Simple pre-procedure risk stratification tool for contrast-induced nephropathy

Ni, Zhonghan; Xie, Nianjin; Liu, Jin; Chen, Shiqun; Ye, Jianfeng; He, Yibo; Guo, Wei; Tan, Ning; Chen, Jiyan; Liu, Yong; Chen, Zhujun; Wang, Shouhong

doi:10.21037/jtd.2019.04.69

Cited by 11 publications

(7 citation statements)

References 33 publications

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“…However, the incidence data reported in Germany, Brazil and Iran were significantly higher, which may be associated with the number of studies and patient characteristics. The patients included in the studies from Germany were elderly, and this was a risk factor for CA-AKI [ 33 , 34 ]. The increased incidence in Brazil and Iran may be related to the small number of patients included.…”

Section: Discussionmentioning

confidence: 99%

The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1.2 million patients

et al. 2021

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Background Contrast-associated acute kidney injury (CA-AKI) is a common complication after coronary angiography (CAG), which brings a poor prognosis. But up to now, there were fewer studies to discuss the incidence of CA-AKI comprehensively. We comprehensively explore the incidence of CA-AKI after coronary angiography. Methods We searched Medline, Embase, and Cochrane Database of Systematic Reviews (to 30th June 2019). We evaluated the world’s incidence of the CA-AKI, and associated mortality, and to described geographic variations according to countries, regions, and economies. CA-AKI was defined as an increase in serum creatinine ≥ 0.5 mg/dl or ≥ 25% within 72 h. Random effects model meta-analyses and meta-regressions was performed to derive the sources of heterogeneity. Results A total of 134 articles (1,211,106 participants) were included in our meta-analysis. Most studies originated from China, Japan, Turkey and United States, from upper middle income and high income countries. The pooled incidence of CA-AKI after coronary angiography was 12.8% (95% CI 11.7–13.9%), and the CA-AKI associated mortality was 20.2% (95% CI 10.7–29.7%). The incidence of CA-AKI and the CA-AKI associated mortality were not declined over time (Incidence rate change: 0.23% 95% CI − 0.050 to 0.510 p = 0.617; Mortality rate change: − 1.05% 95% CI − 3.070 to 0.970 p = 0.308, respectively). Conclusion CA-AKI was a universal complication in many regions, and the burden of CA-AKI remains severe. In clinical practice, physicians should pay more attention to the occurrence and active prevention and treatment of CA-AKI. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1.2 million patients

et al. 2021

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“…Since Mehran first developed a risk scoring system, which involves eight clinical and procedural variables, to predict CIN after PCI, several simpler risk assessment models have been proposed [ 21 , 86 , 87 , 88 , 89 ]. The ACEF (age, creatinine, and ejection fraction) score was originally developed in 2009 to assess the mortality risk in patients undergoing elective cardiac operations, but that simple risk scoring system has subsequently been validated in other clinical conditions, including CIN after CAG or PCI.…”

Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

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“…AMI, hypotension and HS-CRP are the research hotspots of CA-AKI and prognosis. The association between AMI and CA-AKI has been confirmed in previous studies [26,27], and Zafrir et al also found that patients with AMI can have significantly increased long-term mortality [28]. Hypotension, as a strong predictor of CA-AKI, is also a good predictor of death.…”

Section: Discussionmentioning

confidence: 59%

A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

Lun

Zhou

et al. 2020

BMC Cardiovasc Disord

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Background The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes. Methods A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis. Results During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 36.73% and 28.86%, respectively. We found that CA-AKIA (HR: 2.349, 95% CI 1.570–3.517, p = 0.001) and CA-AKIB (HR: 1.608, 95% CI 1.106–2.339, p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA (31.14%), followed by CA-AKIB (14.93%). Conclusions CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.

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Simple pre-procedure risk stratification tool for contrast-induced nephropathy

Cited by 11 publications

References 33 publications

The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1.2 million patients

The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1.2 million patients

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

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