Epidemiology and predictors of contrast-induced nephropathy

McCullough, Peter A.; Soman, Sandeep

doi:10.1201/b14485-4

Cited by 90 publications

(136 citation statements)

References 82 publications

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“…Although the rise in serum creatinine often occurs within the first 24 h after exposure to contrast media in 80% of the patients, the absence of data on serum creatinine later than 48 h after PCI in the present study might result in the slight underestimation of CIN [33]. However, it is doubtful that a delayed creatinine elevation in patients without a significant rise within 48 h after PCI may be at all clinically significant [34].…”

Section: Limitationcontrasting

confidence: 50%

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Martins¹,

Oliveira²,

Mattos³

2017

Interventional-Cardiology.

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Background:Statins may reduce the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). However, there is no knowledge that PCI performed at the same time of statin peak concentration in the blood, may cause additional benefit in renal protection. Methods:This study sought to determine whether PCI realized within the time of rosuvastatin peak concentration was associated with reduced in-hospital CIN compared with standard clinical practice. This single-center prospective, randomized, open-label, non-blinded clinical trial evaluated stable coronary artery disease patients taking chronic statin undergoing PCI. Patients were randomized to receive a loading dose of rosuvastatin (40 mg within 2 to 6 h before angioplasty) or to standard practice (without load dose of rosuvastatin). The pre-specified primary endpoint was the occurrence of CIN defined as an increase in the serum creatinine by {greater than or equal to} 0.3 mg/dl within 24 h after intervention. Contrast-induced nephropathy after coronary angioplasty by creatinine-kinase measure. This trial is registered with (Creatine Leak After Rosuvastatin in Percutaneous Coronary Intervention [CLEAR-PCI]; (ClinicalTrials.gov number: NCT01968577). Results:Of the 544 patients in the main trial, 528 participated in the CLEAR-CIN-PCI substudy, and 493 patients (244 in the rosuvastatin group and 249 in control) were analyzed. CIN occurred in 6 patients of the 244 patients (2.5%) treated with rosuvastatin compared with 9 of the 249 patients (3.6%) in control group (risk ratio, 0.80; 95% confidence interval [CI], 0.42 to 1.50; P=0.455). Conclusion:This result does not support the initiation of rosuvastatin before elective PCI to prevent CIN in patients taking chronic statin therapy.

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Section: Limitationcontrasting

confidence: 50%

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Martins¹,

Oliveira²,

Mattos³

2017

Interventional-Cardiology.

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“…Higher baseline creatinine values are associated with greater risk of CIN [20]. As shown in study by Hall [21] if baseline plasma creatinine level is 1.2 mg/dL, the incidence of CIN was only 2%.…”

Section: Preexisting Renal Diseasementioning

confidence: 91%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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“…4,5 CIN has been variably defined: a postcontrast increase in serum creatinine (SCr) levels of at least 0.5 mg/dL or of more than 25% above precontrast values. 6,7 In most cases, the increase in SCr levels occurs within 24 to 48 hours of the administration of the iodinated contrast agent and normally returns to or near the baseline value within 7 days. 4,6,8 The pathophysiology of CIN is not completely understood, but the literature indicates that a reduction in renal perfusion from a direct effect of CM on the kidney and toxic effects on the tubular cells are the main cause.…”

mentioning

confidence: 99%

“…6,7 In most cases, the increase in SCr levels occurs within 24 to 48 hours of the administration of the iodinated contrast agent and normally returns to or near the baseline value within 7 days. 4,6,8 The pathophysiology of CIN is not completely understood, but the literature indicates that a reduction in renal perfusion from a direct effect of CM on the kidney and toxic effects on the tubular cells are the main cause. 5 Mechanisms responsible for the reduction in renal perfusion involve vascular and tubular effects (eg, increase in intratubular pressure and tubular obstruction).…”

mentioning

confidence: 99%

No Increased Risk for Contrast-Induced Nephropathy after Multiple CT Perfusion Studies of the Brain with a Nonionic, Dimeric, Iso-Osmolal Contrast Medium

Langner¹,

Stumpe²,

Kirsch³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Contrast-induced nephropathy (CIN) is one of the most common causes of in-hospital acute renal failure. The aim of this study was to assess the risk for CIN after repeated administration of the nonionic, dimeric, iso-osmolal contrast agent iodixanol regardless of pre-existing renal function. Changes in serum creatinine (SCr) levels were compared with those of control subjects who did not receive iodinated contrast media (CM).

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Epidemiology and predictors of contrast-induced nephropathy

Cited by 90 publications

References 82 publications

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Contrast‐induced nephropathy

No Increased Risk for Contrast-Induced Nephropathy after Multiple CT Perfusion Studies of the Brain with a Nonionic, Dimeric, Iso-Osmolal Contrast Medium

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