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contrast induced injury in patients with CKD

Werner Ribitsch, Gernot Schilcher, Franz Quehenberger, Stefan Pilz, Rupert H Portugaller, Martini Truschnig-Wilders, Robert Zweiker, Marianne Brodmann, Philipp Stiegler, Alexander R Rosenkranz, John W Pickering, Joerg H Horina
The aim of the study was to evaluate the diagnostic accuracy of urinary neutrophil gelatinase- associated lipocalin (uNGAL) in patients with chronic kidney disease (CKD) as an early biomarker for contrast induced acute kidney injury (CI-AKI) and to investigate whether patients with an uNGAL increase might benefit from an additional intravenous volume expansion with regard to CI-AKI-incidence. We performed a prospective randomized controlled trial in 617 CKD-patients undergoing intra-arterial angiography. Urinary NGAL was measured the day before and 4-6hrs after angiography...
January 27, 2017: Scientific Reports
Hoon Suk Park, Chan Joon Kim, Byung-Hee Hwang, Tae-Hoon Kim, Yoon Seok Koh, Hun-Jun Park, Sung-Ho Her, Sung Won Jang, Chul-Soo Park, Jong Min Lee, Hee-Yeol Kim, Doo Soo Jeon, Pum-Joon Kim, Ki-Dong Yoo, Kiyuk Chang, Dong Chan Jin, Ki-Bae Seung
Chronic kidney disease (CKD) is a significant risk factor for contrast induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). This study included 1592 CKD patients extracted from a prospective multicenter, all comer-based registry of patients undergoing PCI. In multivariate logistic analysis for CI-AKI development, a significant linear trend was observed between the quartiles of HDL-C (quartile 1 vs. 2: odds ratio [OR], 0.716; 95% confidence interval [CI], 0.421-1.219; quartile 1 vs...
October 24, 2016: Scientific Reports
Gillian Balbir Singh, Soe Hee Ann, Jongha Park, Hyun Chul Chung, Jong Soo Lee, Eun-Sook Kim, Jung Il Choi, Jiho Lee, Shin-Jae Kim, Eun-Seok Shin
OBJECTIVE: Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent ischemia-reperfusion injury. When RIPC is applied before percutaneous coronary intervention (PCI), the kidneys may be protected against ischemia-reperfusion injury and subsequently contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the efficacy of RIPC for the prevention of CI-AKI in patients with diabetes with pre-existing chronic kidney disease (CKD) undergoing elective PCI...
2016: PloS One
Erik W Holy, Alexander Akhmedov, Thimoteus Speer, Giovanni G Camici, Stephen Zewinger, Nicole Bonetti, Jürg H Beer, Thomas F Lüscher, Felix C Tanner
BACKGROUND: Carbamylation alters low-density lipoprotein (LDL) structure and is thought to promote vascular inflammation and dysfunction in patients with chronic kidney disease (CKD). OBJECTIVES: This study sought to determine whether carbamylated LDL (cLDL) exerts prothrombotic effects in vascular cells and platelets and whether cLDL enhances arterial thrombus formation in vivo. METHODS: LDL was isolated from healthy subjects or patients with CKD by sequential ultracentrifugation...
October 11, 2016: Journal of the American College of Cardiology
Jonay Poveda, Ana B Sanz, Beatriz Fernandez-Fernandez, Susana Carrasco, Marta Ruiz-Ortega, Pablo Cannata-Ortiz, Alberto Ortiz, Maria D Sanchez-Niño
Current therapy for chronic kidney disease (CKD) is unsatisfactory because of an insufficient understanding of its pathogenesis. Matrix remodelling-associated protein 5 (MXRA5, adlican) is a human protein of unknown function with high kidney tissue expression, not present in rodents. Given the increased expression of MXRA5 in injured tissues, including the kidneys, we have suggested that MXRA5 may modulate kidney injury. MXRA5 immunoreactivity was observed in tubular cells in human renal biopsies and in urine from CKD patients...
January 2017: Journal of Cellular and Molecular Medicine
Koichiro Homma
Because of the increased use of contrast media, the potential risk of contrast-induced acute kidney injury (CIAKI) has also increased. CIAKI often results in chronic kidney disease (CKD), an affliction with increasing incidence in modern society. The current prevalence of CIAKI is difficult to estimate because most victims are asymptomatic. The first Japanese guidelines regarding contrast agent examinations were recently announced, but their only recommendation is to provide classic fluid replacement with saline 6-12 h before and after the contrast procedure...
December 25, 2016: Keio Journal of Medicine
Jing Li, Yi Li, Biao Xu, Guoliang Jia, Tao Guo, Dongmei Wang, Kai Xu, Jie Deng, Yaling Han
BACKGROUND: Female patients are at higher risk of contrast-induced acute kidney injury (CIAKI) compared to males. In the multicenter, prospective, TRACK-D study, short-term rosuvastatin has proven effectively reduce CIAKI in patients with type 2 diabetes mellitus and stage 2-3 chronic kidney disease (CKD). This study aimed to explore the efficacy of rosuvastatin in the female TRACK-D population. METHODS: This study was a gender-based analysis of 2,998 patients (1,044 females) enrolled in the TRACK-D study and were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard of care...
May 2016: Journal of Thoracic Disease
Nana Wang, Qian Xu, Shaobin Duan, Rong Lei, Jun Guo
OBJECTIVE: To investigate the incidence, risk factors and prognosis for contrast-induced acute kidney injury (CI-AKI) according to ESUR and KDIGO criteria in patients undergoing angiography.
 METHODS: We evaluated 260 patients undergoing angiography and/or intervention therapy from April 2011 to January 2012 in the Second Xiangya Hospital of Central South University. All patients received low-osmolality contrast agent (ioversol). Serum creatinine was measured before angiography or at 48 or 72 h after procedure...
January 2016: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
Phoebe Wing-Lam Ho, Wing-Fai Pang, Cheuk-Chun Szeto
Acute kidney injury (AKI) is a common complication associated with high morbidity and mortality in hospitalized patients. One potential mechanism underlying renal injury is ischaemia/reperfusion injury (IRI), which attributed the organ damage to the inflammatory and oxidative stress responses induced by a period of renal ischaemia and subsequent reperfusion. Therapeutic strategies that aim at minimizing the effect of IRI on the kidneys may prevent AKI and improve clinical outcomes significantly. In this review, we examine the technique of remote ischaemic preconditioning (rIPC), which has been shown by several trials to confer organ protection by applying transient, brief episodes of ischaemia at a distant site before a larger ischaemic insult...
April 2016: Nephrology
Lilach Shema-Didi, Batya Kristal, Sarit Eizenberg, Nabil Marzuq, Majdy Sussan, Yulie Feldman-Idov, Pnina Ofir, Shaul Atar
AIM: Contrast-induced-nephropathy (CIN) is associated with poor outcomes, thus prevention of CIN may be of clinical value. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in experimental models and in clinical studies of acute kidney injury. We therefore evaluated its effectiveness for prevention of CIN after coronary angiography (CA) ± percutaneous coronary intervention (PCI) in diabetic patients with chronic kidney disease. METHODS: A prospective, randomized, controlled trial was carried out in 138 diabetic patients with eGFR <60 mL/min who underwent non-urgent CA ± PCI...
April 2016: Nephrology
Maciej T Wybraniec, Katarzyna Mizia-Stec, Andrzej Więcek
The rapidly growing number of percutaneous coronary interventions has led to a considerable improvement in the outcome of patients with acute coronary syndromes, yet concurrently exposing patients to enormous volumes of contrast media with the inherent risk of renal function impairment. The issue of contrast-induced acute kidney injury (CI-AKI) is not only associated with direct sequelae such as prolonged hospital stay, but also with increased risk of chronic kidney disease, recurrent acute coronary syndromes, cerebral ischemia, and increased mortality rate...
2015: Polskie Archiwum Medycyny Wewnętrznej
Michael Donahue, Gabriella Visconti, Amelia Focaccio, Lucio Selvetella, Maria Baldassarre, Chiara Viviani Anselmi, Carlo Briguori
OBJECTIVES: This study sought to investigate acute kidney injury (AKI) following carotid artery stenting (CAS). BACKGROUND: Few data exist on AKI following CAS. METHODS: This study evaluated 126 chronic kidney disease (CKD) patients who underwent CAS. The risk for contrast-induced AKI was defined by the Mehran score. Hemodynamic depression (i.e., periprocedural systolic blood pressure <90 mm Hg or heart rate <60 beats/min), AKI (i.e...
September 2015: JACC. Cardiovascular Interventions
Florian Lüders, Matthias Meyborg, Nasser Malyar, Holger Reinecke
BACKGROUND/AIMS: Contrast medium-induced acute kidney injury (CI-AKI) is an important iatrogenic complication following the injection of iodinated contrast media. The level of serum creatinine (SCr) is the currently accepted 'gold standard' to diagnose CI-AKI. Cystatin C (CyC) has been detected as a more sensitive marker for renal dysfunction. Both have their limitations. METHODS: The role of the preinterventional CyC-SCr ratio for evaluating the risk for CI-AKI and long-term all-cause mortality was retrospectively analyzed in the prospective single-center 'Dialysis-versus-Diuresis trial'...
2015: Nephron
Zh D Kobalava, S V Villeval'de, A A Gaskina, V V Maĭskov, V S Moiseev
AIM: To study the incidence, severity, predictive factors, and prognostic value of contrast-induced acute kidney injury (CIAKI) in patients with ST-segment elevation acute coronary syndrome (STSEACS), who have undergone primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The 2012 KDIGO criteria were used to estimate the incidence of CIAKI in 216 patients (mean age, 64 ± 13 years) admitted to Moscow City Clinical Hospital Sixty-Four and underwent primary PCI for STSEACS (hypertension in 90%, prior myocardial infarction in 27%, chronic kidney disease in 7%, type 2 diabetes mellitus in 21%)...
2015: Terapevticheskiĭ Arkhiv
Seok-In Hong, Shin Ahn, Yoon-Seon Lee, Won Young Kim, Kyung Soo Lim, Jae Ho Lee, Jae-Lyun Lee
PURPOSE: This study was performed to measure the incidence and identify potential predictors of contrast-induced nephropathy (CIN) in cancer patients without chronic kidney disease and with normal or near-normal baseline serum creatinine measures who underwent contrast-enhanced computed tomography (CECT). Severity of CIN was reported based on the RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal disease) classification of acute kidney injury. METHODS: A retrospective analysis was performed on 820 cancer patients who presented at our emergency department from October 2014 to March 2015...
March 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
You Yang, Yan-Xian Wu, Yun-Zhao Hu
We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the protective effects of rosuvastatin on contrast-induced acute kidney injury (CI-AKI) and major adverse cardiovascular events (MACEs) in patients undergoing cardiac catherization.PubMed, MEDLINE, Web of Science, EMBASE,, and the Cochrane Central RCTs were searched for RCTs from inception to May 2015, to compare rosuvastatin for preventing CI-AKI with placebo treatment in patients undergoing cardiac catherization...
July 2015: Medicine (Baltimore)
A Gaskina, S Villevalde, Z Kobalava
OBJECTIVE: The incidence of contrast-induced acute kidney injury (CI-AKI) is rising due to increased use of coronary angiography and percutaneous coronary intervention (PCI). Patients undergoing primary PCI are at high risk of CI-AKI, a complication that negatively affects outcomes. The aim of the study was to evaluate the incidence, predictors and outcomes of CI-AKI in patients with ST-segment elevation myocardial infarction (STEMI) and primary PCI. DESIGN AND METHOD: 216 patients with STEMI and primary PCI (143 male, 64 ± 13 years (M ± SD), arterial hypertension 90%, previous myocardial infarction 27%, diabetes mellitus 21%, known chronic kidney disease 7%, anemia 14%, heart failure 62%, left ventricular ejection fraction (LV EF) 44 ± 15%) were examined...
June 2015: Journal of Hypertension
Vasilios G Athyros, Niki Katsiki, Asterios Karagiannis, Dimitri P Mikhailidis
INTRODUCTION: The prevalence of chronic kidney disease (CKD), a risk factor for cardiovascular disease (CVD), is increasing worldwide. Statin treatment, the cornerstone of prevention or treatment of CVD, might have beneficial effects on urine protein excretion and renal function as determined by the glomerular filtration rate, whereas it might protect from acute kidney injury (AKI), mainly due to contrast-induced AKI. These beneficial effects on CKD may not be drug class effects; specific statins at specific doses may help prevent CKD deterioration and reduce CVD risk...
2015: Expert Opinion on Pharmacotherapy
Keith Thompson, Rabia Razi, Ming Sum Lee, Albert Shen, Gregg W Stone, Swapnil Hiremath, Roxana Mehran, Somjot S Brar
AIMS: A systematic review and a meta-analysis were performed to define better the role of statin use prior to angiography in preventing contrast-induced acute kidney injury (CI-AKI). METHODS AND RESULTS: MEDLINE, Embase, Cochrane Library, references from review articles, and conference proceedings were searched, with no language restriction, for randomised controlled trials (RCT) evaluating the use of statin therapy prior to angiography for the prevention of CI-AKI...
June 20, 2016: EuroIntervention
Hiremath Swapnil, Greg A Knoll, Jeanne Françoise Kayibanda, Dean Fergusson, Benjamin Jw Chow, Wael Shabana, Erin Murphy, Tim Ramsay, Matthew James, Christine A White, Amit Garg, Ron Wald, Jeffrey Hoch, Ayub Akbari
BACKGROUND: Although intravenous saline is the accepted prophylactic measure for the prevention of contrast- induced acute kidney injury, the oral route could offer an equivalent, practical, and cost saving approach. A systematic review of randomized trials that compared oral versus intravenous volume expansion for the prevention of radiocontrast-induced nephropathy in patients receiving arterial contrast reported no significant difference in the risk of contrast induced acute kidney injury between the oral and intravenous arms...
2015: Canadian Journal of Kidney Health and Disease
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