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Contrast-Induced Nephropathy (CIN) is the third leading cause of kidney failure in theworld today (Krasinski, 2020, p.274). The condition develops in patients that receive iodinatedcontrast media (ICM) which is a dye that helps visualize the veins and arteries during coronaryangiograms and computed tomography (CT) scans. CIN is defined as a deterioration of thekidney due to the injection of contrast administration leading to kidney failure. Current CINliterature lacks fundamental understanding of how current hydration methods affect thelikelihood of this condition manifesting itself. The team sought to study this condition using ahydration protocol where 500 mL of normal saline was administered pre- and post-catheterization. Our main method of measurement was serum creatinine (sCr) which is theamount of creatinine found in the blood. The primary question of this study was to determinewhether patients with high-risk factors would be less likely to develop Post-Contrast AcuteKidney Injury (PC-AKI). A rise of the creatinine level of ≥0.30 mg/dL within 48 to 72 hourspost-procedure is the definition used in this observational study for development of PC-AKI.Based on trends found within the post-procedure time span, sCr levels lowered significantly,indicating a reduction in likelihood of patients developing PC-AKI. The decreasing sCr trendssuggested an appreciable difference after a two-sample t test was performed. Applying theseinsights show that elevated saline volume given potentially decreases future risk of PC-AKI.

Prognostic information is important for the management of acute coronary syndrome (ACS). Our aim was to evaluate Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score-II (SSII) for predicting contrast induced nephropathy (CIN) and one-year major adverse cardiac events (MACE) in ACS patients. Coronary angiographic recordings of 1304 ACS patients were retrospectively examined. Predictive values of SYNTAX score (SS), SSII-percutaneous coronary intervention (SSII-PCI), SSII-coronary artery bypass graft (SSII-CABG) scores for CIN and MACE were assessed. Combination of CIN and MACE ratios constituted primary composite end-point. Patients with SSII-PCI scores >32.55 were compared with patients with lower scores. All of the three scoring systems predicted the composite primary end-point [SS: Area under the curve (AUC):.718, P <.001 (95% CI:.689-.747), SSII-PCI: AUC:.824, P <.001 (95% CI:.800-.849), SSII-CABG: AUC:.778, P <.001 (95% CI:.751-.805)]. Comparison of AUC of receiver operating characteristic curves showed that SSII-PCI score had better predictive value than that of SS and SSII-CABG scores. In multivariate analysis, the only predictor of the primary composite end-point was SSII-PCI score (odds ratio: 1.126, 95% CI: 1.107-1.146, P <.001). SSII-PCI score was a valuable tool for prediction of shock, CABG, myocardial infarction, stent thrombosis, development of CIN and one-year mortality. [ABSTRACT FROM AUTHOR]

In April of 2022, the COVID-19 pandemic resulted in a global shortage of intravenous contrast media (ICM), which led our health care system to implement rationing measures. We set out to determine if the reduction in ICM use was associated with a change in the incidence of acute kidney injury (AKI). We conducted a multicenter retrospective cohort analysis to compare the incidence of AKI in patients who presented before and after ICM rationing. Adult patients who had a CT of the abdomen performed who had at least 2 creatinine measurements, at least 24 h apart, were included. The maximum increase in creatinine was determined by subtracting the maximal creatinine obtained within 7 days with the initial creatinine. The primary outcome was the development of AKI. A total of 2168 patients met inclusion criteria (1082 before; 1086 after). There was no significant difference in age, gender, comorbid conditions, disposition, or initial estimated glomerular filtration rate between groups. In the prerationing group, 87.7% of patients received ICM compared to 42.7% after. There was no significant difference in the development of AKI between groups (11.1% vs. 11.0%), including when stratified by baseline renal function and adjusted for age, sex, race, comorbid conditions, and emergency severity index. The dramatic reduction in ICM use that resulted from the global shortage was not associated with a change in the incidence of AKI. This reinforces the results of previous studies which have failed to find evidence of a relationship between ICM administration and AKI. [ABSTRACT FROM AUTHOR]

Contrast-induced nephropathy (CIN) is a prominent complication of ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (pPCI). The systemic immune inflammation response index (SIIRI) is a novel inflammatory marker developed by multiplying the monocyte count by the systemic immune inflammation index (SII) and is associated with coronary artery disease severity. We investigated the predictive ability of SIIRI for detecting CIN in STEMI patients (n = 2289) following pPCI and developed a nomogram based on SIIRI for risk stratifying. CIN was diagnosed based on an elevation in baseline creatinine levels >.5 mg/dL or 25% within 72 h after pPCI; 219 CIN (+) and 2070 CIN (−) patients were included. CIN (+) patients had higher SIIRI than CIN (−) patients and SIIRI was an independent predictor of CIN. A nomogram based on SIIRI had good calibration and discrimination abilities for predicting CIN development. SIIRI was superior to SII in discriminating CIN (+) patients. Adding SIIRI to the baseline model, which consists of age, hypertension, hemoglobin, estimated glomerular filtration rate, albumin, ejection fraction, lesion length, and pain-to-balloon time, had a higher discriminative ability and benefit in detecting CIN (+) patients than baseline model as assessed by decision curve analysis. [ABSTRACT FROM AUTHOR]

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Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.

Background Acute ST-elevation myocardial infarction (STEMI) represents a critical cardiovascular emergency, with percutaneous coronary intervention (PCI) being the preferred treatment. Post-PCI, patients are prone to developing contrast-induced nephropathy (CIN), significantly increasing the risk of adverse events. Thus, early diagnosis and treatment are crucial. Objective This study aims to investigate the diagnostic value of serum levels of NOD-like receptor pyrin domain-containing 3 (NLRP3) and the dosage of contrast agents for CIN following PCI in patients with STEMI. Methods The study included 257 patients diagnosed with STEMI and undergoing emergency PCI at the First People's Hospital of Kashi from June to December 2022. Based on the occurrence of CIN within 24 to 48 hours post-PCI, participants were divided into two groups: 61 in the CIN group and 196 in the non-CIN group. Basic clinical data of patients were collected, along with the dosage of contrast agents used during the procedure. On the second day of hospitalization, fasting venous blood was drawn to assess renal function indicators, lipid profiles, blood glucose, and serum NLRP3 levels, alongside echocardiographic evaluation of the left ventricular ejection fraction (LVEF). Multivariate Logistic regression analysis was utilized to explore factors influencing CIN development. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic value of serum NLRP3 levels and contrast agent dosage for CIN. Results The CIN group showed a lower proportion of males, lower preoperative levels of uric acid and albumin, and higher levels of contrast agent dosage and NLRP3 compared to the non-CIN group (P

Transcatheter closure of sinus venosus defect (SVD) is an emerging intervention that utilizes a covered stent to redirect the right upper pulmonary vein to the left atrium. Preprocedural computed tomography analysis, as well as the interventional procedure, necessitates the use of radiographic contrast media. Contrast use is prohibited in patients with advanced kidney disease, who also carry high surgical risks of cardiopulmonary bypass. Transesophageal echocardiography-guided catheter intervention with zero contrast use is presented in this report, along with technical details about planning the procedure. Covered stent exclusion of SVD without contrast use has not been reported in the literature so far.

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies 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.)

Background: The blood–urea–nitrogen (BUN)-to-serum–albumin (ALB) ratio (BAR) has been identified as a novel indicator of both inflammatory and nutritional status, exhibiting a correlation with adverse cardiovascular outcomes. This study aims to investigate the potential predictive value of BAR levels at admission for the development of CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Methods: Retrospective data were collected from patients who were admitted and underwent CAG or PCI between January 2018 and December 2022 at the Cardiac Medical Center of Union Hospital of Fujian Medical University, and the patients were divided into CIN and non-CIN groups. The BAR was computed by dividing the BUN count by the ALB count. Using multiple variable logistic regression, risk variables associated with the development of CIN were found. Results: A total of 156 patients developed CIN (7.78%). The development of CIN was predicted by a BAR ratio > 4.340 with a sensitivity of 84.0% and a specificity of 70.2%, according to receiver operating characteristic (ROC) analysis. BAR, female gender, diuretic use, and statin medication use were found to be independent predictors of CIN using multifactorial analysis. Conclusions: When patients are receiving CAG/PCI, BAR is a simple-to-use marker that can be used independently to predict the presence of CIN. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. Considering the pivotal role of inflammation in CIN development, the use of peripheral blood-based indexes may be an easily available biomarker to predict CIN risk. Therefore, in the present study, we evaluated the association between the pan-immune-inflammation value (PIV) and the risk of CIN. Patients and Methods: A total of 1343 patients undergoing coronary angiography (CAG) were included. The PIV was calculated with the following equation: (neutrophil count × platelet count × monocyte count)/lymphocyte count. Multivariable regression analyses were used to determine the association between clinical and laboratory parameters and CIN development. Results: The median age of the cohort was 58 (IQR 50–67), and 48.2% of the patients were female. CIN developed in 202 patients (15%) in follow-up. In multivariate analyses, older age (OR: 1.015, 95% CI: 1.002–1.028, p = 0.020) and higher PIV levels (OR: 1.016, 95% CI: 1.004–1.028, p = 0.008) were associated with a higher CIN risk, while the use of antiplatelet agents was associated with a lower risk of CIN (OR: 0.670, 95% CI: 0.475–0.945, p = 0.022). Conclusions: We demonstrated that the risk of CIN was significantly higher in patients with higher PIV and older patients in a large cohort of patients undergoing CAG for stable ischemic heart disease. If supported with prospective evidence, PIV levels could be used as a minimally invasive reflector of CIN. [ABSTRACT FROM AUTHOR]

Aim: Transcatheter closure of the patent ductus arteriosus (TCPDA) is increasingly used in preterm infants as an alternative to surgical ligation. However, clinically ill preterm infants are at risk of contrast nephropathy due to the angiography contrast agents used during the procedure. Methods: We performed a single‐centre before‐and‐after comparative study in VLBW infants to compare the kinetics of serum creatinine during the first 4 days after TCPDA with or without angiography. Results: 69 patients were included and divided into two groups: TCPDA with (contrast+; n = 37) and without (contrast−, n = 32) use of contrast agent. The median dose [range] of contrast agent was 1.0 mL/kg [0.6–2.4 mL/kg]. The change in serum creatinine level between day 2 to 4 after TCPCA and baseline decreased in the contrast‐ group (−17% [−46%; 18%]), while it increased in the contrast+ group (7% [−24%; 202%] p = 0.002). Comparison of blood urea levels between groups showed similar significant differences. The change in serum creatinine between day 2 to 4 and baseline was significantly correlated with the dose of contrast agent (r2 = 0.682; p < 0.001). Conclusion: The use of contrast agents during TCPDA can potentially harm the renal function of very preterm infants. Therefore, we advise minimising or avoiding the use of contrast agents. [ABSTRACT FROM AUTHOR]

Background: Ultra‐low contrast administration during coronary angiography has been previously shown to be feasible and safe among patients with stable chronic kidney disease. In the present study, we investigate the safety of ultra‐low contrast coronary angiography in patients with pre‐existing acute kidney injury (AKI). Methods: The study was a retrospective single‐center evaluation of hospitalized patients who had AKI and required coronary angiography. Ultra‐low contrast use was defined as ≤18 mL of contrast media. Results: The cohort consisted of a case series of eight inpatients with AKI who required coronary angiography. The mean age was 57 (±16) years and half were females. All patients had chronic kidney disease with a mean baseline estimated glomerular filtration rate of 34 (±17) mL/min/1.73 m2. The mean creatinine before angiography was 3 (±1) mg/dL and volume of contrast administered was 14 (±4) mL. One patient had a 0.1 mg/dL increase in creatinine during admission, and no patients had further AKI up to 1‐week postprocedure. Conclusions: The current data suggest that ultra‐low contrast coronary angiography can be safely performed in patients with pre‐existing AKI The study should be viewed as hypothesis‐generating due to its small sample size. A larger cohort is required to validate the results. [ABSTRACT FROM AUTHOR]

Objectives: Iodine in iodine-based contrast agents (ICM) is known as an antioxidant substance from the past to the present. Although some studies suggest that the use of ICM causes contrast-induced nephropathy (CIN) by causing an increase in reactive oxygen species, this is not yet fully understood. Materials and Methods: Before scanning and 24 hours after ICA administration, blood samples were taken from 74 patients from a single center who had no known kidney disease, had Computed Tomography using ICA, and did not develop CIN within a 5-day follow-up period. Results: The mean Total Oxidant Level (TOS) before ICA was 13.72 ± 9.40 and the mean TOS after ICA was 5.20 ± 2.06 (p<0.001). The mean TAS before ICA was 2.50 ± 0.27 and the mean Total Antioxidant Level (TAS) after ICA was 2.20 ± 0.24 (p<0.001). The mean OSI before ICA was 5.36 ± 3.39 and the mean Oxidative Stress Index (OSI) after ICA was 2.39 ± 0.98 (p<0.001). Conclusion: Even while the pathophysiology of CIN is attributed in part to oxidative stress, we found that, on the contrary, it caused a decrease in oxidative stress in patients who did not develop CIN. We think this decrease in oxidative stress may be due to iodine, which is contained in ICA and known as a potent antioxidant. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between serum microRNA (miR)-34a and miR-182 levels before percutaneous coronary intervention (PCI) and postoperative contrast-induced nephropathy (CIN) occurrence in elderly patients with acute coronary syndrome (ACS). Methods A total of 146 elderly patients with ACS who underwent PCI were included. Clinical data of ACS patients were collected. The indexes of preoperative blood lipid and renal function were detected by automatic biochemical analyzer. Serum levels of miR-34a and miR-182 were determined by real time fluorescence quantitative PCR. Patients were divided into the CIN group (20 cases) and non-CIN group (126 cases) according to whether CIN occurred after PCI. Clinical data, preoperative blood lipids, renal function indexes, serum miR-34a, miR-182, postoperative serum creatinine (Scr) and glomerular filtration rate (eGFR) were compared between the CIN group and the non-CIN group. The correlation of preoperative serum miR-34a, miR-182, postoperative Scr, and eGFR in elderly patients with ACS were analyzed, and factors affecting the occurrence of CIN in elderly patients with ACS after PCI were also analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of preoperative serum miR-34a and miR-182 levels for occurrence of CIN in elderly patients with ACS after PCI. Results Preoperative serum miR-34a and miR-182 levels and postoperative Scr levels were higher in the CIN group than those in the non-CIN group, while postoperative eGFR level was lower than those in the non-CIN group (P＜0.05). Preoperative serum miR-34a and miR-182 were positively correlated with postoperative Scr, and negatively correlated with postoperative eGFR in elderly patients with ACS (P＜0.05). Preoperative serum miR-34a was positively correlated with miR-182 (P＜0.05). The increase of serum miR-34a and miR-182 levels before surgery were an independent risk factor for occurrence of CIN in elderly patients with ACS after PCI (P＜0.05). The area under curve (AUC) of preoperative serum miR-34a, miR-182 and their combination in predicting postoperative occurrence of CIN in elderly ACS patients after PCI were 0.881, 0.888, and 0.964, respectively. The AUC predicted by the two combined was higher than that predicted by each separately (P＜0.05). Conclusion The increased serum levels of miR-34a and miR-182 before surgery are risk factors for occurrence of CIN in elderly patients with ACS after PCI, and the combination of the two can effectively predict the occurrence of CIN. [ABSTRACT FROM AUTHOR]

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

Background Contrast media administration during diagnostic and invasive procedures in high risk patients for nephrotoxicity is a common problem in clinical practice. Radiological procedures using intravascular iodinated contrast injection media have been widely used for therapeutic purposes. Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures and results from administration of contrast media (CM), which increases morbidity and mortality rates. Case Description We present these 10 cases with high risk of CIN and diverse characteristics. A new generation iso-osmolar CM (iodixanol) was administered in these cases. Three of the cases experienced CIN events, where one patient experienced an improvement in his condition, but two other patients experienced complications and eventually died due to the underlying disease. The other 6 cases did not experience CIN after receiving CM, which was due to better preparation beforehand. One patient with a history of regular hemodialysis, underwent immediate post-operative dialysis with CM, and no evaluation of the incidence of CIN was required. Conclusion Of the 10 cases observed, 3 of them experienced CIN which was caused by the severity of the patient’s condition and lack of preparation time before the CM procedure. Management of CIN is complex, starting from the pre-treatment evaluation until 72 hours or more after the CM procedure. This case series suggests that even new generation CM (including iodixanol) may be severely nephrotoxic, when administered to high risk patients. The amount of CM given must be below the maximum limit and adjusted to the patient’s condition. Additionally, we review the complex mechanisms involved in management of CM nephrotoxicity.

BackgroundContrast-induced nephropathy (CIN) can lead to serious complications following percutaneous coronary intervention (PCI). Urine N-Acetyl-β-D-glucosaminidase (uNAG) and serum homocysteine (sHCY) are both potential predictors for CIN detection, but their combination has not been explored. We aimed to combine uNAG and sHCY as predictors for the early detection of CIN and for prognosis prediction in patients after PCI.MethodsA total of 232 consecutive patients who underwent PCI at a university hospital were recruited for this study. According to the European Society of Urology and Reproduction (ESUR) criterion, CIN is defined as an elevation of serum creatinine (sCr) by ≥25% or ≥0.5 mg/dl from baseline within 48 h. We assessed the use of individual biomarkers (uNAG and sHCY) measured around PCI and their combinations for CIN detection and prognosis prediction. Receiver operating characteristic curves (ROC) and area under the curve (AUC) were used to evaluate the predictive efficiency of potential predictors.ResultsIn total, 54 (23.28%) patients developed CIN. Concentrations of uNAG and sHCY increased significantly in CIN subjects (p

Introduction and purpose Contrast-induced nephropathy (CIN) remains a significant concern in clinical practice, particularly among patients undergoing contrast-enhanced imaging or interventional procedures. Characterized by an acute decline in renal function following exposure to contrast media, CIN not only poses substantial morbidity and mortality risks but also presents challenges in patient management and healthcare resource utilization. Despite extensive research efforts, the precise pathophysiology of CIN remains incompletely understood, with multifactorial mechanisms involving renal ischemia, oxidative stress, and direct tubular toxicity implicated in its development. This review explores the impact of hydration and other prophylactic strategies on the prevention of CIN. Numerous studies have demonstrated the effectiveness of various hydration protocols, including isotonic saline and bicarbonate solutions, in reducing the incidence of CIN. Additionally, the review evaluates the efficacy of pharmacological agents such as N-acetylcysteine, statins, and ascorbic acid, as well as emerging techniques like remote ischemic preconditioning.

Objective: To explore the efficacy and potential mechanisms of the ethanol extract of Abelmoschus manihot (L.) Medic in contrast-induced nephropathy (CIN). Methods: CIN rat models and human renal proximal tubular cells (HK-2) with iopromide-induced injury were employed to mimic CIN conditions. The effect of Abelmoschus manihot extract on the rat models and HK-2 cells was evaluated. In rat models, kidney function, histology, oxidative stress and apoptosis were determined. In HK-2 cells, cell viability, apoptosis, mitochondrial membrane potential, and endoplasmic reticulum stress were assessed. Results: Abelmoschus manihot extract significantly improved structural and functional impairments in the kidneys of CIN rats. Additionally, the extract effectively mitigated the decline in cellular viability and reduced iopromide-induced oxidative stress and lipid peroxidation. Mechanistic investigations revealed that Abelmoschus manihot extract prominently attenuated acute endoplasmic reticulum stress-mediated apoptosis by downregulating GRP78 and CHOP protein levels. Conclusions: Abelmoschus manihot extract can be used as a promising therapeutic and preventive agent in the treatment of CIN.

AbstractBackgroundMethodsResultsConclusionCraniocerebral interventional surgery is a common and essential treatment for cerebrovascular diseases. Despite continuous progress in interventional diagnosis and treatment technology, there is no effective method to alleviate contrast-induced kidney injuries. In this retrospective cohort study, we investigated the effect of the concurrent use of Dexmedetomidine (DEX) during the perioperative period on the renal function of patients following craniocerebral interventional surgery.We identified 228 cases of patients underwent craniocerebral interventional surgery from January 2018 to March 2022. Patients who used DEX during general anesthesia were in the DEX group (DEX group) or that did not use dexmedetomidine as the control group (CON group). The markers of kidney injury were recorded before and within 48 h after surgery.Compared with CON group, the urea nitrogen (BUN) of the DEX group decreased significantly on the first day and the second day after surgery (p < 0.05). The serum cystatin-C and the blood urea nitrogen/creatinine ratio (BUN/Cr) was significantly lower than that in CON group on the second day (p < 0.05). The urine output in the DEX group increased significantly, and the mean arterial pressure (MAP) was higher than the CON group (p < 0.01). There was no difference in postoperative complications, ICU stay time and hospitalization time between the two groups.The combined use of dexmedetomidine in general anesthesia for craniocerebral interventional surgery can reduce BUN levels within 48 h after surgery, significantly increase intraoperative urine volume, maintain intraoperative circulation stability. [ABSTRACT FROM AUTHOR]

Transcatheter closure of sinus venosus defect (SVD) is an emerging intervention that utilizes a covered stent to redirect the right upper pulmonary vein to the left atrium. Preprocedural computed tomography analysis, as well as the interventional procedure, necessitates the use of radiographic contrast media. Contrast use is prohibited in patients with advanced kidney disease, who also carry high surgical risks of cardiopulmonary bypass. Transesophageal echocardiography-guided catheter intervention with zero contrast use is presented in this report, along with technical details about planning the procedure. Covered stent exclusion of SVD without contrast use has not been reported in the literature so far. [ABSTRACT FROM AUTHOR]

Considering the increasing use of the transcatheter aortic valve implantation (TAVI) procedure, the relationship of contrast-induced nephropathy (CIN) with post-TAVI mortality has become important. The Mehran score was developed to detect the risk of CIN development after cardiac intervention. We aimed to compare the role of the modified Mehran score, which can be calculated pre-procedure, in predicting CIN development and compare it with the original Mehran score. We retrospectively collected data from TAVI procedures at our institution between December 2016 and June 2021; of 171 patients, 44 (25.7%) had CIN. We found no association between contrast media volume and CIN (387 ± 120 vs 418 ± 139 mL, P =.303). High and very high modified Mehran score and preoperative C-reactive protein (CRP) level were independent risk factors for CIN development after TAVI procedure. The area under curve (AUC) was.686 with 95% CI:.591-.780 and P <.001, and also, with a cut-off point of >7.5 points, there was 79.5% sensitivity and 63.0% specificity; otherwise, with a cut-off point of >9.5 points, there was 54.5% sensitivity and 71.7% specificity, for the modified Mehran score. The modified Mehran score comes into prominence compared with the original Mehran score since it can be calculated pre-procedure. [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.)

Background Contrast-induced nephropathy has become increasingly prevalent as the age and prevalence of comorbidities in the general population have increased. Most cases of contrast-induced nephropathy are reversible; however, some may progress to acute kidney disease, and subsequently, to chronic kidney disease. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are known for their renoprotective effects. However, whether the use of these inhibitors affects the risk of contrast-induced kidney injury remains unclear. Methods Data were collected from the Taipei Medical University Clinical Research Database. We included patients with diabetes who had contrast exposure between 2016 and 2020 because of computed tomography or coronary angiography. The primary outcome was the risk of a major adverse kidney event (MAKE), which encompassed acute kidney disease, chronic kidney disease progression, and the need for renal replacement therapy. Overlap weighting was performed to reduce the effects of potential confounders. Results This study included 12 421 patients, who were divided into two groups: SGLT2i users (n  = 920) and nonusers (n  = 11 501). The follow-up period after contrast exposure was 6 months. The risk of a MAKE was lower in SGLT2i users than in nonusers (incidence, 36.9 vs. 49.9 per 1000 person-months, respectively; P  = .0011). Furthermore, the incidence of acute kidney disease or chronic kidney disease progression was significantly lower in the SGLT2i users than in nonusers. However, no significant between-group difference was noted in the incidence of other MAKEs. Conclusions SGLT2i may be safely used in diabetic patients needing contrast exposure. The risk of a MAKE may be lower in SGLT2i users than in nonusers. [ABSTRACT FROM AUTHOR]

Contrast-induced nephropathy (CIN) is an important cause of morbidity and mortality, in patients with diabetes who undergo coronary angiography (CAG). It is known that serum C-peptide has renoprotective effects in diabetic nephropathy. Patients with diabetes (n = 552) who underwent CAG in our center between January 2020 and December 2021 were included, retrospectively. The patients were divided into 2 groups: not-developing CIN (group 1) and developing CIN (group 2). CIN developed in 128 (23.1%) of the patients with diabetes who underwent CAG. C-peptide, albumin, hemoglobin, hematocrit, initial creatinine, ejection fraction (EF), were significantly lower in the group that developed CIN compared with the group that did not (P <.05, for all). In correlation analysis, creatinine increase rate (ΔCr) was negatively correlated with C-peptide, hematocrit, and ejection fraction (r = −.241, P <.001; r = −.135, P <.001; r = −.194, P =.001; respectively). In logistic regression analysis, C-peptide level (Odds Ratio:.404, 95% Confidence Interval:.286-.571, P <.001) was an independent predictor of CIN. In the present study, C-peptide level was an independent predictor of CIN in patients with diabetes. This study suggests that low levels of C-peptide are associated with a greater risk of CIN. [ABSTRACT FROM AUTHOR]

Objective: Contrast-induced nephropathy (CIN) is the third leading cause of iatrogenic acute kidney injury, affecting approximately 10% of patients. Multiple risk factors, including preexisting kidney disease, diabetes mellitus, and hypertension, have been described; however, there is no specific therapeutic approach. Also, there is no consensus on premedication or which drugs should be discontinued before the exposure, whether discontinued drugs should be restarted, and, if started, how long after the exposure. In this cross-sectional survey-based study, we aim to assess the attitudes of clinicians about the discontinuation of renin–angiotensin system (RAS) blockers, sodium–glucose cotransporter 2 (SGLT-2) inhibitors, loop diuretics, and metformin before contrast exposure to reduce the risk for CIN. Method: We performed a survey-based study on clinicians, for which announcements were made through online platforms and national associations. Fully licensed physicians from the fields of internal medicine, cardiology, endocrinology, and nephrology with adult patients were included. Results: We have included 517 clinicians—288 in internal medicine, 70 in endocrinology, 59 in cardiology, and 100 in nephrology. Most of the clinicians prefer the discontinuation of metformin before contrast exposure. About 51.5% of the nephrologists think that SGLT2 inhibitors should be stopped before exposure, as compared with only 25.9% of the cardiologists. The nephrologists were the main physicians who believed that RAS blockers should be stopped before the investigation (52.6%) and were more reluctant to restart rapidly after the exposure. The attitudes of the clinicians toward renin–angi otensin–aldosterone system blockers, loop diuretics, and SGLT-2 inhibitors are considerably variable. Conclusion: The attitudes of clinicians regarding the discontinuation and reinitiation of such medications are clinician dependent. We hereby emphasize the need for future large-scale randomized clinical trials investigating this issue to reach a consensus in such a common clinical scenario. [ABSTRACT FROM AUTHOR]

This study evaluated the role of the C-reactive protein (CRP)/albumin ratio (CAR) in estimating the probability of occurring contrast-induced nephropathy (CIN) after carotid artery angiography (CAAG). Patients (n = 410) who had CAAG for carotid artery stenosis (CAS) were included in this study. A spike in serum creatinine was used to define CIN within 72 h of the procedure (>.5 mg/dL or >25% above baseline). CAR was calculated by dividing the CRP by the albumin level. Patients with CIN had higher numbers of white blood cells (P =.002), numbers of neutrophils (P =.007), neutrophil–lymphocyte ratios (P =.026), high-sensitivity CRP levels (P <.001), and CAR levels (P <.001) than those without CIN. They were also older (P <.001) and more likely to have diabetes mellitus (P =.006) and hypertension (P =.016). According to receiver operator characteristic curve (ROC) analysis, the CAR value has a 75% sensitivity and a 68% specificity for identifying CIN at a cutoff of 1.8. Also, NLR and CRP predicted CIN with 71% sensitivity and 67% specificity, 71% sensitivity and 66% specificity at the best cutoff values of 1.96 and 7.91, respectively. According the present study, in patients with CAS, the development of CIN after CAAG is independently correlated with CAR at admission. [ABSTRACT FROM AUTHOR]

The aim of the work was to determine the risk factors of contrast-induced nephropathy in patients with acute coronary syndrome and to evaluate the effectiveness of methods of its prevention. There were examined 62 patients admitted to the interventional cardiology department during 9 months of routine practice with a diagnosis of acute coronary syndrome and concomitant chronic kidney disease. Among them, 56.45% have diabetic nephropathy, 21% – hypertensive nephro­pathy, 19.35% – chronic pyelonephritis, 3.2% – gouty nephropathy. According to the stages of chronic kidney disease: I stage – 8.1%, II stage – 46.8%, III A stage – 30.6%, III B stage – 14.5% of patients. The control group consisted of 32 patients with acute coronary syndrome without kidney pathology. All patients underwent urgent percutaneous coronary intervention with a water-soluble low-osmolarity radiocontrast medium. The risk of contrast-induced nephropathy was determined according to the Mehran scale. Contrast-induced nephropathy was diagnosed by an increase in serum creatinine by >25% over 24-48 hours. Prevention of contrast-induced nephropathy according to existing recommendations was carried out by prescribing early statin therapy and diuresis-controlled combined hydration in 22 patients with concomitant chronic kidney disease. Mathematical processing was performed using Statistica 8.0 software (StatSoft Inc, USA). Patients with chronic kidney disease had a high and very high risk of contrast-induced nephropathy in 19.4% and 3.2% of cases, among them in 91.6% high, and in 100% – very high-risk contrast-induced nephropathy developed. Patients in the control group had a low to moderate risk, none of them developed contrast-induced nephropathy. It has been shown that the risk of contrast-induced nephropathy depends on the stage of chronic kidney disease and is associated with a decrease in the ejection fraction of the left ventricle (≤40%), acute left ventricle failure of the III and IV classes according to Killip, a decrease in diuresis up to ≤0.6 ml/h/kg in the first 12-24 hours after urgent percutaneous coronary intervention; taking metformin 6-12 hours before the administration of the X-ray contrast medium and the glomerular filtration rate ≤45 ml/min./1.73 m2. In patients who underwent prevention of contrast-induced nephropathy in its entirety, its development was not registered.

Abstract Background Contrast-induced nephropathy (CIN) is a major clinical problem associated with acute kidney injury during hospitalization. However, effective treatments for CIN are currently lacking. Mesenchymal stem cells (MSCs) have protective effects against kidney injury by suppressing inflammation and fibrosis. We previously showed that MSCs cultured in serum-free medium (SF-MSCs) enhance their anti-inflammatory and anti-fibrotic effects. However, whether SF-MSCs potentiate their anti-apoptotic effects is unknown. Here, we investigated the effects of SF-MSCs on a CIN mouse model. Methods To create CIN model mice, we removed right kidney at first. One week later, the left renal artery was clamped for 30 min to cause ischemia–reperfusion injury, and mice were injected with iohexol. Then the kidney received 10 Gy of irradiation, and MSCs or SF-MSCs were injected immediately. At 24 h post-injection, mice were sacrificed, and their blood and kidneys were collected to evaluate renal function, DNA damage, and apoptosis. In addition, apoptosis was induced in HEK-293 cells by irradiation and cells were treated with conditioned medium from MSCs or SF-MSCs. Results Treatment of CIN model mice with SF-MSCs markedly improved renal function compared with MSCs treatment. Cleaved caspase-3 levels and TUNEL-positive cell numbers were strongly suppressed in CIN model mice treated with SF-MSCs compared with the findings in those treated with MSCs. γH2AX levels, a chromosome damage marker, were reduced by MSCs and further reduced by SF-MSCs. In addition, cleaved caspase-3 in irradiated HEK-293 cells was more strongly suppressed by conditioned medium from SF-MSCs than by that from MSCs. Secretion of epidermal growth factor (EGF) was enhanced by culturing MSCs in serum-free medium. Knockdown of EGF by siRNA attenuated the inhibitory effects of SF-MSCs on CIN-induced renal dysfunction and tubular apoptosis. Conclusions These findings strongly suggest that SF-MSCs improve CIN in model mice by exerting anti-apoptotic effects in a paracrine manner. Thus, SF-MSCs represent a potential novel therapy for CIN. Graphical Abstract

Background: Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the leading cause of death in CKD patients. Despite the high cardiovascular risk, ACS patients with renal dysfunction are less commonly treated with guideline-based medical therapy and are less frequently referred for coronary revascularization. Summary: The management of CAD is more challenging in patients with CKD than in the general population due to concerns regarding side effects and renal toxicity, as well as uncertainty regarding clinical benefit of guideline-based medical therapy and interventions. Patients with advanced CKD and especially those receiving dialysis have not traditionally been represented in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses are available. Recently published studies suggest that there are significant opportunities to substantially improve both cardiovascular and renal outcomes of patients with CAD and CKD, including new medications and interventions. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to improvement of both cardiovascular and renal outcomes. Key Messages: Adequate medical therapy and coronary interventions using evidence-based strategies can improve both cardiac and renal outcomes in patients with CAD and CKD.