Prophylaxis Strategies for Contrast-Induced Nephropathy

Pannu, Neesh; Wiebe, Natasha; Tonelli, Marcello

doi:10.1001/jama.295.23.2765

Cited by 355 publications

(250 citation statements)

References 132 publications

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“…1,2) CIN is most frequently defined as an increase in serum creatinine (sCr) by 25-50% above the baseline. 5) However, sCr is an unreliable indicator during acute changes in kidney function, and alterations in sCr levels are not particularly sensitive or specific for small changes in the glomerular filtration rate (GFR). 6) In addition, sCr level could also be influenced by many factors such as age, gender, race, and intravascular volume.…”

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confidence: 99%

A Nomogram to Predict Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Zhuang

et al. 2017

Int. Heart J.

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SummaryContrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury (AKI). Emerging evidence has revealed that soluble klotho (sklotho) could be a novel biomarker for early AKI diagnosis. The aims of this study were to assess the predictive role of sklotho for CIN and to develop a prediction nomogram in patients undergoing percutaneous coronary intervention (PCI). This study is registered on Clinicaltrials.gov (NCT 02650336).Patients aged 18 years or older undergoing planned PCI were prospectively recruited between May 2014 and July 2015. CIN was defined as an increase in serum creatinine of 0.5 mg/dL within 48-72 hours after the procedure. Plasma sklotho was measured by enzyme linked immunosorbent assay (ELISA). Stratified analysis, interaction test, covariate screening, and curve fitting were performed to explore the association between sklotho and CIN. A nomogram was then developed and validated using the bootstrapped technique.A total of 192 patients aged 54.75 ± 12.19 years were selected, 32 (16.7%) of whom were diagnosed with CIN. A logistic regression model indicated significant associations between CIN and sklotho, age > 75 years, diabetes, and the Mehran risk score. Saturation effects analysis detected a two-stage change between sklotho and CIN, with the inflection point was 477.4 pg/mL. The area under the ROC curve was 0.758 and the sensitivity and specificity of this point were 90.6% and 53.9%, respectively. A nomogram was developed for the prediction of CIN and showed a bootstrapped-corrected area under the curve value of 0.913. In addition, sklotho significantly increased the predictive value of the nomogram.A strong association between sklotho and CIN was identified in patients undergoing elective PCI. A lower level of sklotho would be well correlated with CIN. The nomogram with sklotho is a useful tool to predict CIN in patients who will undergo PCI. (Int Heart J 2017; 58: 191-196)

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A Nomogram to Predict Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Zhuang

et al. 2017

Int. Heart J.

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“…Newer iso-osmolar IRCM is theoretically less cytotoxic due to lower osmolarity (similar to plasma, ϳ300 mOsm), compared with low-osmolar IRCM. 19,20 However, complex mechanisms other than osmolarity alone are acting as well. IRCM effects on infarct volume and ICH may be due to osmotic, direct neurotoxic, hydrostatic, or vascular occlusive effects.…”

Section: Discussionmentioning

confidence: 99%

Decreased Infarct Volume and Intracranial Hemorrhage Associated with Intra-Arterial Nonionic Iso-Osmolar Contrast Material in an MCA Occlusion/Reperfusion Model

Morales

Kurosawa

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Infarct volume and intracranial hemorrhage after reperfusion with nonionic low-osmolar and isoosmolar iodinated IRCM has not been previously compared. We postulated that iso-osmolar and low-osmolar iodinated contrast media exert varied effects on cerebral infarct after intra-arterial injection. We compared infarct volume and hemorrhagic changes following intra-arterial infusion of iodixanol, iopamidol, or normal saline in a rat MCA occlusion/reperfusion model.

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“…Currently, the standard of care in the management of patients requiring coronary diagnostic imaging is sufficient hydration, minimisation of the volume of contrast agent, and careful use of nephrotoxic drugs [11]. Antioxidant (AO) supplementations such as N-acetyl cysteine (NAC), vitamin C, vitamin E, and alpha-lipoic acid are known as cytoprotective agents with scavenging action against oxygen free radicals that can also attenuate renal damage and inhibit pro-inflammatory markers, such as interlukin-10 and tumour necrosis factor-alpha [12]. This systematic review with meta-analysis sought to determine the strength of evidence for effects of anti-oxidants such as NAC, vitamin C, vitamin E, and alpha-lipoic acid on the incidence of CIN, requirement for haemodialysis, level of serum creatinine, and mortality after coronary angiography.…”

Section: Introductionmentioning

confidence: 99%

Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review

et al. 2016

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A b s t r a c t Background and aim:This systematic review with meta-analysis sought to determine the strength of evidence for effects of antioxidants (AO) such as N-acetyl cysteine (NAC), vitamin C, vitamin E, and alpha-lipoic acid on the incidence of contrast-induced nephropathy (CIN), requirement for haemodialysis, level of serum creatinine, and mortality after coronary angiography. Methods and results:After Medline, Embase, Elsevier, Sciences online database, and Google Scholar literature searches, studies with randomised controlled design were selected for the meta-analysis. The effect sizes measured were odds ratio (OR) for categorical variables and standard mean difference (SMD) with 95% confidence interval (CI) for calculating differences between mean changes of serum creatinine in intervention and control groups. A value of p < 0.1 for Q test or I 2 > 50% indicated significant heterogeneity between the studies. Literature search of all major databases retrieved 2350 studies. After screening, a total of 49 trials were identified that reported outcomes. Pooled treatment effect analysis revealed that NAC (OR of 0.79; 95% CI 0.69-0.9; p = 0.000), vitamin C (0.63; 95% CI 0.45-0.89; p = 0.000), and vitamin E (OR of 0.5; 95% CI 0.27-0.92; p = 0.026) could significantly reduce the incidence of CIN. NAC (SMD of -0.119; 95% CI -0.191 --0.046; p = 0.000), but not vitamin C (SMD of -0.08; 95% CI -0.22-0.04; p = 0.1) and vitamin E (-0.25; 95% CI -0.46--0.05; p = 0.1), could significantly reduce mean levels of serum creatinine. Nevertheless, AO could not reduce the incidence of mortality, with an OR of 0.94 (95% CI 0.69-1.28; p = 0.7). Conclusions:Overall, antioxidants such as NAC, vitamin C, and vitamin E can reduce the incidence of CIN, while only NAC might be able to significantly lower serum creatinine levels. There is no impact of AO supplementation on mortality.

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Prophylaxis Strategies for Contrast-Induced Nephropathy

Cited by 355 publications

References 132 publications

A Nomogram to Predict Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

A Nomogram to Predict Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Decreased Infarct Volume and Intracranial Hemorrhage Associated with Intra-Arterial Nonionic Iso-Osmolar Contrast Material in an MCA Occlusion/Reperfusion Model

Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review

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