Rates Of Contrast-induced Acute Kidney Injury Research Articles

Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction: data from SGLT2-I AMI PROTECT Registry

Abstract Background Diabetes patients presenting with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) have an increased risk of contrast induced-acute kidney injury (CI-AKI). It has been shown that SGLT2-I have a nephroprotective effect. Purpose To analyze the association between SGLT2-I treatment and the development of contrast-induced acute kidney injury (CI-AKI) in diabetic patients with AMI (both ST- and non-ST segment elevation myocardial infarction - STEMI and NSTEMI) treated with PCI. Methods In this multicenter international registry, all consecutive diabetic AMI patients undergoing PCI between 2018 and 2021 were enrolled. Based on the admission anti-diabetic therapy, they were divided into SGLT-I users versus non-SGLT2-I users. All patients had estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2. No patient discontinued SGLT2-I during hospitalization. Serum creatinine was collected at admission and within 72 h post-PCI. CI-AKI was defined as absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine at 48-72 h after PCI compared to baseline serum creatinine values. Results The study population consisted of 646 AMI patients: 111 SGLT2-I users and 535 non-SGLT-I users. The mean age of the overall study population was 70 [61-79] years, and more than 77% were males. The mean T2DM duration was similar for both groups. SGLT2-I patients were younger and with better renal function at admission compared to non-SGLT2-I users (p<0.018 for both). Gender, cardiovascular risk factors, glucose-metabolic control, and comorbidities were similar in the two groups. The rate of STEMI and the main angiographic characteristics were similar between the two study groups, except for the higher number of stents implanted in the SGLT2-I group (p=0.041). Vascular access and contrast dosage did not differ between the 2 cohorts. A similar rate of complete revascularization, staged procedure and complex PCI was observed between the study groups. After PCI, the overall rate of CI-AKI was 76 (11.8%). SGLT2-I users exhibit a lower rate of CI-AKI compared to non-SGLT-I ones (5.4% vs 13.1%, p=0.02), with significantly lower creatinine values both after PCI (p=0.016) and at discharge (p=0.046). At multivariate analysis, after adjusting for all confounding factors, the use of SGLT2-I was identified as independent predictor of reduced rate of CI-AKI (OR 0.374; 95% CI 0.142-0.987, p=0.040). During a median follow-up of 24±13 months, patients with CI-AKI showed a higher incidence of MACE compared to patients without (44.7% vs 25.8%, p=0.001). Conclusion In diabetic patients with AMI, the use of SGLT2-I was associated with a lower risk of CI-AKI during index hospitalization, providing new insights into the cardioprotective effects of SGLT2-I in the setting of AMI.

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography: Evaluation of a Practice Change.

Development of contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity, mortality, hospital length of stay, and overall health care costs. The purpose of this project was to evaluate a clinical practice change-the addition of high-dose statin therapy to standard renal protection measures-in adults undergoing acute cardiac catheterization procedures and assessing its effect on CI-AKI. The evaluation was a pretest/posttest descriptive design. Adult patients undergoing acute cardiac catheterization procedures were evaluated for the rate of CI-AKI before (10 months preimplementation, N = 283) and after (10 months postimplementation, N = 286) a recent practice change that added high-dose statin therapy (within 24 hours of dye exposure) to a standard renal protection bundle (intravenous fluids, maximum dye calculations, and avoidance of nephrotoxic medications). Outcomes included the rate of CI-AKI, stage of acute kidney injury, need for new hemodialysis, discharge disposition (alive or died in the hospital), and hospital length of stay. Patients in the postintervention group that received renal protection bundle with high-dose statin had significantly lower incidence of CI-AKI (10.1% pre vs 3.2% post; P < .001). There were no significant differences in hospital length of stay, need for new hemodialysis, or mortality. Administration of high-dose statin within 24 hours of the cardiac catheterization procedure improved significantly (19.4% pre vs 74.1% post; P < .001). Adherence to all 5 components of the renal bundle improved post intervention (17% pre vs 73.4% post; P < .001). The addition of a high-dose statin in addition to existing renal protective measures in patients with acute cardiac procedures is associated with a decreased incidence of CI-AKI.

Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction with and without chronic kidney disease: Insight from SGLT2-I AMI PROTECT registry

AimsTo analyze the association between chronic SGLT2-I treatment and development of contrast-induced acute kidney injury (CI-AKI) in diabetic patients with acute myocardial infarction (AMI) undergoing PCI. MethodsMulticenter international registry of consecutive patients with type 2 diabetes mellitus (T2DM) and AMI undergoing PCI between 2018 and 2021. The study population was stratified by the presence of chronic kidney disease (CKD) and anti-diabetic therapy at admission (SGLT2-I versus non-SGLT2-I users). ResultsThe study population consisted of 646 patients: 111 SGLT2-I users [28 (25.2%) with CKD] and 535 non-SGLT2-I users [221 (41.3%) with CKD]. The median age was 70 [61–79] years. SGLT2-I users exhibited significantly lower creatinine values at 72 h after PCI, both in the non-CKD and CKD stratum. The overall rate of CI-AKI was 76 (11.8%), significantly lower in SGLT2-I users compared to non-SGLT2-I patients (5.4% vs 13.1%, p = 0.022). This finding was also confirmed in patients without CKD (p = 0.040). In the CKD cohort, SGLT2-I users maintained significantly lower creatinine values at discharge. The use of SGLT2-I was an independent predictor of reduced rate of CI-AKI (OR 0.356; 95%CI 0.134–0.943, p = 0.038). ConclusionIn T2DM patients with AMI, the use of SGLT2-I was associated with a lower risk of CI-AKI, mostly in patients without CKD.

Repeated Dose of Contrast Media and the Risk of Contrast-Induced Acute Kidney Injury in a Broad Population of Patients Hospitalized in Cardiology Department

Contrast-induced acute kidney injury (CI-AKI) can lead to the development of chronic kidney disease (CKD) and impaired in-hospital and long-term outcomes among cardiac patients. The aim of this study was to evaluate the impact of repeated contrast media (CM) administration during a single hospitalization on the rate of CI-AKI. The study group (n = 138) comprised patients with different diagnoses who received CM more than once during hospitalization, while the control group (n = 153) involved CAD patients subject to a single CM dose. Following propensity score matching (PSM), both groups of n = 84 were evenly matched in terms of major baseline variables. CI-AKI was defined by an absolute increase in SCr ≥ 0.3 mg/dL or >50% relative to the baseline value within 48-72 h from the last CM dose. Patients in the study group were older, had a higher prevalence of diabetes and CKD, received a higher total volume of CM, had a lower left ventricular ejection fraction, lower prevalence of multivessel coronary artery disease (MV-CAD), and a trend towards a lower prevalence of arterial hypertension and smoking. SCr did not differ between the study and control groups at 72 h after the CM use. CI-AKI occurred in 18 patients in the study (13.0%) and in 18 patients (11.8%) in the control group (p = 0.741). The rate of CI-AKI was also comparable following the PSM (13.1% vs. 13.1%, p = 1.0). Logistic regression analysis revealed that CKD, diabetes mellitus, MV-CAD, age, and non-steroidal anti-inflammatory drugs use, but not repeated CM use, were independent predictors of CI-AKI.

Association of periprocedural phentolamine infusion with favorable outcome in patients with chronic kidney disease and chronic coronary syndrome undergoing coronary catheterization: a prospective randomized controlled pilot study

BackgroundChronic kidney disease (CKD) is a major risk factor for contrast induced acute kidney injury (CI-AKI) in chronic coronary syndrome (CCS) patients undergoing coronary catheterization. We aimed to evaluate the efficacy of phentolamine in prevention of CI-AKI in CKD and CCS patients undergoing percutaneous coronary catheterization for diagnostic angiography ± stenting.MethodsParticipants with CKD and CCS planned for percutaneous coronary catheterization were included, while participants with normal kidney functions were excluded. A consecutive sample of 107 participants (mean age 58.62 ± 8.96 years, 64.5% males) was selected, underwent diagnostic coronary angiography or percutaneous coronary intervention, and received either conventional CI-AKI prevention strategy (group 1) or periprocedural phentolamine and conventional CI-AKI prevention strategy (group 2).ResultsThe percentages of study participants who had CI-AKI were 82.9% for group 1 and 17.1% for group 2, respectively. The incidence rate of CI-AKI was significantly lower in group 2 versus group 1 (p < 0.001). The urine output (ml/kg) and the urine output (ml/hour) within 72 hours post procedure was significantly higher in group 2 versus group 1 (t(105) = − 0.69, p < 0.001, t(105) = − 52.46, p < 0.001, respectively), the peak change in serum creatinine and the percentage of change relative to the baseline serum creatinine at 72 hours post procedure was significantly lower in group 2 versus group 1 (t(102) = 0.2, p 0.018, t(102) = 23.54, p < 0.001, respectively), and the incidence rate of major adverse cardiac and cerebrovascular events within 90 days post procedure was significantly lower in group 2 versus group 1 (t(102) = 1.168, P < 0.001), respectively. There was a statistically significant association of periprocedural phentolamine infusion with prevention of CI-AKI (OR = 0.041, 95% CI 0.0149–0.1128, P < 0.0001).ConclusionOur study highlights the potential role of phentolamine for protection of the kidney in CKD patients planned for coronary catheterization.Trial registrationPan African Clinical Trial Registry Number: PACTR202209493847741.Date of Trial Registration: 22/09/2022.

A risk score model of contrast-induced acute kidney injury in patients with emergency percutaneous coronary interventions.

BackgroundThe previously built score models of contrast-induced acute kidney injury (CI-AKI) were principally founded on selective percutaneous coronary intervention (PCI) cases. Our study was to form a risk score model of CI-AKI and make a temporal validation in a population who underwent emergency PCIs.MethodsWe included patients who underwent emergency PCIs from 2013 to 2018 and divided them into the derivation and validation cohorts. Logistic regression analysis was harnessed to create the risk model. In this research, we defined CI-AKI as an increase in serum creatinine (SCr) ≥0.5 mg/dL (44.2 μmol/L) above baseline within seven days following exposure to contrast medium.ResultsA total of 3564 patients who underwent emergency PCIs were enrolled and divided into the derivation (2376 cases) and validation cohorts (1188 cases), with CI-AKI incidence of 6.61 and 5.39%, respectively. By logistic analysis, the CI-AKI risk score model was constituted by 8 variables: female (1 point), history of transient ischemic attack (TIA)/stroke (1 point), left ventricular ejection fraction (LVEF) classification (1 point per class), big endothelin-1 (ET-1) classification (1 point per class), estimated glomerular filtration rate (eGFR) classification (1 point per class), intra-aortic balloon pump (IABP) application (1 point), left anterior descending (LAD) stented (1 point), and administration of diuretic (2 points). The patients could be further divided into three groups: low-risk, moderate-risk, and high-risk groups, in accordance with the risk scores of 3–6, 7–10, and ≥11 points, and to the CI-AKI rates of 1.4, 11.9, and 42.6%. The CI-AKI risk score model performed well in discrimination (C statistic = 0.787, 95% CI: 0.731–0.844) and calibration ability, and showed a superior clinical utility.ConclusionWe developed a simple CI-AKI risk score model which performs well as a tool for CI-AKI prediction in patients who underwent emergency PCIs.

The Target Vessel SYNTAX Score: A Novel Pre-Procedural Predictor for Contrast-Induced Acute Kidney Injury After Rotational Atherectomy

BackgroundRotational atherectomy (RA) is a complex procedure often associated with high contrast load. Known risk scores do not predict contrast-induced acute kidney injury (CI-AKI) before RA. We aim to investigate pre-procedural predictors of CI-AKI after RA, and the role of the target vessel SYNTAX score (tvSS). MethodsAmong 295 patients who underwent RA between 01.2010 and 02.2019 at a single center, 49 developed CI-AKI. Those who were on chronic hemodialysis or with no available 48-h' kidney function tests were excluded. Predictors of CI-AKI were assessed in the whole cohort and those with no basal renal impairment. ResultsThe rate of CI-AKI was 16.6 %. The tvSS was 18 [14–23] vs. 12 [9–18] in patients with vs. without CI-AKI (p < 0.001). The tvSS cut-off value of 15 provided 75 % sensitivity and 60 % specificity for predicting CI-AKI. Consequently, a tvSS ≥15 emerged as an independent pre-procedural predictor for CI-AKI (adjusted OR: 4.94, 95 % CI: 2.38–10.20, p < 0.001), along with left ventricular ejection fraction (LVEF) ≤35 % (p = 0.016) and glomerular filtration rate (GFR) <45 ml/min (p = 0.004). TvSS was the only independent pre-procedural predictor for CI-AKI in patients with GFR ≥60 ml/min (p < 0.001). The contrast volume/GFR ratio and peri-procedural myocardial infarction (MI) were independent procedural predictors for CI-AKI in the whole cohort and in patients with basal GFR ≥60 ml/min. ConclusionCI-AKI after RA is frequent. The tvSS is an efficient pre-procedural predictor for CI-AKI after RA, along with LVEF ≤35 % and GFR <45 ml/min. Contrast volume/GFR ratio and peri-procedural MI emerged as procedural predictors for CI-AKI.

Trends in contrast-induced acute kidney injury rate after percutaneous coronary interventions in coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background. Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated. Purpose. The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively. Methods. 1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury. Results. The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p &amp;lt; 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs). Conclusion. The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.

Obesity as a risk factor of contrast-induced acute kidney injury in patients with arterial hypertension and stable coronary artery disease

Background. The prevalence of obesity in patients with stable coronary artery disease (CAD) and arterial hypertension (AH) is increasing each year. As the number of percutaneous coronary interventions requiring contrast media administration is rising in this group of patients, the risk of contrast-induced acute kidney injury (CI-AKI) remains high. The most important risk factors of CI-AKI in this group of patients remain to be determined as well as their prognostic significance.&#x0D; Aim. The aim of the study was to assess the role of obesity as a risk factor of CI-AKI in patients with stable CAD and AH.&#x0D; Materials and methods. 863 patients with stable CAD and AH were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). 398 patients were obese and 465 had body mass index (BMI) below 30 kg/m2. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was the development of CI-AKI.&#x0D; Results. The rate of CI-AKI in patients with obesity was 12.6%, without obesity 12.7%, but the difference between groups was not statistically significant (p=0.935, 95% CI -0.0430.046). The rate of CI-AKI in male patients with obesity was higher than in female ones. The logistic regression model of CI-AKI development in patients with stable CAD, AH and obesity was build (AUC 0.9928, р0,0001, 95% CI 0.98191) and included age, weight, body mass index, female gender, heart failure, diabetes mellitus, proteinuria, anemia, baseline creatinine, contrast volume and the difference between baseline serum creatinine and creatinine level after the contrast media exposure. The baseline level of creatinine and the difference between the levels of creatinine before and after contrast media administration were statistically significant risk factors in the model.&#x0D; Conclusion. The rate of CI-AKI in patients with stable CAD, AH and obesity was 12.6%. The main risk factors of CI-AKI development in multiple logistic regression model were the baseline level of creatinine and the difference between levels of serum creatinine before and after contrast media administration.

Гиперурикемия как фактор риска контраст-индуцированного острого повреждения почек

Aim. To assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and hyperuricemia. Materials and methods. Patients with stable CAD receiving optimal medical therapy and with indications to coronary angiography and possible coronary angioplasty were included in an observational open prospective cohort study. The protocol of the study was registered in clinicaltrials.gov with ID NCT04014153. We conducted a sub-analysis of the group of patients with hyperuricemia (uric acid level &gt;7 mg/dl). Results. We included 1023 patients with stable CAD. 32 patients suffered from hyperuricemia. The rate of CI-AKI in this group was 6.25% (2 patients), that was lower than in patients with normal levels of uric acid (13.1%). The difference was not statistically significant probably due to the small number of patients with hyperuricemia. The patients with hyperuricemia had proteinuria 3 times more frequently, than patients without, the rate of diabetes mellitus was 7% higher as well as anemia by 4.5% but didn’t reach statistical significance. Conclusion. The rate of CI-AKI in patients with hyperuricemia was twice lower than in patients with normal levels of uric acid. More research needs to be conducted in patients with metabolic syndrome in larger groups. Keywords: contrast-induced acute kidney injury, contrast-associated acute kidney injury, contrast-induced nephropathy, coronary artery disease, percutaneous coronary intervention, contrast, hyperuricemia For citation: Mironova OIu, Lakotka PG, Fomin VV. Hyperuricemia as a risk factor of contrast-induced acute kidney injury. Consilium Medicum. 2021; 23 (1): 25–27. DOI: 10.26442/20751753.2021.1.200572

Effects of a High Dose of the Contrast Medium Iodixanol on Renal Function in Patients Following Percutaneous Coronary Intervention.

Iodixanol is associated with lower rates of contrast-induced acute kidney injury (CI-AKI). However, the effects of high volumes of iodixanol on renal function after percutaneous coronary intervention (PCI) have not been fully elucidated. This study evaluates the effects of high-dose (>300 mL) iodixanol on renal function within 72 hours of PCI. We retrospectively reviewed 676 consecutive patients who received high-dose (>300 mL) iodixanol during PCI between October 2015 and December 2017 in 4 centers. Logistic regression analysis was used to identify significant independent predictors for CI-AKI. The incidence of CI-AKI was 3.5% (23/651). In patients administered 300 to 500 mL and >500 mL iodixanol, the incidence of CI-AKI was 3.9% and 1.7%, respectively. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, the incidence of CI-AKI was 2.6%. In high-risk and very high-risk patients, stratified by the Mehran risk score, the incidence of CI-AKI was 3.3% and 4.3%, respectively. In patients received high-dose iodixanol (>300 mL), logistic regression analysis demonstrated that female sex, chronic kidney disease, and eGFR were independent risk factors for CI-AKI, but contrast volume was not. The administration of high (300-500 mL) and very high (>500 mL) dose of iodixanol is associated with low rates of CI-AKI.

Contrast-induced acute kidney injury.

Although major advancements in the field of cardiology have allowed for an increasing number of patients to undergo minimally invasive imaging and interventional procedures, contrast-induced acute kidney injury (CI-AKI) continues to be a dreaded complication among patients receiving intravascular contrast media. CI-AKI is characterized by progressive decline in kidney function within a few days of contrast medium administration. Physiological changes resulting from the direct nephrotoxic effect of contrast media on tubular epithelial cells and release of vasoactive molecules have been implicated in creating a state of increased oxidative stress and subsequent ischemic renal cell injury. Over the last several years, preventive strategies involving intravenous hydration, pharmaceutical agents and renal replacement therapies have resulted in lower rates of CI-AKI. However, due to the evolving paradigm of diagnostic and therapeutic interventions, several unanswered questions remain. This review highlights the epidemiology, pathogenesis and preventive strategies of CI-AKI.

Колебания уровня сывороточного креатинина и контрастиндуцированное острое повреждение почек у больных со стабильной ишемической болезнью сердца

Aim. The aim of our study was to assess the influence of different risk factors on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD). Materials and methods. Patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angioplasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. Most of the patients, included in the study, were males aged 61.7±10.1 years with arterial hypertension and overweight. The rate of CI-AKI in this group was 12.9% (132 patients). The rate of CI-AKI using the absolute creatinine rise definition was 1.8% cases (18 cases). A logistic regression model was created, where baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors. The AUC was 0.984 (95% CI 0.969–0.999; p&lt;0.0001). Conclusion. The most significant risk factors in the logistic regression model created were baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors.

Сердечная недостаточность и контрастиндуцированное острое повреждение почек у больных с ишемической болезнью сердца

Aim. To assess the influence of heart failure on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) with indications to diagnostic procedures requiring intra-arterial administration of contrast media. Materials and methods. 1023 patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angio-plasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. CI-AKI was defined as 25% or more increase of baseline serum creatinine, or more than 0.5 mg/dl and was assessed 48 hours after contrast media administration. The primary endpoint was the CI-AKI development according to KDIGO criteria. Most of the patients, included in the study, were males aged 66.3±10 years with arterial hypertension and overweight (BMI 29.14±5 kg/m2). Results. The study included 1023 patients, 76 suffered from heart failure. The rate of CI-AKI in this group was 13.2% (10 patients). The rate of CI-AKI using the absolute creatinine rise definition was 4% cases (3 cases). Conclusion. Female patients suffering from heart failure with higher levels of serum creatinine and low glomerular filtration rate need more attention, less amount of contrast and adequate preventive measures before contrast media administration in order to lower the risk of CI-AKI development.

Гиперурикемия у пациентов со стабильной ишемической болезнью сердца и артериальной гипертензией и чрескожные коронарные вмешательства

Aim. To assess the influence of hyperuricemia on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and arterial hypertension. Materials and methods. Patients receiving optimal medical therapy and with indications for coronary angiography and possible coronary angioplasty, with stable CAD and arterial hypertension were included in the study. We conducted an observational open prospective cohort study, that was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. 863 had arterial hypertension. Hyperuricemia was diagnosed in 31 patients, 832 had normal levels of uric acid on admission. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. In patients with stable CAD, AH and no hyperuricemia the rate of CI-AKI was 107 (12.9%) patients. The difference between groups was not statistically significant (95% CI -0.056–0.183, р=0.292). We built a multiple linear regression model that included age, weight, female gender, heart failure, diabetes mellitus, kidney diseases in past medical history, protei-nuria, anemia, baseline glomerular filtration rate, contrast volume and difference between baseline creatinine and creatinine after contrast administration. No risk factor showed any statistical significance in the model. Conclusion. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. The rate of CI-AKI in patients without hyperuricemia was twice higher but the results were not statistically significant. Among the risk factors included in the multiple linear regression model none was statistically significant.

Renal impact of high-loading-dose statin pre-cardiac catheterization in patients with chronic kidney disease and long-term statin use.

Previous studies have reported that short-term statin loading effectively protects statin-naive patients with mild renal insufficiency from contrast-induced acute kidney injury (CI-AKI). The aim of the present study was to determine whether patients with more advanced chronic kidney disease (CKD) and long-term statin therapy also benefit from high-loading statin pretreatment. A total of 256 consecutive patients with moderate-to-severe CKD receiving long-term statin therapy and undergoing percutaneous coronary intervention (PCI) or coronary artery angiography (CAG) were divided into the statin-loading group (n=34) and the no statin-loading group (n=222), depending on whether the respective patient received high-dose statin within 24 h prior to the intervention. The primary endpoint was the percent change in serum creatinine (SCr) levels. Additional endpoints included absolute change in SCr levels, estimated glomerular filtration rate (eGFR) at 48–72 h after contrast exposure, incidence rate of CI-AKI and composite in-hospital adverse events. The mean SCr decreased from baseline in either of the two groups, and the differences in the percent (P=0.930) and absolute change (P=0.990) in SCr levels were not significant between the two groups. Furthermore, no significant difference in the post-procedural eGFR was observed between the two groups. The incidence rates of CI-AKI (2.9 vs. 4.1%, P>0.999) and in-hospital adverse events (0.0 vs. 3.6%, P=0.602) were also similar between the two groups. Stratified analyses were then performed, which yielded results consistent with the above. Multiple linear regression indicated that the baseline eGFR value and current smoking status were independent factors affecting the post-procedural eGFR value, while high-dose statin loading was not. Therefore, statin reloading prior to intervention may not provide any further renal protection or decrease the occurrence of in-hospital adverse events in patients with moderate-to-severe CKD receiving long-term statin therapy, which warrants validation in prospective trials.

Early β-blockers administration might be associated with a reduced risk of contrast-induced acute kidney injury in patients with acute myocardial infarction.

Contrast-induced acute kidney injury (CI-AKI) is a common complication of coronary angiography (CAG), which is associated with worse prognosis. Some studies indicated β-blockers could preserve renal function among patients with acute myocardial infarction (AMI), but the relationship between β-blockers and CI-AKI has not been well documented among patients with AMI who were undergoing CAG or percutaneous coronary intervention (PCI). In this prospective, observational study, 1,309 AMI patients who were undergoing CAG or PCI were consecutively recruited between January 2010 and December 2013. Patients were assigned into β-blockers group (n=1,074) or non-β-blockers group (n=235) according to use or non-use of β-blockers (including metoprolol tartrate/metoprolol succinate/Bisoprolol Fumarate) within 24 hours of perioperative period. CI-AKI was defined as an absolute increase of >0.5 mg/dL from baseline serum creatinine (SCr) within 48-72 hours after contrast medium (CM) exposure. The overall incidence of CI-AKI was 247/1,309 (18.9%).After multivariate adjusting, a total of 10 variables were related to CI-AKI, including β-blockers [β-blockers group vs. non-β-blockers group: odds ratio (OR) =0.520; 95% confidence interval (CI), 0.291-0.930; P=0.027], age, diabetes mellitus, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, left ventricular ejection fraction (LVEF) <40%, use of intra-aortic balloon pump (IABP), peri-hypotension, emergent PCI, coronary lesions and CM dose >200 mL. During the mean follow-up of 2.35±0.99 years, the β-blockers group was significantly associated with lower rates of mortality [β-blockers group vs. non-β-blockers group: adjusted hazard ratio (HR) =0.43; 95% CI, 0.27-0.71; P=0.001] among patients with AMI. Use of β-blockers within 24 hours of perioperative period may be associated with lower rates of CI-AKI and long-term mortality among patients with AMI who are undergoing CAG or PCI. PRECOMIN, ClinicalTrials.gov NCT01400295.

Safe Hydration to Prevent Contrast-Induced Acute Kidney Injury and Worsening Heart Failure in Patients with Renal Insufficiency and Heart Failure Undergoing Coronary Angiography or Percutaneous Coronary Intervention.

An optimal hydration volume (HV) that prevents contrast-induced acute kidney injury (CI-AKI) in patients with renal insufficiency and heart failure (HF) at a high risk of worsening HF (WHF) has not been determined. We aimed to determine a safe HV that prevents CI-AKI and WHF following coronary angiography (CAG) or percutaneous coronary intervention (PCI) in patients with renal insufficiency and HF. We recruited 1,307 patients with renal insufficiency and HF and investigated the relationships between the peri-procedural HV/weight (HV/W) ratio, and the risks of CI-AKI and WHF following CAG or PCI. Higher HV/W quartiles were associated with higher CI-AKI rates (Q1: 6.2%, Q2: 9.1%, Q3: 12.5%, and Q4: 18.7%; P < 0.001) and a greater likelihood of WHF (Q1: 2.2%, Q2: 2.7%, Q3: 4.9%, and Q4: 11.7%; P < 0.001). The multivariate analyses indicated that excessively high HV/W ratios were associated with moderately increased risks of CI-AKI (Q4 versus Q1: adjusted odds ratio [OR] 2.16, 95% confidence interval [CI] 1.17-4.00) and WHF (Q4 versus Q1: adjusted OR 3.09, 95% CI 1.21-7.88). The multivariate Cox regression analysis indicated that a higher HV/W ratio was associated with significantly increased long-term mortality (Q2 versus Q1: adjusted hazard ratio [HR] 2.36; Q3 versus Q1: adjusted HR 2.85; Q4 versus Q1: adjusted HR 2.94; all P < 0.05). In conclusion, an excessively high HV/W might be associated with a moderately increased risk of CI-AKI, WHF, and long-term mortality in patients with renal insufficiency and HF.

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

Background:Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI).Methods:Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results:A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min−1·1.73 m−2), 26.0% (118/454) in Group 2 (120 ml·min−1·1.73 m−2> eGFR ≥90 ml·min−1·1.73m−2), 18.3% (86/469) in Group 3 (90 ml·min−1·1.73 m−2> eGFR ≥60 ml·min−1·1.73 m−2), 21.8% (26/119) in Group 4 (60 ml·min−1·1.73 m−2> eGFR ≥30 ml·min−1·1.73 m−2), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min−1·1.73 m−2), with statistical significance (χ2 = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min−1·1.73 m−2). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ2 = 16.26, P = 0.009 at 6-month follow-up, and χ2 = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients.Conclusions:High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

Effect of a Contrast Modulation System on Contrast Media Use and the Rate of Acute Kidney Injury After Coronary Angiography

ObjectivesThe aim of the AVERT (AVERT Clinical Trial for Contrast Media Volume Reduction and Incidence of CIN) trial was to test the efficacy of the AVERT system to reduce the contrast media volume (CMV) used during coronary angiographic procedures without impairing image quality and to prevent contrast-induced acute kidney injury (CI-AKI) in patients at risk for CI-AKI. BackgroundCI-AKI is a common complication of percutaneous coronary procedures, associated with increased morbidity and mortality. The AVERT system alters the coronary injection pressure profile by diverting contrast away from the patient during coronary injection. MethodsThe AVERT trial was a prospective, multicenter, 1:1 randomized clinical trial in 578 subjects with either baseline estimated glomerular filtration rate 20 to 30 ml/min/1.73 m2 or estimated glomerular filtration rate 30 to 60 ml/min/1.73 m2 and at least 2 additional risk factors for CI-AKI. Patients undergoing coronary angiography with planned or possible percutaneous coronary intervention (PCI) were randomized to hydration plus the AVERT system (n = 292) or hydration only (n = 286). The primary effectiveness endpoints were: 1) the total CMV used; and 2) the incidence of CI-AKI, defined as a ≥0.3 mg/dl increase in serum creatinine within 5 days post-procedure. ResultsPatient demographics were well balanced between the groups, with mean baseline serum creatinine of 1.6 ± 0.4 mg/dl and 64.9% patients with diabetes mellitus. PCI was performed in 42.2% of procedures, with coronary angiography in the remainder. Use of AVERT resulted in a 15.5% relative reduction in CMV overall (85.6 ± 50.5 ml vs. 101.3 ± 71.1 ml; p = 0.02) and a 22.8% relative reduction in CMV among PCI patients (114 ± 55 ml vs. 147 ± 81 ml; p = 0.001). The maximum relative reduction in CMV was 46% (124 ± 48 ml vs. 232 ± 97 ml; p = 0.01) when ≥3 lesions were treated. There were no differences in the rates of CI-AKI (27.0% vs. 26.6%; p = 0.70) between the study groups. ConclusionsUse of the AVERT system was feasible and safe, with acceptable image quality during coronary angiography and PCI. AVERT significantly reduced CMV, with the extent of CMV reduction correlating with procedural complexity. No significant differences in CI-AKI were observed with AVERT in this trial. (AVERT Clinical Trial for Contrast Media Volume Reduction and Incidence of CIN [AVERT]; NCT01976299)