Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

Murakami, Ryusuke; Kumita, Shin‐ichiro; Hayashi, Hiromitsu; Sugizaki, Kenichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

doi:10.1016/j.ejrad.2013.06.004

Cited by 27 publications

(27 citation statements)

References 31 publications

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“…Previous studies have shown that anemia increases the risk of CIN in various patient populations. [14][15][16] Nikolsky et al, in a large cohort of patients who underwent percutaneous coronary intervention, demonstrated that patients with the lowest eGFR and hematocrit had the highest rates of CIN. 14 A recent report by Li et al demonstrated that among patients who underwent percutaneous coronary intervention, anemia was an independent risk factor for CIN in all patients, 26 however, in that report < 20% of patients had an acute myocardial infarction, and the incidence of CIN was significantly reduced, compared with the AKI rate that we demonstrated in our cohort (3.1% vs 9.8%).…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] Previous studies have shown that anemia increases the risk of contrast-induced nephropathy (CIN) in patients who undergo computed tomography and non-emergent percutaneous coronary intervention. [14][15][16] As far as the authors know there are no previous reports that have specifically addressed a selective subset of STEMI patients who undergo PPCI in whom preprocedural preparatory measures to reduce AKI are often underused because of the need for emergent reperfusion therapy. In the present study we evaluated the association of admission hemoglobin levels on the occurrence of AKI in a large cohort of consecutive STEMI patients treated with PPCI.…”

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confidence: 99%

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Association of Admission Hemoglobin Levels and Acute Kidney Injury Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention

Shacham

Gal‐Oz

Leshem

et al. 2015

Canadian Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Association of Admission Hemoglobin Levels and Acute Kidney Injury Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention

Shacham

Gal‐Oz

Leshem

et al. 2015

Canadian Journal of Cardiology

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“…The increased risk of CIN in patients with anaemia and poorer clinical outcomes is multifactorial in aetiology; in the presence of anaemia, CIN-induced renal ischaemia and hypoxia are significantly worsened in the outer renal medulla amid already prevailing low oxygen tension, and oxygen affinity and demand are increased. [26,31,32] Anaemia also signifies underlying comorbidities; therefore it is a biomarker for severity of disease at the time of contrast media administration, and increased mortality risk. [26,30] Age, baseline renal function (determined by eGFR) and prehydration were not associated with the prevention of CIN in our study.…”

Section: Survived N=48mentioning

confidence: 99%

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

et al. 2016

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Despite preventive guidelines, iatrogenic contrast-induced nephropathy (CIN) ranks third as a cause of hospital-acquired AKI, impacts significantly on morbidity and mortality, and is associated with longer stays in hospitals, with higher medical costs. [1][2][3][4] The rates of CIN vary, depending on the study definitions employed and underlying risk factors, and range from 0.6% to 30% or higher among risk groups. [5][6][7][8] CIN is also associated with increased duration of hospitalisation and early and late mortality. In-hospital mortality due to CIN ranges from 7% to 22%. [9] McCullough et al. [9] reported early mortality of 1.1% in controls, 7.1% in CIN patients, and 35% in CIN patients that required dialysis. Owing to increased comorbidities, hospitalised patients have increased risk for developing CIN compared with ambulatory patients .[10]Inflammation and endothelial dysfunction, together with reactive oxygen species (ROS), are implicated in the pathogenesis of CIN. [8] Iodinated contrast media directly injures the renal tubular epithelium by producing ROS radicals that cause intra-renal vasoconstriction leading to ischaemia and death of tubular cells. [8,10,11] Serum albumin is an important antioxidant that reduces the formation of oxygen free radicals and is important in expanding intravascular volume. [12,13] However, the role of serum albumin in reducing the incidence of CIN remains unexplored.Sub-Saharan Africa has a dearth of data on rates of CIN. This study investigated the rates of CIN together with the influence of serum albumin, albuminuria, age, haemoglobin, and glomerular filtration rate (GFR) levels on CIN and patient outcomes. Methods Study design, setting and populationThis study was a prospective observational study conducted at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, from 1 July 2014 to 30 July 2015. Ethical approval was obtained from the human research ethics committee (HREC) of the University of the Witwatersrand and informed written consent was obtained from all patients. We consecutively recruited hospitalised patients undergoing computed tomography (CT) and angiography from the Divisions of Radiology and Cardiology, respectively. The following exclusion criteria were used: <18 years of age; evidence of pre-existing AKI (clinical or laboratory); end-stage renal disease (ESRD); renal replacement therapy (RRT); prior contrast media administration in the preceding 7 days; pregnancy; or incomplete data. Study proceduresThe study physician reviewed participants' medical records and examined the participants in order to determine pre-existing risk factors for CIN. The medical records were reviewed to determine patient duration of hospitalisation, dialysis requirements and mortality. Study phlebotomists collected blood samples prior to and post contrast media administration. Pre contrast, urine was collected and analysed for microalbuminuria using the Chemistrip Micral 30 immune assay test (Roche 11544039172). Serum creatinine was analysed using the Jaff...

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“…However, the role of anemia as a risk factor for developing CI-AKI should be reevaluated, especially in patients with multiple myeloma. A couple of very recent studies investigated the incidence of CI-AKI in anemic patients, suggesting that low hemoglobin and low hematocrit values may be considered independent predictors of CI-AKI [60, 61]. Since anemia is highly prevalent in multiple myeloma, being reported in about 70% of patients with newly diagnosed multiple myeloma [62, 63], it may represent an important risk factor.…”

Section: Contrast Media-induced Nephropathy and Plasma Cell Dyscramentioning

confidence: 99%

Pathogenesis of Renal Failure in Multiple Myeloma: Any Role of Contrast Media?

Mussap

Merlini

2014

BioMed Research International

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The spectrum of kidney disease-associated monoclonal immunoglobulin and plasma cell malignancies is remarkably broad and encompasses nearly all nephropathologic entities. Multiple myeloma with kidney impairment at presentation is a medical emergency since the recovery of kidney function is associated with survival benefits. In most cases, kidney impairment may be the first clinical manifestation of malignant plasma cell dyscrasias like multiple myeloma and light chain amyloidosis. Multiple myeloma per se cannot be considered a main risk factor for developing acute kidney injury following intravascular administration of iodinated contrast media. The risk is increased by comorbidities such as chronic kidney disease, diabetes, hypercalcemia, dehydration, and use of nephrotoxic drugs. Before the administration of contrast media, the current recommended laboratory tests for assessing kidney function are serum creatinine measurement and the estimation of glomerular filtration rate by using the CKD-EPI equation. The assessment of Bence Jones proteinuria is unnecessary for evaluating the risk of kidney failure in patients with multiple myeloma, since this test cannot be considered a surrogate biomarker of kidney function.

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Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

Cited by 27 publications

References 31 publications

Association of Admission Hemoglobin Levels and Acute Kidney Injury Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention

Association of Admission Hemoglobin Levels and Acute Kidney Injury Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

Pathogenesis of Renal Failure in Multiple Myeloma: Any Role of Contrast Media?

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