Radiocontrast-Induced Acute Renal Failure

Weisbord, Steven D.; Palevsky, Paul M.

doi:10.1177/0885066604273503

Cited by 85 publications

(66 citation statements)

References 104 publications

(130 reference statements)

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“…These include sepsis that induces renal vasoconstriction through the release of endothelin and the use of radiocontrast imaging dyes that increase oxygen consumption for solute reabsorption and reduce regional inner medullary blood flow. [54][55][56][57][58][59][60][61] More generalized reductions in blood flow represent another major cause of AKI. These can result from hemorrhage, decompensated liver cirrhosis, treatment with non-steroidal anti-inflammatory drugs, congestive heart failure, and renal artery occlusion or stenosis.…”

Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

128

111

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In the United States the prevalence of end-stage renal disease (ESRD) reached epidemic proportions in 2012 with over 600,000 patients being treated. The rates of ESRD among the elderly are disproportionally high. Consequently, as life expectancy increases and the baby-boom generation reaches retirement age, the already heavy burden imposed by ESRD on the US health care system is set to increase dramatically. ESRD represents the terminal stage of chronic kidney disease (CKD). A large body of evidence indicating that CKD is driven by renal tissue hypoxia has led to the development of therapeutic strategies that increase kidney oxygenation and the contention that chronic hypoxia is the final common pathway to end-stage renal failure. Numerous studies have demonstrated that one of the most potent means by which hypoxic conditions within the kidney produce CKD is by inducing a sustained inflammatory attack by infiltrating leukocytes. Indispensable to this attack is the acquisition by leukocytes of an adhesive phenotype. It was thought that this process resulted exclusively from leukocytes responding to cytokines released from ischemic renal endothelium. However, recently it has been demonstrated that leukocytes also become activated independent of the hypoxic response of endothelial cells. It was found that this endothelium-independent mechanism involves leukocytes directly sensing hypoxia and responding by transcriptional induction of the genes that encode the β2-integrin family of adhesion molecules. This induction likely maintains the long-term inflammation by which hypoxia drives the pathogenesis of CKD. Consequently, targeting these transcriptional mechanisms would appear to represent a promising new therapeutic strategy.

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Section: Repeated Episodes Of Acute Kidney Injurymentioning

confidence: 99%

Hypoxia: The Force that Drives Chronic Kidney Disease

Colgan

Shelley

2016

Clinical Medicine & Research

128

111

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“…T he intravascular administration of iodinated contrast media is a well-recognized cause of acute kidney injury, which in turn, is associated with in-hospital morbidity and mortality (1)(2)(3)(4). Clinical factors that increase the risk for contrast-induced acute kidney injury (CIAKI) include preexistent kidney disease, diabetes mellitus in the setting of underlying renal impairment, advanced congestive heart failure, intravascular volume depletion, administration of large volumes of contrast, and the use of high-osmolal contrast media (1,(5)(6)(7)(8).…”

mentioning

confidence: 99%

Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography

Weisbord

Mor

Resnick

et al. 2008

Clinical Journal of the American Society of Nephrology

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180

127

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Background and objectives: Most studies of contrast-induced acute kidney injury (CIAKI) have focused on patients undergoing angiographic procedures. The incidence and outcomes of CIAKI in patients undergoing nonemergent, contrastenhanced computed tomography in the inpatient and outpatient setting were assessed.Design, setting, participants, & measurements: Patients with estimated glomerular filtration rates (GFRs) <60 ml/min per 1.73 m 2 undergoing nonemergent computed tomography with intravenous iodinated radiocontrast at an academic VA Medical Center were prospectively identified. Serum creatinine was assessed 48 to 96 h postprocedure to quantify the incidence of CIAKI, and the need for postprocedure dialysis, hospital admission, and 30-d mortality was tracked to examine the associations of CIAKI with these medical outcomes.Results: A total of 421 patients with a median estimated GFR of 53 ml/min per 1.73 m 2 were enrolled. Overall, 6.5% of patients developed an increase in serum creatinine >25%, and 3.5% demonstrated a rise in serum creatinine >0.5 mg/dl. Although only 6% of outpatients received preprocedure and postprocedure intravenous fluid, <1% of outpatients with estimated GFRs >45 ml/min per 1.73 m 2 manifested an increase in serum creatinine >0.5 mg/dl. None of the study participants required postprocedure dialysis. Forty-six patients (10.9%) were hospitalized and 10 (2.4%) died by 30-d follow-up; however, CIAKI was not associated with these outcomes.Conclusions: Clinically significant CIAKI following nonemergent computed tomography is uncommon among outpatients with mild baseline kidney disease. These findings have important implications for providers ordering and performing computed tomography and for future clinical trials of CIAKI.

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“…If patients who are at high risk for developing AKI can be well characterized and identified early, then preventive treatments can be initiated expeditiously. The risk factors for developing AKI have been well characterized in certain subset populations, such as contrast-related AKI and AKI after cardiac surgery (11)(12)(13). However, only three studies have evaluated the predictors of AKI in patients with sepsis (sepsis-associated AKI [SA-AKI]), and two of these studies were conducted in the same intensive care unit using two separate cohorts (14 -16).…”

mentioning

confidence: 99%

Elevated Plasma Concentrations of IL-6 and Elevated APACHE II Score Predict Acute Kidney Injury in Patients with Severe Sepsis

Chawla¹,

Seneff²,

Nelson³

et al. 2007

Clinical Journal of the American Society of Nephrology

171

103

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Acute kidney injury (AKI) is common in critically ill patients with severe sepsis (SS), and the predictors of AKI in this population have not been well characterized. The study group was the placebo group of the Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) data set. PROWESS is a prospective, randomized, controlled study of the use of drotrecogin ␣ (activated) for the treatment of SS. Placebo patients who had an admission renal sepsis organ failure score of 2 or more were excluded. AKI was defined as an increase in serum creatinine of 25% or 0.3 mg/dl during the first week postbaseline. The incidence of relevant parameters was then compared in patients with and without AKI. Half of the patients were randomly assigned to a model-building data set, and multivariable Cox regression was used to determine risk factors. Factors that remained significant in the remaining "model validation" data set were considered significant. Of the 840 patients in the placebo group, 547 met inclusion criteria. Of the 547 patients, 127 (23.2%) patients met criteria for AKI. The mean age of the 547 patients was 59.8 ؎ 17.0, and 43.3% of the cohort were female. The ethnicity breakdown was as follows: White 83.2%, black 5.9%, and other 11%. Univariate analyses indicated that patients with AKI had a higher incidence of a dependence on the basis of activity of daily living scale (38.6 versus 26.7%; P ‫؍‬ 0.01), a lower baseline platelet count (193,000 versus 222,000; P ‫؍‬ 0.02), a higher baseline respiratory Sepsis Organ Failure Assessment score (2.9 versus 2.7; P ‫؍‬ 0.02), higher preinfusion Acute Physiology and Chronic Health Evaluation II (APACHE II) score (24.8 versus 22.0; P ‫؍‬ 0.0002), older age (63.7 versus 58.7 yr; P ‫؍‬ 0.008), and higher log IL-6 (6.6 versus 5.8; P ‫؍‬ 0.0006). In a multivariable Cox regression, the predictors of AKI were log IL-6 (P < 0.0001) and APACHE II (P ‫؍‬ 0.0008). Increased log IL-6 and APACHE II score are significant risk factors of AKI in patients with SS. IL-6 data and the absence of correlation with measures of hypotension (e.g., mean arterial pressure, dosage of vasopressors) support the notion that inflammation is a significant component of AKI in SS.

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Radiocontrast-Induced Acute Renal Failure

Cited by 85 publications

References 104 publications

Hypoxia: The Force that Drives Chronic Kidney Disease

Hypoxia: The Force that Drives Chronic Kidney Disease

Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography

Elevated Plasma Concentrations of IL-6 and Elevated APACHE II Score Predict Acute Kidney Injury in Patients with Severe Sepsis

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