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Preexisting renal impairment and the amount of contrast media are the most important risk factors for contrast-induced acute kidney injury (CI-AKI). We aimed to investigate whether the product of contrast medium volume and urinary albumin/creatinine ratio (CMV × UACR) would be a better predictor of CI-AKI in patients undergoing nonemergency coronary interventions. This was a prospective single-center observational study, and 912 consecutive patients who were exposed to contrast media during coronary interventions were investigated prospectively. CI-AKI is defined as a 44.2 μmol/L rise in serum creatinine or a 25% increase, assessed within 48 h after administration of contrast media in the absence of other causes. Fifty patients (5.48%) developed CI-AKI. The urinary albumin/creatinine ratio (UACR) (OR = 1.002, 95% CI = 1.000-1.003, p = .012) and contrast medium volume (CMV) (OR = 1.008, 95% CI = 1.001-1.014, p = .017) were independent risk factors for the development of CI-AKI. The area under the ROC curve of CMV, UACR and CMV × UACR were 0.662 (95% CI = 0.584-0.741, p < .001), 0.761 (95% CI = 0.674-0.847, p < .001) and 0.808 (95% CI = 0.747-0.896, p < .001), respectively. The cutoff value of CMV × UACR to predict CI-AKI was 1186.2, with 80.0% sensitivity and 62.2% specificity. The product of CMV and UACR (CMV × UACR) might be a predictor of CI-AKI in patients undergoing nonemergency coronary interventions, which was superior to CMV or UACR alone.

Objectives: To evaluate the effect of reduced glutathione on renal outcomes following the selective coronary angiography and/or intervention., Background: Contrast agents can cause an acute reduction in renal function that may be due to the generation of reactive oxygen species. The role of antioxidants in prevention of this renal impairment is controversial., Methods and Results: We conducted a randomized, placebo-controlled trial of reduced glutathione in 825 patients who underwent selective coronary angiography and/or intervention. Patients were assigned to reduced glutathione 1800 mg (n = 416) or placebo (n = 411) intravenously. Contrast-induced acute kidney injury was defined by an absolute increase of serum creatinine ≥0.5 mg/dl (44.2 μmol/L) or a relative increase of ≥25% measured 48 hours after the procedure. The incidence of contrast-induced acute kidney injury was 5.07% in the glutathione group and 4.97% in the control group (relative risk, 1.04; 95% confidence interval, 0.59-1.83; P = 0.886). Change in serum malondialdehyde was (-) 1.01 ± 1.69 nmol/ml in the glutathione group and (-) 0.67 ± 1.55 nmol/ml in the control group (P = 0.054), and change in serum total antioxidant capacity level was also similar in both groups (0.91 ± 2.06 nmol/ml and 0.79 ± 2.18 nmol/ml, respectively; P = 0.936)., Conclusions: A single dose of reduced glutathione does not reduce the risk of contrast-induced acute kidney injury in patients undergoing coronary angiography and/or intervention., (© 2015, Wiley Periodicals, Inc.)