Search

Abstract: Background: Although the pleiotropic effects of statins are postulated to be renoprotective, clinical studies have demonstrated conflicting results. We undertook a meta-analysis of published trials to evaluate the impact of statin therapy on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. Methods: We searched MEDLINE and EMBASE databases through December 2010 for articles evaluating the effect of statins on the incidence of CIN in patients undergoing coronary angiography. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using random effects modeling. Results: Three randomized controlled trials involving 770 patients (330 in the statin group and 340 in the control group) and 7 non-randomized studies involving 31,959 patients (11,936 statin-pretreated and 20,023 statin-naïve). The definition of CIN varied somewhat among the studies. Based on the pooled estimate across the 3 randomized controlled trials, statin therapy did not significantly reduce the incidence of CIN compared to control (OR=0.76, 95% CI: 0.41–1.41, p =0.39). No significant heterogeneity was found in the randomized studies (I2 =0%, p =0.48). The pooled analysis of the non-randomized studies showed a marginally significant benefit associated with statin therapy (OR=0.60, 95% CI: 0.36–1.00, p =0.05). There was significant heterogeneity among the non-randomized studies (I2 =88%, p <0.00001). Conclusions: Our meta-analysis suggests that statin therapy might be associated with a significant reduction in the incidence of CIN in patients undergoing coronary angiography. Further studies are warranted to clarify this issue. [Copyright &y& Elsevier]

Background and Aim: Previous studies have demonstrated that endogenous bone morphogenic protein-7 (BMP-7) level is reduced in acute kidney injury and administration of exogenous BMP-7 has a beneficial effect on kidney function. In spite of preventive management, contrast-induced nephropathy (CIN) is still the third cause of acute deterioration of kidney function in hospitalized patients. With this background in mind, we studied changes in serum BMP-7 in a group of patients with chronic kidney disease and contrast-induced nephropathy. Materials and Methods: We enrolled 45 consecutive adult patients with a baseline serum creatinine ≥1.4 mg/dl admitted for coronary angiography. We measured serum BMP-7 levels before and 48 h after coronary angiography. The primary end point was the development of CIN, defined as an increase in serum creatinine concentration by 0.25 mg/dl or 25% over the baseline value within 72 h from contrast exposure. Results: Overall, CIN occurred in 8 (17%) patients. The concentrations of serum BMP-7 were significantly decreased in the CIN group compared to baseline (488.6 ± 56.8 vs. 356.4 ± 24.8, P = 0.01); in contrast, the concentration of BMP-7 level did not change in patients without CIN (444.6 ± 54.6 vs. 440.0 ± 53.9, P = 0.09). Conclusion: BMP-7 level significantly decreases in patients who develop CIN after coronary angiography. Therefore, BMP-7 might be a diagnostic biomarker for CIN and a possibly promising agent for the treatment of CIN. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) is a common manifestation of atherosclerotic vascular disease and the incidence of infrapopliteal PAD continues to rise in the population. The historical experience with surgical and endovascular interventions for infrapopliteal stenosis was disappointing as operators experienced high rates of early technical failures and procedural complications, coupled with high rates of restenosis in this vascular territory when compared with more proximal vascular beds. While patients with infrapopliteal PAD may be asymptomatic, the majority would ultimately develop intermittent claudication or may also present with critical limb ischemia. In this article, we review the current literature, and discuss some of the technical aspects of endovascular therapy in this vascular bed. We also emphasize the importance of adjunctive evidence-based therapies such as antiplatelet agents, statins, and lifestyle modification such as smoking cessation in this particularly high-risk cohort to optimize clinical outcomes. [ABSTRACT FROM PUBLISHER]

Topics covered in this review include the relation of estimated glomerular filtration rate, proteinuria and outcome; sudden cardiac death; contrast-induced acute kidney injury (CI-AKI); imaging; clinical trials targeting cardiovascular disease in chronic kidney disease (CKD) patients; and treatment of ischemic heart disease and valvular disease. Several studies reinforce the importance of CKD in predicting mortality and make a case for redefining CKD to incorporate levels of proteinuria in the staging system. Another study provides support for using a combination of echocardiography and cardiac biomarkers for cardiac risk stratification in dialysis patients. Two studies reveal ongoing interest in and difficulty preventing CI-AKI. One study discusses chest ultrasound to detect pulmonary congestion and potentially guide ultrafiltration and volume removal in dialysis patients. Several clinical trials assess folic acid, statins and aspirin for prevention of future cardiovascular events in CKD patients. Finally, several studies compare the use of drug-eluting and bare metal stents in dialysis patients, discuss methods of surgical coronary artery revascularization in dialysis patients and describe testing allopurinol as a treatment for ischemic heart disease in non-renal patients. [ABSTRACT FROM AUTHOR]

Summary: Subjects with hypovolemia and/or dehydration and pre-existing renal failure are considered at highest risk for radiocontrast-medium-induced acute kidney injury (RCI-AKI), and this risk increases in the presence of glomerular filtration rate or creatinine clearance rates lower than 60mL/min (stage 3-5 chronic kidney disease according to the National Kidney Foundation). The authors critically review the evidence-based literature on RCI-AKI, its diagnosis, epidemiological aspects, predisposing conditions, and markers of risk, including advanced age. Procedures requiring the use of iodinated contrast media are increasingly performed in patients over 70 years of age, and there is no definitive consensus regarding the role of advanced age as a marker of risk for RCI-AKI. [Copyright &y& Elsevier]

Aim: The aim of this study is to investigate the efficacy and mechanism of action of intravenous (IV) bicarbonate in preventing radiocontrast nephropathy (RCN). Materials and methods: Twenty-eight Wistar rats were randomized into four groups including control (group 1), radiocontrast (group 2), bicarbonate (group 3), and radiocontrast plus bicarbonate (group 4). Once blood chemistry and arterial blood gases were examined and 24 h urine samples were collected, all rats were administered furosemide (2 mg/kg subcutaneous) and deprived of water for 24 h. Iothalamate sodium (6 mL/kg) was administered to group 2 and group 4. IV bicarbonate (8.4%) was administered to group 3 and group 4 (3 h before the administration of iothalamate). On the fourth day, 24 h urine was collected, and at the end of the day rats were sacrificed and blood chemistry and arterial blood gases were reexamined. Myeloperoxidase (MPO), nitric oxide (NO), total glutathione, and malondialdehyde were quantified on the renal tissue. H&E slides were examined. Results: Basal creatinine and creatinine clearance were similar between groups. There was no significant difference between creatinine and creatinine clearance by the end of the experiment. Glutathione level in group 2 was lower than in group 4. Histopathologically, there was no injury in the control group (group 1) whereas there was an intermediate-severe injury (71.4%) in the radiocontrast group (group 2). The percentage of intermediate-severe injury was significantly lower (71.4% vs. 28.6%, p = 0.02) in the radiocontrast plus bicarbonate group (group 4). Conclusions: Sodium bicarbonate attenuates the development of radiocontrast-induced tubular necrosis. [ABSTRACT FROM AUTHOR]

Objectives: We sought to evaluate whether pre-procedural glucose levels are associated with contrast-induced acute kidney injury (CI-AKI) after coronary angiography. Background: Although diabetes is a known risk factor for CI-AKI in patients undergoing coronary angiography, whether elevated pre-procedural glucose levels (regardless of pre-existing diabetes) are associated with higher risk for CI-AKI is unknown. Methods: We evaluated 6,358 patients with acute myocardial infarctions undergoing coronary angiography. Patients were stratified into 5 pre-procedural glucose groups: <110 mg/dl, 110 to <140 mg/dl, 140 to <170 mg/dl, 170 to <200 mg/dl, and ≥200 mg/dl. Logistic regression models were used to evaluate the relationship between glucose levels and risk for CI-AKI, first in the entire cohort and then in patients with and without established diabetes. The primary outcome was CI-AKI (≥0.3 mg/dl absolute or ≥50% relative serum creatinine increase during 48 h after the procedure). Results: The relationship between pre-procedural glucose and CI-AKI varied markedly in patients with and without diabetes. There was a strong association between glucose and CI-AKI risk in patients without diabetes (CI-AKI rates across the 5 glucose groups from lowest to highest: 8.2%, 9.9%, 12.4%, 14.9%, and 24.3%; p < 0.001), but not in patients with diabetes (20.9%, 16.1%, 16.3%, 14.8%, and 19.2%, respectively; p = 0.24; p for glucose × diabetes interaction <0.001). After adjusting for confounders (including baseline glomerular filtration rate), the relationship between higher glucose and greater CI-AKI risk persisted in patients without diabetes (odds ratios [95% confidence intervals] for glucose groups of 110 to <140 mg/dl, 140 to <170, mg/dl 170 to <200 mg/dl, and ≥200 mg/dl: 1.31 [1.00 to 1.71], 1.51 [1.11 to 2.10], 1.58 [1.03 to 2.43], and 2.14 [1.46 to 3.14] vs. glucose <110 mg/dl, respectively), but this relationship was not seen in patients with established diabetes. Conclusions: Elevated pre-procedural glucose is associated with greater risk for CI-AKI in patients without known diabetes who undergo coronary angiography in the setting of acute myocardial infarction. Measures used to prevent CI-AKI should be considered in these patients. [Copyright &y& Elsevier]

This study was done to investigate whether aminophylline reduces the incidence of contrast induced nephropathy (CIN) after coronary angioplasty. Sixty patients who had serum creatinine concentration of > 1.3 mg/dl randomly received 250 mg IV aminophylline or placebo 30 minutes before coronary angiography. Serum creatinine and blood urea nitrogen were determined immediately before (base line) and at 24 and 48 hours after administration of contrast medium. The primary end point was the incidence of CIN. The incidence of CIN was 20% in placebo group and 13.3% in aminophylline group; older age was significantly associated with CIN: In this study, we could not demonstrate the prophylactic effect of a single infusion of 250 mg aminophylline, 30 minutes before administration of contrast media. A larger trial that incorporates the evaluation of clinically relevant outcomes is required to more adequately assess the role for aminophylline in CIN prevention. [ABSTRACT FROM AUTHOR]

Aim: Oxidative stress and ischaemia are suggested as possible mechanisms of contrast-induced nephropathy (CIN). Statins may offer renoprotection in both acute and chronic kidney diseases because of their antioxidant and anti-inflammatory properties. We investigated whether use of statins before non-emergent percutaneous coronary intervention (PCI) reduces the incidence of CIN. Methods: We retrospectively evaluated 540 consecutive adult patients who underwent non-emergent PCI over a 3 year period at a tertiary care centre. CIN was defined as 25% or 44 mmol/L increase from baseline creatinine at 48–72 h. In addition, we classified patients based on Mehran score for risk of development of CIN and analysed the effect of statins. Results: Three-hundred and fifty-three patients met inclusion criteria. Two-hundred and thirty-nine patients were taking statins before PCI and 114 were not. Baseline characteristics were similar for both groups. CIN occurred in 75 patients (21.2%). There was a higher incidence of CIN in patients on statins as compared with patients not on statins (24.7% vs 14%; 95% CI: 1.09–3.67; P = 0.02). However, propensity-based adjustment for receipt of statins revealed no significant differences in CIN between both groups (OR: 1.6; 95% CI: 0.87–3.22; P = 0.12). Multivariate logistic regression revealed Mehran score to be independently predictive of CIN. None of the patients who developed CIN required dialysis. Conclusions: Statin use before non-emergent PCI is not associated with reduction in CIN. Further randomized controlled trials based on proper risk adjustment for development of CIN are needed. [ABSTRACT FROM AUTHOR]

The article presents information on a study related to sodium bicarbonate therapy to prevent contrast media-induced acute kidney injury (CI-AKI). The researchers had made a comprehensive meta-analysis including a total of 18 trials focusing on separate analysis of papers both published and unpublished. It is reported that sodium bicarbonate-based hydration was found to be superior to normal saline in the prevention of CI-AKI in all recent meta-analyses.

Background/Aims. Different serum and urinary biomarkers have been recently proposed to serve as markers of acute kidney injury. We tested the hypothesis whether NGAL and other biomarkers could represent an early biomarker of contrast nephropathy (CIN) in diabetic patients with normal serum creatinine undergoing cardiac catheterization in comparison with non-diabetic patients. Methods. Serum, urinary NGAL, cystatin C, urinary kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and liver-type fatty acid binding protein (L-FABP) were evaluated before and 2, 4, 8, 24, and 48 hours after cardiac catheterization using commercially available kits. Results. In both groups we found a significant rise in serum NGAL after 2, 4, and 8 hours, and in urinary NGAL and IL-18 after 4, 8, and 24 hours after cardiac catheterization. Serum cystatin C increased significantly 8 hours, reaching peak 24 hours after cardiac catheterization in both groups, and then decreased after 48 hours. L-FABP and KIM-1 increase significantly after 24 and 48 hours after cardiac catheterization. Conclusions. CIN was similarly prevalent in both diabetic and non-diabetic patients undergoing cardiac catheterization. NGAL seems to be a potential early marker for nephrotoxicity and predictor of contrast nephropathy. It is particularly important in the upcoming setting of short-time hospitalizations for cardiac catheterization. [ABSTRACT FROM AUTHOR]

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Intravenous administration of saline and non-ionic isosmolar contrast media significantly reduces the incidence of contrast-induced nephropathy, one of the most common causes of acute renal failure. Results with oral N-acetylcysteine are conflicting. The aim of our study was to evaluate the prophylactic role of N-acetylcysteine in patients with stable chronic renal failure undergoing coronary and/or peripheral angiography and/or angioplasty. [ABSTRACT FROM PUBLISHER]

Contrast-induced nephropathy is well-known sequelae of iodinated contrast (diatrizoate meglumine). Carbon dioxide (CO2) can be used as an alternative contrast agent. The aim of this study was to compare the renal injury and the quality of images of aortogram using iodinated contrast versus CO2 using digital subtraction angiography (DSA). This prospective randomized study was done in 29 healthy dogs using DSA aortogram. Dogs were randomly assigned to receive iodinated contrast or CO2. 6-F pigtail catheter was introduced via femoral artery approach to perform aortogram under general anesthesia. Serum creatinine (S.Cr.) and urinary enzymes, namely: N-acetyl D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and gamma glutamyl transferase (GGT), were measured before and 48 hours after aortogram. There was no change in S.Cr. in both the groups. Significantly more enzymuria was seen following iodinated contrast than CO2. Enzymuria pre and postaortogram following the iodinated contrast was GGT: 14.9 ± 5.92 vs. 26.2 ± 15.1 (P = 0.001), NAG: 1.63 ± 0.90 vs. 3.6 ± 2.14 (P = 0.0001), and AAP: 1.51 ± 0.75 vs. 3.38 2.41 (P = 0.001), and in the CO2 group was GGT: 15.5 ± 4.9 vs. 21.1 ± 9.04 (P = 0.02), NAG: 2.12 ± 1.06 vs. 3.82 3.27 (P = 0.08), and AAP: 1.28 ± 0.76 vs. 2.51 ± 1.72 (P = 0.03). More than 50% increase over the preprocedural value was significantly less following CO2. Images obtained with iodinated contrast were superior to those with CO2, however, the quality of image with CO2 was adequate for delineation of the renal artery and major branches. Both iodinated contrast and CO2 cause significant enzymuria. More severe enzymuria (>50% increase) was seen significantly less with the use of CO2. Quality of images is better with iodinated contrast. [ABSTRACT FROM AUTHOR]

The incidence of both acute kidney injury (AKI, previously referred to as acute renal failure) and chronic kidney disease (CKD) is reaching epidemic proportions. In both situations, early intervention can significantly improve the prognosis. However, the paucity of early, predictive, non-invasive biomarkers has impaired our ability to institute potentially effective therapies for these common clinical conditions in a timely manner. The current status of one of the most promising novel biomarkers, namely neutrophil gelatinase-associated lipocalin (NGAL), is presented in this review. The evidence for the role of NGAL measurements in a variety of clinical situations leading to AKI (cardiac surgery, kidney transplantation, contrast nephropathy, haemolytic uraemic syndrome and in the intensive care setting) or to CKD (lupus nephritis, glomerulonephritides, obstruction, dysplasia, polycystic kidney disease, IgA nephropathy) is explored. The emerging utility of standardized clinical platforms for reliable measurement of NGAL in plasma (Triage® NGAL Device; Biosite Incorporated) and urine (ARCHITECT® analyzer; Abbott Diagnostics) is also discussed. It will be important in future studies to validate the sensitivity and specificity of NGAL concentration measurements in clinical samples from large cohorts and from multiple clinical situations. Such studies will be facilitated by the anticipated widespread availability of standardized commercial tools in the near future. [ABSTRACT FROM AUTHOR]

Background: Previous studies that have attempted to evaluate the effectiveness of an iso-osmolar contrast medium (IOCM) iodixanol compared to a low-osmolar contrast medium (LOCM) for contrast procedures show variable results. Purpose: To evaluate the nephrotoxicity of the IOCM iodixanol compared to the LOCM iohexol. Material and Methods: We performed a retrospective cohort study from April 2004 to March 2006. All contrast procedures with a pre- and post-exposure creatinine value were evaluated for inclusion. Contrast nephropathy (CN) was defined as post-exposure creatinine elevation of ≥25% or >0.5 mg/dl within 7 days of contrast exposure. Cases of iodixanol exposure were matched to control cases of iohexol exposure (1:1) based on age, sex, presence of diabetes, pre-exposure creatinine value, and type of imaging study performed. We matched 397 cases of iodixanol (IOCM) exposure to 397 cases of iohexol (LOCM) exposure. Cases of iodixanol which could not be matched to controls were not included in the analysis. Results: After adjustment for prior creatinine, medications, contrast iodine load, prior exposure to contrast material, heart failure, and hypertension, use of iodixanol did not significantly alter rates of CN compared to iohexol (OR 0.92, 95% CI 0.57-1.46; P=0.71) or mortality (RR 0.79, 95% CI 0.59-1.06; P=0.12). Conclusion: The use of the IOCM iodixanol was not associated with statistically significant protection against contrast nephropathy or all-cause mortality compared to a matched cohort of patients receiving the LOCM iohexol. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the methods to prevent femoral arteriotomy complications and contrast nephropathy in patients undergoing cardiac catheterization in Turkey. The study found that traditional approaches to the management of the femoral artery insertion site in patients undergoing cardiac catheterization continue in the country. It concludes that the characteristics of the patient and the preferences of the professional doing the procedure are important in the choice of method.

The correct strategy to prevent radiocontrast-induced nephropathy (CIN) in high-risk patients going for cardiac angiography is widely debated in the literature. It is well known that chronic kidney disease (CKD) patients with lower estimated glomerular filtration rates (eGFRs) at baseline are at the greatest risk for a significant loss in kidney function, or even dialysis after a contrast load. For this reason potentially life-saving procedures such as angiography are sometimes withheld or delayed. We describe a case series of 31 well-characterized patients with CKD who underwent cardiac or peripheral vessel angiography, and patients with renal artery stenosis (RAS) who underwent angioplasty and stenting. All were treated with a standardized outpatient protocol of withholding their diuretics and angiotensin-converting enzyme (ACE) inhibitors (ACEs)/angiotensin receptor blockers (ARBs) the day prior to and 2 days after the procedure, restarting the diuretic the day after the procedure and the ACE inhibitor/ARB after 2 days. Calcium channel blockers were prescribed for the 2 days prior to and 2 days after the procedure. Patients had bloodwork on days 2–3 and days 7–10 post-procedure. The patients had a mean baseline creatinine of 214 µmol/l (SD = 123), ranging from 87 to 535 µmol/l. This corresponded to a mean baseline eGFR of 34 ml/min (SD = 15.8), ranging from a minimum of 12–59 ml/min. The mean age was 64 ± 13.8 years; 48% were male and 11 (35.5%) were diabetic. All patients enrolled had a baseline eGFR of less than 60 ml/min as calculated by the Modification of Diet in Renal Disease (MDRD) formula. Based on pre-procedure CKD stage, 21 (68%) were stage 3 (eGFR 30–60 ml/min), 5 (16%) were stage 4 (eGFR 15–30 ml/min), and 6 (19%) were stage 5 (eGFR < 15 ml/min). No patient required urgent hemodialysis following their angiography. All patients have had a longitudinal follow up of 26 months, and none developed any change in the rate of progression from prior to procedure. This case series provides data in support of a conservative, outpatient-based approach for high-risk CKD patients going for cardiac angiography. This protocol warrants further study in randomized control trials. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this pilot study was to examine the safety and efficacy of two doses of the prostacyclin analogue iloprost in preventing CMN in high-risk patients undergoing a coronary procedure. Methods: Forty-five patients undergoing coronary angiography and/or intervention who had a serum creatinine concentration ≥1.4 mg/dL were randomized to receive iloprost at 1 or 2 ng/kg/min or placebo, beginning 30–90 minutes before and terminating 4 hours after the procedure. CMN was defined by an absolute increase of serum creatinine ≥0.5 mg/dL or a relative increase of ≥25% measured 2 to 5 days after the procedure. Study drug infusion was discontinued in 2 patients in the low-dose iloprost group due to flush/nausea and in 5 patients in the high-dose group due to severe hypotension. Results: The mean creatinine concentration change in the placebo group (0.02 mg/dL) was unfavorable compared to that in the low-dose iloprost group (-0.11 mg/dL; p=0.08) and high-dose iloprost group (-0.23 mg/dL; p=0.048). The difference between the absolute changes in creatinine clearance was favorable compared to placebo for both the low (mean difference 6.1 mL/min, 95%CI -0.5 to 12.8 mL/min, p=0.07) and the high-dose iloprost group (11.8 mL/min, 95%CI 4.7 to 18.8 mL/min, p=0.002). Three cases of CMN were recorded; all in the placebo group (p=0.032). Conclusions: The results of this pilot study suggest that prophylactic administration of iloprost may effectively prevent CMN, but higher dosages are connected with substantial tolerability issues. [ABSTRACT FROM AUTHOR]

Background/aims: The value of neutrophil-gelatinase-associated lipocalin (NGAL), a novel biomarker in the detection of acute renal failure in children after cardiac surgery, has been highlighted in previous studies. The incidence of percutaneous coronary intervention (PCI) increases, which may possibly result in increased incidences of contrast nephropathy, its potentially serious complication. Therefore, the aim of our study was to assess prospectively NGAL in patients undergoing elective PCI in relation to serum creatinine. Methods: NGAL was assessed in the serum and urine using commercially available kits. Results: We measured urinary and serum NGAL before, and 2, 4, 12, 24 and 48 h after PCI. We found a significant rise in serum NGAL 2 and 4 h after PCI, and a rise in urinary NGAL 4 and 12 h after PCI. Before PCI, serum NGAL was significantly associated with serum creatinine, urea, urinary NGAL, hemoglobin, hematocrit, albumin, age and presence of diabetes. In multivariate analysis, serum creatinine was the only predictor of serum NGAL. Serum NGAL 2 h after PCI correlated with serum creatinine, duration of PCI, HbA1c, hematocrit, hemoglobin and urinary NGAL. In multivariate analysis, the only predictors of serum NGAL 2 h after PCI were serum creatinine, time of PCI and HbA1c. Serum NGAL before PCI was significantly higher in diabetics than in non-diabetics. Conclusions: NGAL may represent a sensitive early biomarker of renal impairment after PCI. Serum creatinine, duration of PCI, but not type and amount of contrast agent, and appropriate treatment of diabetes, reflected by HbA1c, predict a rise in serum NGAL and kidney function following PCI. [ABSTRACT FROM AUTHOR]

The Dialysis Outcomes Quality Initiative emphasizes increasing arteriovenous fistula prevalence, by promoting referral for fistula creation in patients with stage 4 chronic kidney disease (CKD). The aim is to provide an optimal access for initiation of dialysis, thus avoiding central venous catheter use. The endovascular management of nonmaturing fistulas is more complicated in these patients, where the expected benefit of catheter avoidance must be weighed against the risk of contrast induced nephropathy (CIN). This study reports on the safety of a low-dose radiocontrast regimen, used in performing endovascular fistula salvage procedures in patients with stage 4 CKD. All consecutive endovascular procedures performed over a 2-year period in patients with stage 4 CKD and nonmaturing access were identified. Data collected included the type of procedure, contrast volume per procedure, pre, 2- and 7-day creatinine, need for acute dialysis, and the type of access used to initiate dialysis. Total of 65 procedures were performed in 34 patients. The mean contrast volume was 7.8 ml per procedure. The incidence of CIN (25% increase in serum creatinine) was 4% at 2 days and 4.6% at 1 week. All values returned to baseline within 2 weeks, and no patient required acute dialysis. Among the 33 patients with nonmaturing fistulas, 20 initiated dialysis during the follow-up period, 15 (75%) using their fistula, and five (25%) using a catheter. This study demonstrates that in patients with advanced CKD, fistulas can be successfully salvaged using small contrast volumes with a low incidence of CIN.Kidney International (2006) 69, 1444–1449. doi:10.1038/sj.ki.5000276; published online 1 March 2006 [ABSTRACT FROM AUTHOR]

Reactive oxygen species play a major role in the pathogenesis of contrast-induced nephropathy (CN). Hydration with sodium bicarbonate (HCO) can reduce the incidence of CN in high-risk patients, suggesting a direct causal relationship between low pH of tubular fluid and enhanced activity of generated reactive oxygen species to damage renal tubular cells. Whether acetazolamide (AZ), a carbonic anhydrase inhibitor, is more effective than HCO unknown. Ninety-six children with stable chronic renal insufficiency were randomly assigned to receive either a 154 mEq/L infusion of sodium bicarbonate (HCO) ( n = 46) or 0.9% sodium chloride plus oral AZ ( n = 50) at a rate of 3 ml/kg/hr for 1 hour before and 1 ml/kg/hr for 6 hours after the radiographic procedure. Serum creatinine concentration (Scr) was measured before and 48 hours after the procedure. The primary endpoint was an increase in the Scr concentration of ≥25% 48 hours after the contrast administration. The baseline clinical and biochemical characteristics of the two groups were similar. The mean Scr concentration after contrast administration was significantly lower in the AZ group ( p = 0.02) than in the HCO group ( p = 0.27). The mean absolute decrease in Scr concentration at 48 hours was significantly greater in the AZ group ( p < 0.01). Four of the 46 patients (8.7%) in the HCO group had an increase in the Scr concentration of ≥25% compared with none of the 50 patients (0%) in the AZ group ( p = 0.049). Thus, compared to HCO, AZ plus saline hydration was more effective for the prevention CN after radiographic procedure. [ABSTRACT FROM AUTHOR]

Background: Contrast agents used in angiography procedures for patients with cardiovascular disease are known to cause contrast-induced nephropathy (CIN), which may be partially due to the production of nephrotoxic oxygen-free radicals. It is uncertain whether administration of intravenous (IV) anti-oxidant, N-acetylcysteine (NAC), can prevent reduction in renal function and whether this is a cost-effective approach. Methods: Sixty-five day-only patients with renal impairment (mean serum creatinine concentration 0.16+/-0.03 mmol/l) due to undergo coronary or peripheral angiography and/or stenting were randomly assigned to IV NAC 300 or 600 mg immediately before and after the procedure or IV fluid alone. Results: Of the 60 patients with complete data, none had acute CIN (increase in serum creatinine concentration > or = 0.044 mmol/l, 48 h after administration of contrast agent). Eight patients (13%) have demonstrated an increase in their serum creatinine concentration > or = 0.044 mmol/l 30 days after administration of contrast agent: 2/19 (11%) in the control group, 2/21 (10%) in the 600 mg NAC group and 4/20 (20%) the 300 mg NAC group (p = 0.66). The mean volumes of contrast agent used and prehydration given for each of the three groups did not differ significantly (p > 0.83). There was significant improvement in creatinine clearance within each group from baseline to 30 days (p < or = 0.03), but no significant difference between the groups at 48 h and 30 days (p > or = 0.43). Considering the cost of NAC and its administration, we estimate that this would translate to a saving of dollar 26,637 per annum. Conclusion: For day-stay patients with mild-to-moderate chronic renal impairment undergoing angiography and/or intervention, prehydration alone is less complicated and more cost-effective than a combination of IV NAC (at doses used) and hydration. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown. Subjects and methods: We studied 29409 patients who had both baseline preprocedure and peak postprocedure serum creatinine measured at the time of their percutaneous coronary intervention (PCI). Baseline demographics and creatinine profile before and after the procedure were compared between patients who received preprocedure statins and those who did not. CIN was defined as an increase in serum creatinine of ≤0.5 mg/dL. Results: Baseline serum creatinine was similar between the two groups. When compared with patients who did not receive preprocedure statins, patients on preprocedure statins had a lower incidence of CIN (4.37 vs 5.93, P &#60;0.0001) and nephropathy requiring dialysis (0.32 vs 0.49, P = 0.03). After adjustments for comorbidities, preprocedure statin use was associated with a significant reduction in CIN (odds ration [OR] 0.87, 95% confidence interval [CI] 0.77–0.99, P = 0.03). Conclusions: Preprocedure statin use is associated with significant reduction in CIN after contemporary PCI. This reinforces the need to initiate statin therapy before percutaneous coronary interventions. [Copyright &y& Elsevier]

Introduction: The use of contrast medium can result in an acute reduction in renal function. The exact mechanism of this side effect is not yet fully understood. There is accumulating evidence that reactive oxygen species have a role in renal damage. Prophylactic administration of antioxidant drugs could prevent this reduction in renal function. We examined whether there is a correlation between the antioxidant capacity of the serum and the risk of contrast medium nephropathy. Methods: We studied prospectively 193 patients with normal renal function who underwent cardiac catheterization. Serum haptoglobin, uric acid, albumin and the total antioxidant capacity were measured before the injection of contrast media. Serum urea and creatinine concentrations were measured before angiography and on days 3 and 7 following the procedure. Results: Eleven patients developed mild renal failure. We compared the serum levels of antioxidant compounds of this group with the serum levels of these compounds in patients who did not develop renal damage. No statistical significant difference in the baseline levels of antioxidant species was found between the two groups. Conclusions: These prospective data indicate that among low-risk patients with normal renal function, baseline levels of antioxidant material did not predict the possible development of contrast medium nephropathy. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Kidney Injury Molecule-1 (KIM-1): A novel biomarker for human renal proximal tubule injury. Background. Traditional blood and urine markers for the diagnosis of various renal diseases are insensitive and nonspecific. Kidney Injury Molecule-1 (KIM-1) is a type 1 transmembrane protein, with an immunoglobulin and mucin domain, whose expression is markedly up-regulated in the proximal tubule in the post-ischemic rat kidney. The ectodomain of KIM-1 is shed from cells. The current studies were carried out to evaluate whether KIM-1 is present in human acute renal failure and might serve as a urinary marker of acute renal tubular injury. Methods. Kidney tissue samples from six patients with biopsy-proven acute tubular necrosis (ATN) were evaluated by immunohistochemistry for expression of KIM-1. Urine samples were collected from an additional thirty-two patients with various acute and chronic renal diseases, as well as from eight normal controls. Urinary KIM-1 protein was detected by immunoassay and was quantified by ELISA. Results. There was extensive expression of KIM-1 in proximal tubule cells in biopsies from 6 of 6 patients with confirmed ATN. The normalized urinary KIM-1 levels were significantly higher in patients with ischemic ATN (2.92 ± 0.61; N = 7) compared to levels in patients with other forms of acute renal failure (0.63 ± 0.17, P < 0.01; N = 16) or chronic renal disease (0.72 ± 0.37, P < 0.01; N = 9). Adjusted for age, gender, length of time delay between the initial insult and sampling of the urine, a one-unit increase in normalized KIM-1 was associated with a greater than 12-fold (OR 12.4, 95% CI 1.2 to 119) risk for the presence of ATN. Concentrations of other urinary biomarkers, including total protein, γ-glutamyltransferase, and alkaline phosphatase, did not correlate with clinical diagnostic groupings. Conclusions. A soluble form of human KIM-1 can be detected in the urine of patients with ATN and may serve as a useful biomarker... [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) after contrast-guided interventions is associated with adverse outcomes, but the role of contrast in the context of renal function is less well described for patients undergoing transcatheter aortic valve replacement (TAVR)., Methods: Patients from the Michigan TAVR registry between January 2016 and December 2019 were included. AKI was defined using Valve Academic Research Consortium 2 definitions. An integer cut point for the ratio of contrast volume (CV) to renal function (estimated glomerular filtration rate [eGFR]) as a predictor of AKI was calculated., Results: Of 7112 cases, AKI occurred in 629 (8.8%) patients. Unadjusted mortality was higher among patients with AKI (32.5% vs 9.0%, P  ​< ​.0001). AKI remained significantly associated with the risk of mortality after multivariable adjustment (hazard ratio = 4.50, P  ​< ​.001). Procedural characteristics associated with AKI included CV/eGFR >2 (adjusted odds ratio [aOR] = 1.36, P = .003, 95% CI = 1.10-1.67), CV/eGFR >3 (aOR = 1.38, P  ​= ​.009, 95% CI = 1.09-1.77), and use of general anesthesia (aOR = 1.67, P  ​< ​.0001, 95% CI = 1.38-2.03)., Conclusions: CV in the context of renal function administrated during TAVR is a robust tool to predict AKI. AKI after TAVR is associated with an increased risk of mortality. Incorporation of thresholds of >2× and > 3× eGFR into procedural planning should be considered as a quality initiative., Competing Interests: S. Gualano, W. Merhi, C. Schwartz, and F. Shannon have no disclosures. S. Chetcuti has been a consultant and proctor for Medtronic, with research support from 10.13039/100004374Medtronic, Gore, 10.13039/100008497Boston Scientific, 10.13039/100006520Edwards Lifesciences, and JenaValve. D. Sukul receives research funding from 10.13039/100001502Blue Cross Blue Shield of Michigan. H. Patel is a consultant for Medtronic and WL Gore. H. Gurm receives research funding from 10.13039/100001502Blue Cross Blue Shield of Michigan and the 10.13039/100000002National Institutes of Health Center for Accelerated Innovation and is a consultant for Osprey Medical. W. O’Neill is a consultant for Abbott, Edwards Lifesciences, Boston Scientific, and Abiomed, with research grant support from Abiomed, 10.13039/100001316Abbott, 10.13039/100006520Edwards Lifesciences, and 10.13039/100004374Medtronic. P. Grossman is a consultant for Medtronic Cardiovascular, has research support from 10.13039/100004374Medtronic Cardiovascular, 10.13039/100006520Edwards Life Sciences, and 10.13039/100016476Cardiovascular Systems Incorporated, has registry support from 10.13039/100001502Blue Cross Blue Shield of Michigan, and has research support from 10.13039/100000002National Institutes of Health. None of the authors have any conflicts directly relevant to this study.

Contrast associated acute kidney injury (CA-AKI) is a controversial subject in the field of nephrology, cardiology, radiology and hospital medicine. Much has been written and published concerning the causes, risk factors, outcomes, and potential treatments to avoid the ultimate outcome of complete kidney failure requiring dialysis. Over the decades many proposed preventative strategies and treatments have failed to produce a reliable outcome. Additionally, there is now a growing discussion of the severity and sincerity of CA-AKI being a major entity to worry about for patients. We discuss the present state of CA-AKI and highlight potential risk factors and possible therapeutic interventions to minimize any impact a contrast procedure may have on a patient in order to maximize the medical care. [ABSTRACT FROM AUTHOR]

Background: Contrast nephropathy is a common and often reversible cause of acute renal failure (ARF). About 10% of ARF in admitted patients might be due to it and may also lead to dialysis. Some methods could prevent it such as fluid therapy with half or normal saline, Na bicarbonate, N-acetyl cysteine (NAC), and so on. The aim of this study was to evaluate the efficacy of NAC to prevent contrast nephropathy. Materials and Methods: In a cross-sectional study, 110 patients who were candidate for intravenous pyelography (IVP) or CT scan enrolled in two groups: Case and control. In patients of case group, meglumine compound and in control group, placebo was prescribed before procedure. Before study and after 48 h, blood urea nitrogen (BUN) and creatinine (Cr) was checked, and glomerular filtration rate (GFR) was measured with Cockcroft-Gault formula. Results: There were no difference between age and gender of two groups. There was also no significant difference between mean Cr before and after study; however, GFR of patients in case group was significantly higher than the control group after 48 h of procedure. Conclusion: Because GFR was higher in case group and there were no drug side-effects in patients, we recommend the use of NAC before administration of intravenous contrast especially in high-risk population such as diabetic patients.