Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures

Patschan, Daniel; Buschmann, Ivo; Ritter, Oliver

doi:10.1155/2018/5727309

Cited by 16 publications

(14 citation statements)

References 47 publications

(47 reference statements)

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“…29,30 Most of the published clinical trials investigating preventive strategies have focused on one mechanism at a time and pharmacologic compounds that are usually administered directly before or together with the contrast media. 19 However, such strategies are probably not appropriate to allow for profound protective adaptations on a cellular level and none of these approaches has reached the clinical setting. Recently, the principle of dietary preconditioning has gained large interest in this respect and might provide a distinct and innovative therapeutic approach.…”

Section: Discussionmentioning

confidence: 99%

Dietary restriction for prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary angiography: a randomized controlled trial

Grundmann

Hoyer-Allo

Späth

et al. 2020

Sci Rep

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Short-term dietary restriction (DR) may prevent organ damage from ischemic or toxic insults in animals, but clear evidence in humans is missing. While especially intraarterial administration of contrast media represents a cause of hospital-acquired acute kidney injury (AKi), targeted preventive strategies are not available. This trial investigated the feasibility and effectiveness of pre-interventional DR for preventing AKi in patients undergoing percutaneous coronary intervention (pci). patients were randomized to receive a formula diet containing 60% of daily energy requirement (DR group) or ad-libitum food during the 4-day-interval before PCI. Primary endpoint was change of serum creatinine 48 h after PCI (Δcreatinine). further analyses included incidence of AKi and safety evaluation. Δcreatinine post PCI in the DR group vs. the control group did not show any difference (DR: 0.03(−0.15,0.14)mg/dL vs. control: 0.09(−0.03,0.22)mg/dL;p = 0.797). Subgroup analyses revealed a significant beneficial impact of DR in patients that received ≤100 ml of contrast agent (DR n = 26: Δcreatinine −0.03(−0.20,0.08) mg/dL vs. control n = 24: Δcreatinine 0.10(−0.08,0.24)mg/dL; p = 0.041) and in patients with ≤2 risk factors for AKi (DR: n = 27; Δcreatinine −0.01(−0.18,0.07)mg/dL vs. control n = 31: Δcreatinine 0.09(−0.03,0.16)mg/dl; p = 0.030). Although the primary endpoint was not met, the results of this trial suggest a beneficial impact of DR in low-to-moderate risk patients. Dietary restriction (DR) is characterized by reduced food intake without inducing poor nutrition and subsumes numerous interventions including general calorie restriction (CR), protein restriction (PR) and various fasting protocols. Short-term DR-usually excercised for several days to weeks-has an extraordinary power to reduce cellular damage susceptibility by promoting resistance towards ischemic insults in rodent models of injury to the liver, 1,2 kidney 3,4 brain, 5 and heart. 6 Furthermore, DR has also been proven highly effective in preventing or ameliorating chemotoxic injury to the heart (secondary to doxorubicin) 7 and the kidney (secondary to cisplatinum) 8 and successfully improved survival in a murine chemotoxic stress model. 9 Possible mechanisms contributing to this phenomenon are versatile and include improvement of insulin sensitivity and reduction of oxidative stress and free radical induced damage, as well as modification of DNA repair. Alterations in the mechanistic target-of-rapamycin(mTOR)-signaling and other pathways, such as 5′ adenosine monophosphate-activated

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Section: Discussionmentioning

confidence: 99%

Dietary restriction for prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary angiography: a randomized controlled trial

Grundmann

Hoyer-Allo

Späth

et al. 2020

Sci Rep

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“…29 Although studies on oral hydration are limited, preliminary evidence on this strategy suggests that it is as safe and effective as intravenous prophylaxis. 30 For this reason, when it is not possible to hydrate the patient by the intravenous route, at least oral hydration is recommended.…”

Section: Role Of Hydration and N-acetylcisteinementioning

confidence: 99%

Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies

et al. 2020

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Patients with cancer are subjected to several imaging examinations which frequently require the administration of contrast medium (CM). However, it has been estimated that acute kidney injury (AKI) due to the injection of iodinated CM accounts for 11% of all cases of AKI, and it is reported in up to 2% of all computed tomography (CT) examinations. Remarkably, the risks of developing AKI are increased in the elderly, in patients with chronic kidney disease or diabetes, and with dehydration or administration of nephrotoxic chemotherapeutics. Given the common occurrence of post-contrast acute kidney injury (PC-AKI) in clinical practice, primary care physicians and all specialists involved in managing patients with cancer should be aware of the strategies to reduce the risk of this event. In 2018, a panel of five experts from the specialties of radiology, oncology and nephrology were speakers at the annual meeting of the Italian Society of Medical Radiology (Società Italiana di Radiologia Medica e Interventistica), with the aim of commenting on existing evidence and providing their experience on the incidence and management of PC-AKI in patients with cancer. The discussion represented the basis for this white paper, which is intended to be a practical guide organised by statements describing methods to reduce renal injury risks related to CM-enhanced CT examinations in patients with cancer.

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“…Pre-hydration with normal saline, minimise contrast volume and use of low-or iso-osmolar contrast media are recommended for patients who proceed with invasive management by current guidelines (Chew et al, 2016;Khwaja, 2012;Owen et al, 2014;Windecker et al, 2014). Several pharmacological interventions for the prevention of contrast-induced nephropathy in high-risk patients have shown inconsistent results in randomised trials and meta-analyses (Patschan et al, 2018;Sharp et al, 2019), including N-acetylcysteine (NAC), bicarbonate, statin, trimetazidine and nicorandil. The PRESERVE trial, published in 2018, is the largest randomised trial to-date that compared oral NAC and intravenous sodium bicarbonate against placebo (intravenous 0.9% sodium chloride) in 4,993 patients with stage 3 and 4 CKD undergoing coronary angiography (Weisbord et al, 2018).…”

Section: Acute Myocardial Infarctionmentioning

confidence: 99%

High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond

Chuang,

Nguyen,

Kung

et al. 2020

Rev. Cardiovasc. Med.

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Acute myocardial infarction (MI) represents one of the most common hospital encounters, with significant short-term and long-term morbidity and mortality, and frequently occurs in patients with chronic kidney disease (CKD). Cardiac troponin is an exquisitely sensitive biomarker for myocardial injury and plays an essential role in the diagnosis, risk-stratification, and management of MI. In 2017, the United States Food and Drug Administration approved Roche Diagnostics’ 5th generation high-sensitivity cardiac troponin (hs-cTn) for clinical use. Whilst the improved analytical sensitivity of these new high-sensitivity troponin assays facilitate early diagnosis of MI, it also frequently identifies troponin elevations above the conventional reference threshold in the context of non-coronary conditions such as renal dysfunction, and can represent a major diagnostic challenge to clinicians. Furthermore, the optimal management strategy of patients with troponin elevation and high comorbidity burden, a common issue in patients with CKD, remains undefined. In recent years, there has been substantial research and progress undertaken in this rapidly evolving area. In this review, we aim to provide clinicians with an overview of hs-cTn in the setting of CKD as well as an update on its application and the particular considerations involved in the management of myocardial infarction, stable coronary artery disease and myocardial injury in this high risk population.

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Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures

Cited by 16 publications

References 47 publications

Dietary restriction for prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary angiography: a randomized controlled trial

Dietary restriction for prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary angiography: a randomized controlled trial

Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies

High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond

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