods: A systematic literature search and meta-analysis was conducted in Scopus, Web of Science and PubMed for articles published by December 30, 2019 including the keywords of "N-acetyl cysteine ", "Acute kidney injury", "Nephrotoxicity", "Contrast media", "Contrast-induced AKI" and "Contrast nephropathy". Results: A total of 29 articles of 537 studies examining 5,980 individuals were incorporated in this systematic review and meta-analysis. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 9% (0.09), i.e. nine out of every 100 patients undergoing contrast media resulted in CIN but a prevalence of 14% (0.14) was observed in the placebo group. In addition, 41 out of every 100 patients with hypertension undergoing contrast media resulted in CIN (prevalence: 41%) and 64 out of every 100 patients with diabetes undergoing contrast media resulted in CIN (prevalence: 64%). Conclusion: The prevalence of CIN in the group receiving NAC is lower than those who did not receive this drug. Additionally, in patients suffering from diabetes and hypertension, CIN is more prevalent compared to healthy people.

The effect of trimetazidine on contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention - A systematic review and meta-analysis.

In this study, we aimed to evaluate whether the trimetazidine administration before CAG and/or PCI reduces the incidence of contrast-induced nephropathy (CIN). We also aimed to evaluate the factors affecting the effect and the certainty of the evidence. A systematic literature search was performed to obtain studies that assess trimetazidine's effect on the incidence of CIN in CAG/PCI patients up until 21 January 2021 through PubMed, Embase, and Scopus. The main outcome is CIN, defined as the increase in serum creatinine level ≥ 0.5 mg/dL (44.2 mmol/L) or > 25% of the baseline value 48-72 h after contrast media (CM) administration. This systematic review and meta-analysis includes seven studies involving a total of 1590 patients. The prevalence of CIN was 11% [8%, 14%]. CIN's prevalence was 6% [4%, 8%] in the trimetazidine group and 16% [12%, 20%] in the control group. Trimetazidine use is associated with a lower incidence of CIN (RR 0.46 [0.34, 0.63], p<0.001; I2: 0%) with a high certainty of evidence, with an absolute risk reduction of 78 fewer per 1000. Subgroup analysis in patients with renal insufficiency showed that trimetazidine lowers the risk of CIN (RR 0.40 [0.26, 0.61], p<0.001; I2: 0%). The CIN reducing effect of trimetazidine was not significantly influenced by the age (p=0.960), body mass index (p=0.816), hypertension (p=0.595), diabetes (p=0.362), ejection fraction (p=0.261), baseline serum creatinine (0.579), and contrast media volume (p=0.958). Trimetazidine administration decreases the risk of CIN in patients undergoing CAG/PCI.

High-Dose Atorvastatin Raises Threshold of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Elective Coronary Intervention: A Randomized Controlled Study

Background. Contrast-induced nephropathy (CIN) is a significant complication of angiographic procedures resulting from injection of iodinated contrast media (CM). Patients with diabetes mellitus (DM) are at the highest risk of CIN. Statins have recently been proposed for protection against CIN due to their antioxidant and anti-inflammatory properties. Aim of Work. To investigate the potential benefit of acute pretreatment with high-dose atorvastatin (80 mg) in reduction of the incidence of CIN in diabetic patients indicated for elective coronary intervention. Patients and Methods. 200 diabetic patients with indication for coronary intervention were enrolled in the study. 100 patients will be randomly assigned to receive atorvastatin (80 mg) just before coronary intervention (statin group) and 100 patients received placebo (control group). CIN was defined as a rise of serum creatinine of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 hours of the angiography. After the procedure, Thrombolysis in Myocardial Infarction (TIMI) flow of the culprit vessel was reported, as well as the volume of used contrast media and time of X-ray exposure. Results. Our study reported a CIN incidence of 12, 18, and 6% among the whole study, placebo, and statin groups, respectively, P value of 0.001. Among the placebo group, CIN is likely to develop after a 13.5-minute X-ray exposure time with a specificity of 73.2% and sensitivity of 77.8%, area under the curve (AUC) of 0.879 (CI: 0.798–0.960), and P value of 0.001, while in the statin group, CIN is likely to develop after 14.5-minute X-ray exposure time with a specificity of 74.5% and sensitivity of 83.3%, AUC of 0.818 (CI: 0.727–0.910), and P value of 0.009. In the placebo group, CIN is likely to develop after injection of 145 ml of contrast media with a specificity of 75.6% and sensitivity of 77.8%, AUC of 0.855 (CI: 0.757–0.952), and P value of 0.001, while in the statin group, CIN is likely to develop after injection of 165 ml of contrast media with a specificity of 84% and sensitivity of 83.3%, AUC of 0.878 (CI: 0.811–0.944), and P value of 0.002. Conclusions. Acute pretreatment with high-dose atorvastatin can effectively protect against CIN and was associated with a marked decrease in the prevalence of CIN in diabetic patients undergoing coronary interventions. Moreover, pretreatment with high-dose atorvastatin raises the threshold of X-ray exposure time and the amount of contrast media beyond which CIN is likely to develop. The trial is registered with NCT04375787.

CONTRAST-INDUCED NEPHROPATHY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND 1-YEAR PROGNOSIS

Aim. The aim of our study was to assess the prevalence of contrast-induced nephropathy (CIN) in patients with chronic coronary artery disease (CAD) and its 1-year prognostic significance.Materials and methods. 462 patients with chronic CAD and indications to the interventions with intraarterial contrast media administration were included in the study. We conducted a prospective open cohort study (ClinicalTrials.gov NCT04014153). The primary endpoint was the development of CIN. The secondary endpoints were total mortality, cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, acute decompensation of heart failure, coronary artery bypass grafting, repeat percutaneous coronary intervention.Results. 28 patients (6%) developed CIN. The rate of CIN in female patients was twice higher, than in males (9,29% vs. 4,66%). There was a trend towards less cases of CIN in patients without obesity (5,88% vs. 6,22%). CIN developed more frequently in patients with anemia (8,9% и 5,7%, р=0,3649, ОR 1,633,95% CI 0,6507-4,239). There was a trend to higher incidence of CIN in people with hyperuricemia (8% vs. 5,95%, р=0,6575, ОR 1,375,95% CI 0,3055-5,808). The rate of CIN in patients with diabetes mellitus was 2% higher, then without one. People, who suffered from myocardial infarction after 1 year of follow up, had the highest rate of CIN (26,7%), as well as patients with other major cardiovascular complications (18,1%). The rate of repeat percutaneous coronary interventions was 9,5%, the rate of acute decompensation of heart failure was 7%.Conclusion. The prevalence of CIN in patients with chronic CAD was 6%. After 1 year of follow up the rate of CIN was higher in patients who had myocardial infarction, repeat percutaneous coronary interventions and acute decompensation of heart failure.

Prevalence of contrast-induced nephropathy in cardiac patients in a hemodynamic sector

Objetivo: Determinar a prevalência da nefropatia induzida por contraste em pacientes cardiopatas submetidos a procedimentos angiográficos de diagnóstico e/ou tratamento. Método: Estudo prospectivo, quantitativo, realizado no setor de hemodinâmica de um hospital de grande porte, situado na região norte do Rio Grande do Sul, Brasil. A amostra foi constituída por 79 participantes através do cálculo de tamanho amostral. Resultados: A amostra foi formada por 52 (65,8%) homens e 27 (34,2%) mulheres. A idade média foi de 65,9 ± 9,52 anos. A incidência de nefropatia induzida por contraste foi de 30,38%, totalizando 24 pacientes. Conclusão: Foi evidenciada uma alta prevalência de nefropatia por contraste, apesar dos pacientes apresentarem poucos fatores de risco, o que ressalta a necessidade de medidas preventivas e redução do volume de contraste.

Effect of allopurinol in the prevention of contrast-induced nephropathy in patients undergoing angioplasty: randomized clinical trial

Introduction : Allopurinol could decrease the undesirable effects of free radicals and then prevent contrast induced nephropathy (CIN). Therefore, it may be useful for reducing the ischemia-reperfusion induced nephropathy and inhibiting nitric oxide synthesis produced in CIN. This study was performed aimeing to determine the effect of allopurinol in the prevention of CIN in patients undergoing angioplasty. Methods: In this randomized clinical trial, 100 patients (50 cases as the intervention group receiving allopurinol 300 mg one day and one hour before angiography and 50 cases as the control group) were evaluated. CIN was considered if the serum creatinine (SCr) value was increased 25% in relation to its basic value. Additionally, the prevalence of CIN was evaluated. Results: The case and control groups had CIN 38% and 12%, respectively (P = 0.003). Hyperuricemia was significant indicator of higher CIN rate in the control group (37.5% versus 7.1%) (P = 0.044). Conclusion: Finally, the administration of allopurinol before procedure might prevent CIN following elective percutaneous coronary intervention (PCI) and decrease the rate of CIN.

MON-227 ARE PATIENTS WITH DIABETES AT GREATER RISK FOR CONTRAST INDUCED NEPHROPATHY THAN THOSE WITHOUT DIABETES?

Contrast-induced nephropathy (CIN) is an important cause of acute kidney injury (AKI) in inpatients. However, the prevalence and predisposing factors for CIN remain poorly documented. The aim of this study was to investigate the association between CIN, kidney function and diabetic status in inpatients. We identified inpatients who received IV contrast prior to a computed tomography (CT) scan between July 2012 to March 2018 at Austin Health, Melbourne. Our study was restricted to patients > 54 years as all patients above this age who have a HbA1c measurement when admitted to our hospital as part of the Diabetes Discovery Initiative. Outpatients, patients <54 years, patients who had multiple CT scans with IV contrast and patients with a baseline estimated Glomerular Filtration Rate (eGFR) <30ml/min/1.73m2 were excluded. We obtained creatinine measurements at baseline and 48 hours post contrast administration and defined CIN as an absolute rise in creatinine of ≥44mmol/L. Patients were divided into those with and without a history of diabetes and/or those with renal impairment (defined as an eGFR < or ≥ 60/ml/min/1.73m2). Firth logistic regression model was used for data analysis. Out of 1280 patients, 28.75% had a history of diabetes and 29.53% had baseline eGFR of <60/ml/min/1.73m2 and 70.47% has baseline eGR of ≥60/ml/min/1.73m2. The overall prevalence of CIN was 3.2%. Pre-existing diabetes, degree of glycaemic control (assessed by admission HbA1c) or presence of renal impairment was not associated with an in increased risk of developing CIN. Patients with or without diabetes who had a CT scan with IV contrast appear to have a similar risk for the development of CIN after adjusting for other variables. A larger data set may yield different outcomes.

Contrast-Induced Nephropathy in Ischemic Stroke Patients Undergoing Computed Tomography Angiography: CINISter Study

Goal: Computed tomography angiography (CTA) is a well-tolerated, noninvasive study of the intracranial vascular circulation; however, contrast-induced nephropathy (CIN) has been reported in 5%-7% of patients undergoing CTA. Limited studies have evaluated the risks of CIN in patients undergoing CTA. Our study was designed to evaluate the prevalence and risk factors for CIN in patients with ischemic stroke who receive a CTA. Materials and Methods: Single-center, nested, case-control study of patients with ischemic stroke who received a CTA between June 18, 2012 and January 1, 2016. Patients were grouped based on development of CIN.Findings: A total of 209 patients were included in the final analysis (178 controls, 31 cases). The prevalence of CIN during the time period studied was 14.8% (95% confidence interval [CI]: 10.2-20.2). A higher proportion of patients who developed CIN had a history of diabetes mellitus (37 [20.56%] versus 15 [48.39%]; P = .0009) and reported taking no medications prior to admission (35 [19.44%] versus 11 [35.48%]; P = .0458). However, a lower proportion of patients who developed CIN had a history of smoking (59 [32.78] versus 3 [9.68]; P = .0091). After statistical adjustment, only a history of diabetes (odds ratio [OR] 4.15 [95% CI: 1.765, 9.754), taking no medications prior to admission (OR 3.56 [95% CI: 1.417, 8.941]) and a self-reported history of smoking (OR 0.204 [95% CI: 0.057, 0.721]) remained associated with the development of CIN. Conclusions: Those patients with a history of diabetes mellitus or not taking medications prior to admission should be monitored closely for the development of contrast-induced nephropathy CIN.

Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis.

BackgroundResults of studies on the efficacy of atorvastatin pretreatment on reducing the prevalence of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) have been controversial.ObjectiveWe undertook a meta-analysis to evaluate the efficacy of atorvastatin on contrast-induced nephropathy (CIN) after CAG or PCI.Materials and methodsWe undertook a systematic search of electronic databases (PubMed, Embase, and the Cochrane Library) up to June 2017. A meta-analysis was carried out including randomized controlled trials (RCTs) that compared atorvastatin pretreatment with pretreatment with a low-dose statin or placebo for CIAKI prevention in patients undergoing CAG. The main endpoint was CIN prevalence.ResultsNine RCTs were included in our meta-analysis. Atorvastatin pretreatment reduced the prevalence of CIN significantly (odds ratio [OR] 0.46; 95% confidence interval [95% CI] 0.27–0.79; p=0.004). The benefit of high-dose atorvastatin pretreatment was consistent when compared with the control group (OR 0.45; 95% CI 0.21–0.95; p=0.04).ConclusionAt high doses, atorvastatin pretreatment was associated with a significant reduction in the prevalence of CIAKI in patients undergoing CAG. Pretreatment with high-dose atorvastatin could be employed to prevent CIAKI.

Antithrombin Ⅲ is a Novel Predictor for Contrast Induced Nephropathy After Coronary Angiography

Background/Aims: Antithrombin Ⅲ (AT Ⅲ) is an important endogenous anticoagulant and has strong anti-inflammatory properties. Low ATⅢ activity is considered to be a predictor of poor outcomes in several conditions, including acute kidney injury after cardiac surgery. However, the association between the ATⅢ level and the occurrence of contrast induced nephropathy (CIN) has not been elucidated. In this study, our aim was to identify the potential predictive value of ATⅢ for CIN. Methods: We enrolled a total of 460 patients who underwent coronary angiography (CAG) from January 2015 to December 2016 in coronary care units (CCU). ATⅢ activity in plasma collected before CAG was measured and <75% was considered low activity according to reference values. A cross-sectional study on CIN after CAG was conducted and the risk factors were analyzed. CIN was diagnosed according to the KDIGO guideline. Results: Of these 460 patients undergoing CAG, 125 (27.17%) progressed to CIN. The incidence of CIN was significantly higher in patients with low ATⅢ activity compared to patients with normal ATⅢ activity (Pearson’s chi-squared test P=0.002). As ATⅢ activity declined, the prevalence of CIN progressively increased, with the highest value (58.8%) in patients with an ATⅢ activity <60%. Moreover, the ATⅢ activity was significantly lower in CIN patients than in non-CIN patients (84.43±16.3% vs. 92.14±13.94%, P<0.001). After multivariable analysis, ATⅢ activity <75% remained a significant independent predictor of CIN (OR 2.207,95%CI [1.29-3.777]; P=0.004) as well as baseline serum creatinine (OR 1.009,95%CI [1.001-1.016]; P=0.026). Conclusions: Patients with low ATⅢ activity had a higher risk of developing CIN after CAG. The initial ATⅢ activity may be a novel independent predictor for CIN.

Fragmented QRS complex predicts contrast-induced nephropathy and in-hospital mortality after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.

Contrast-induced nephropathy (CIN) is associated with increased mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Recently, fragmented QRS complex (fQRS) on 12-lead electrocardiography has been introduced as a marker of cardiovascular disease and is associated with increased morbidity and mortality. fQRS on ECG is associated with CIN and in-hospital mortality after primary PCI in patients with STEMI. Eight hundred ninety-five patients with first STEMI treated by primary PCI were enrolled in the study. Patients were divided into 2 groups according to the presence or absence of fQRS as shown by 12-lead electrocardiography in the first 24 hours. fQRS was defined by presence of an additional R wave (R″), or notching of the S wave, or >1 R' in 2 contiguous leads. Patients were then reallocated to 2 groups according to presence or absence of postprocedural CIN, which was defined as a rise in serum creatinine of 0.5 mg/dL or a 25% increase from baseline value within 72 hours after the procedure. Patients with a fQRS were older and had significantly lower left ventricular ejection fraction. CIN occurred in 77 (8.6%) patients. The prevalence of CIN and in-hospital mortality was significantly higher in the fQRS(+) group. In multivariate analysis, fQRS was found to be an independent predictor of CIN (odds ratio: 3.125, P = 0.029) and in-hospital mortality (odds ratio: 9.062, P = 0.009). The fQRS is an independent predictor of postprocedural CIN and in-hospital mortality in STEMI patients.

A comparison of definitions of contrast-induced nephropathy in patients with normal serum creatinine.

Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury in hospitalized patients. The prevalence of CIN is reported to range from 0% to 50%, depending not only on patient condition and the procedure used but also the definition of CIN applied. We aimed to determine the best diagnostic indicator of CIN in patients with normal serum creatinine. This study included 206 patients with normal serum creatinine who underwent coronary angiography/angioplasty. Serum creatinine level and glomerular filtration rate (GFR) were measured before and on the second and fifth days after contrast administration. The incidence of CIN based on a 25% increase in serum creatinine was calculated and compared with the incidence based on a 25% decrease in GFR or an increase of at least 0.5 mg/dL in serum creatinine. Of 206 patients, 127 were male (61.7%) and 79 were female (38.3%); the mean age was 59.56±10.3 years. The prevalence of CIN was 30% based on a 25% increase in serum creatinine, 23% based on a 25% decrease in GFR (P<0.012) and 3.8% based on a serum creatinine increase of at least 0.5 mg/dL (P<0.0001). The serum creatinine levels remained within the normal range in the majority of patients with CIN based on the different definitions. In patients with normal serum creatinine, the absolute increase in serum creatinine may describe the prevalence of CIN more accurately than the relative increase in serum creatinine or relative decrease in GFR.

Effect of Dongchongxiacao (Cordyceps) therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography

ObjectiveTo study the protective effects of Dongchongxiacao (Cordyceps) (DCXC) on contrast-induced nephropathy (CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography. MethodsA total of 120 patients with type 2 diabetes whose estimated glomerular filtration rate (eGFR) was ≤ 60 mL/min • 1.73 m2, were divided randomly into three groups, basic treatment group (n = 41), standard DCXC therapy group (n = 39, 2-g corbrin capsules, 3 times/d, 3 days before and after angiography), and intensive DCXC therapy group (n = 40, 3-g corbrin capsules, 3 times/d, 3 days before and after angiography). Serum creatinine (Scr) and eGFR were assessed at the time of admission to hospital, and on days 1, 2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in eGFR. ResultsCIN occurred in 11 of 120 patients (9.17%). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group (P < 0.05), with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group (P < 0.01). Compared with the basic treatment group, a lower proportion of patients in the DCXC treatment groups had an eGFR decrease of 25% or greater (P < 0.05); patients with an eGFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group (P < 0.01). Within 1 day of the procedure, urine levels of KIM-1, NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group (P < 0.05). ConclusionDCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography, with intensive DCXC therapy being more effective.

Cystatin C is an early marker of contrast-induced nephropathy in patients with sepsis in the intensive care unit.

Contrast-induced nephropathy (CIN) is becoming an increasingly common cause of acute kidney injury in hospitalized patients. To evaluate the prevalence of CIN in critically ill patients, we conducted a prospective study on intensive care unit patients who had undergone diagnostic computed tomography scan or non-coronary angiography with intravenous administration of iodinated contrast media. Patient demographics, disease characteristics and biochemical markers, including cystatin C, creatinine and urea, were compared between the patients who developed and those who did not develop CIN. A total of 42 patients were diagnosed with sepsis, 52 were diagnosed with diabetes mellitus, 18 with ischemic heart disease and 49 with hypertension. We found a similar incidence of CIN among the groups (28.6-36.8%). There was no association of patient age, gender or body mass index with the development of CIN. In sepsis patients, cystatin C levels were significantly raised at baseline in patients who developed CIN (P = 0.020) and also on the day before CIN was detected (P = 0.035) and the day of CIN detection (P = 0.012). No associations with cystatin C or other serum or urinary biomarkers were detected in any of the other disease groups. In conclusion, a relatively high prevalence of CIN was found in all disease groups. No demographic or disease factors were found to be associated with the development of CIN. Cystatin C may be a useful early marker of CIN in sepsis patients, but further work is required to understand the difference in cystatin C expression levels in patients with different underlying pathologies.