Microalbuminuria in patients with preserved renal function as a risk factor for contrast-Induced acute kidney injury following invasive coronary angiography

Meng, Haoyu; Wu, Peng; Zhao, Yuhai; Xu, Zhihui; Wang, Ze‐Mu; Li, Chunjian; Wang, Liansheng; Yang, Zhaohui

doi:10.1016/j.ejrad.2016.03.010

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…. (34)(35)(36)(37)(38)(39) Association between microalbuminuria detection on early stages of endothelial dysfunction, intrinsic pathophysiologic mechanism on atherosclerotic plaque and its vulnerability, explains the strong association with cardiovascular events and mortality. (40)(41)(42)(43)(44)(45)(46) In contrast to previous studies, our work was able to detect a robust association between microalbuminuria and all-cause mortality at very long-term follow-up, through a spontaneous sample determination at admission and in a non-selected non-ST-segment elevation acute coronary syndromes.…”

Section: Discussionmentioning

confidence: 99%

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation.

Higa

2023

MRAJ

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Background: Up to date there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes (NSTE-ACS). Aim: To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of NSTE-ACS patients. Methods: A prospective cohort study was conducted, including patients with NSTE- ACS admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26. Results: 600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR > 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average IAC among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with IAC of 0 to 4 mg/gr, tercile 2: IAC from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p 0.0001). Conclusion: Single spot urine ACR at admission is a strong predictor of 12-year follow- up mortality in an unselected cohort of patients with NSTE-ACS.

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Section: Discussionmentioning

confidence: 99%

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation.

Higa

2023

MRAJ

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“…Molnar et al demonstrated that individuals with the higher levels of perioperative dipstick albuminuria had the greatest risk for AKI (RR 2.46; 95% CI 1.16–4.97) and improved the clinical prediction of AKI above clinical models alone [ 18 ]. Recently, some researchers reported a close look at the predictive value of albuminuria for CIN after coronary angiography, the study of Meng et al and Saito et al suggested the preprocedural albuminuria was associated with greater risk for CIN regardless of the baseline renal function (eGFR < 30 mL/min/1.73m 2 : OR 17.4, P = 0.0001; eGFR 30–44 mL/min/1.73m 2 : OR 12.1; P = 0.0006; eGFR ≥ 60 mL/min/1.73m 2 : 12.1 vs 5.0%, P = 0.005) [ 19 , 20 ]. For patients with T2DM undergoing elective cardiac catheterization, Yang et al found preprocedural albuminuria was an independent risk factor of CIN (OR 3.8; 95% CI 1.5–9.2; P = 0.004) [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of preprocedural albuminuria for contrast-induced nephropathy non-recovery in patients undergoing percutaneous coronary intervention

et al. 2021

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Objective The present study investigated the predictive value of albuminuria for contrast-induced nephropathy (CIN) non-recovery in patients undergoing percutaneous coronary intervention (PCI). Methods We retrospectively enrolled 550 consecutive patients inflicted with CIN after PCI and reassessing kidney function among 1 week–12 months between January 2012 and December 2018. Patients were stratified into three groups according to urine albumin: negative group (urine dipstick negative), trace group (urine dipstick trace) and positive group (urine dipstick ≥ 1 +). The primary outcomes were CIN non-recovery (a decrease of serum creatinine which remains ≥ 25% or 0.5 mg/dL over baseline at 1 week–12 months after PCI in patients inflicted with CIN). The odds ratio (OR) of CIN non-recovery was analyzed by logistic regression using the negative urine dipstick group as the reference group. Results Overall, 88 (16.0%) patients had trace urinary albumin, 74 (13.5%) patients had positive urinary albumin and 40 (7.3%) patients developed CIN non-recovery. Patients with positive urinary albumin had significantly higher incidence of CIN non-recovery [negative (3.4%), trace (11.4%) and positive (23.0%), respectively; P < 0.0001]. Multivariate analysis showed that trace and positive urinary albumin were associated with an increased risk of CIN non-recovery (trace vs negative: OR 2.88, P = 0.022; positive vs negative: OR 2.99, P = 0.021). These associations were consistent in subgroups of patients stratified by CIN non-recovery risk predictors. And CIN non-recovery was associated with an increased risk of long-term mortality during a mean follow-up period of 703 days (P < 0.001). Conclusion Preprocedural albuminuria was associated with CIN non-recovery in patients undergoing PCI.

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“…Albuminuria, which occurs due to microvascular dysfunction in DM, is a biomarker for chronic kidney disease, and it is associated with a greater risk of AKI even in patients with a preserved renal function after contrasted exam [29,30]. Lifestyle modification program, including physical exercise, demonstrated reduction of albuminuria and maintenance of glomerular filtration rate in diabetic patients [31].…”

Section: Effects Of Physical Training On Renal Functionmentioning

confidence: 99%

Physical Training Is a Potential Modifier of Risk for Contrast‐Induced Acute Kidney Injury in Diabetes Mellitus

Couto

Machado

Conde

et al. 2020

BioMed Research International

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Background. Iodinated contrast (IC) is a leading cause of hospital-based acute kidney injury (AKI). Contrast-induced acute kidney injury (CI-AKI) is a decline in renal function due to iodinated contrast administration and occurs more frequently in individuals with increasingly common risk factors, such as diabetes mellitus (DM). Physical training (PT) can have renoprotective effects on CI-AKI in diabetic nephropathy. The aim of this study was to evaluate the injury in kidneys of diabetic rats submitted to treatment with IC, evaluating the impact of PT on hemodynamics and renal function in addition to oxidative profile in diabetic rats submitted to IC-AKI. Materials and Methods. Adult male Wistar rats are randomized into four groups: citrate ( n = 7 ): control group, citrate buffer (streptozotocin-STZ vehicle), intravenous tail (iv), single dose; DM ( n = 7 ): STZ, 60 mg/kg, iv, single dose; DM+IC ( n = 7 ): DM rats treated with IC (sodium meglumine ioxithalamate, 6 mL/kg, intraperitoneal (ip), single dose); DM+IC+PT ( n = 7 ): DM rats treated with IC as mentioned and submitted to physical training. Renal function parameters (inulin clearance, neutrophil gelatinase-associated lipocalin (NGAL), serum creatinine, and urinary albumin), hemodynamics (renal blood flow and renal vascular resistance), and oxidative profile (urinary peroxides, urinary TBARS, urinary nitric oxide, and renal tissue thiols) were evaluated. Results. It was possible to observe a decrease in inulin clearance, renal blood flow, and thiols in renal tissue accompanied by an increase in urinary flow, serum creatinine, urinary albumin, renal vascular resistance, urinary peroxides, urinary nitrate, and TBARS in the DM group compared to the citrate group. The DM+IC group showed a reduction in inulin clearance, and the renal dysfunction was also seen by the increased NGAL. Renal hemodynamics and oxidative profile compared were also worsened in the DM group. PT improved renal function by increasing renal blood flow and thiol levels in renal tissue and reduced renal vascular resistance, metabolites of reactive oxygen, nitrogen species, and lipid peroxidation in the DM+IC+PT group compared to DM+IC. Conclusions. Our results confirmed that DM induction increases renal vulnerability to the toxicity of IC and an association between DM with IC predisposes to severe AKI with reduced renal function alongside with renal hemodynamic alterations and oxidative mechanism of injury. The PT showed a renoprotective effect in DM animals subjected to damage with IC by modulating renal hemodynamics and oxidative profile, confirming a potential to modify the risk of CI-AKI when diabetes mellitus is present.

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Microalbuminuria in patients with preserved renal function as a risk factor for contrast-Induced acute kidney injury following invasive coronary angiography

Cited by 5 publications

References 18 publications

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation.

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation.

Predictive value of preprocedural albuminuria for contrast-induced nephropathy non-recovery in patients undergoing percutaneous coronary intervention

Physical Training Is a Potential Modifier of Risk for Contrast‐Induced Acute Kidney Injury in Diabetes Mellitus

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