The use of radiographic contrast media during PCI: A focused review

Klein, Lloyd W.; Sheldon, Mark; Brinker, Jeffrey A.; Mixon, Timothy A.; Skelding, Kimberly A.; Strunk, Adam; Tommaso, Carl L.; Weiner, Bonnie H.; Bailey, Steven R.; Uretsky, Barry F.; Kern, Morton J.; Laskey, Warren K.

doi:10.1002/ccd.22113

Cited by 45 publications

(15 citation statements)

References 99 publications

(156 reference statements)

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“…Baseline kidney function is a robust predictor of CI-AKI events [7], [8], [10], [11], [12], [43] but we did not find any association between the benefit with either the intravenous or oral route and baseline kidney function. The volume of contrast administered has been identified in previous observational studies as a predictor of CI-AKI events, with doses greater than 100 ml [6] or exceeding a safe dose threshold (based on weight and serum creatinine [44]) being associated with AKI [45].…”

Section: Discussioncontrasting

confidence: 62%

“…Severe acute kidney injury requires dialysis and results in increased morbidity and mortality, prolonged hospitalization and overall increased healthcare resource utilization [3], [4], [5], [6]. Of the various prophylactic measures tested in clinical trials, intravenous near-isotonic fluid administration has stood out as the having the most consistent therapeutic benefit [7], [8], [9], [10], [11], [12], [13].…”

Section: Introductionmentioning

confidence: 99%

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Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence

et al. 2013

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BackgroundPre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral to the intravenous route in prevention of contrast-induced acute kidney injury.Study DesignA systematic review and meta-analysis of randomised trials with a stratified analysis and metaregression. Databases included MEDLINE (1950 to November 23 2011), EMBASE (1947 to week 47 2011), Cochrane CENTRAL (3rd quarter 2011). Two reviewers identified relevant trials and abstracted data.Settings and PopulationTrials including patients undergoing a contrast enhanced procedure.Selection CriteriaRandomised controlled trial; adult (>18 years) population; comparison of oral versus intravenous volume expansion.InterventionOral route of volume expansion compared to the intravenous route.OutcomesAny measure of acute kidney injury, need for renal replacement therapy, hospitalization and death.ResultsSix trials including 513 patients met inclusion criteria. The summary odds ratio was 1.19 (95% CI 0.46, 3.10, p = 0.73) suggesting no difference between the two routes of volume expansion. There was significant heterogeneity (Cochran’s Q = 11.65, p = 0.04; I2 = 57). In the stratified analysis, inclusion of the five studies with a prespecified oral volume expansion protocol resulted in a shift towards oral volume expansion (OR 0.75, 95% CI 0.37, 1.50, p = 0.42) and also resolved the heterogeneity (Q = 3.19, P = 0.53; I2 = 0).LimitationsSmall number of studies identified; lack of hard clinical outcomes.ConclusionThe oral route may be as effective as the intravenous route for volume expansion for contrast-induced acute kidney injury prevention. Adequately powered trials with hard endpoints should be done given the potential advantages of oral (e.g. reduced patient burden and cost) over intravenous volume expansion.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence

et al. 2013

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“…But, certain subgroup of coronary heart disease patients, especially with acute coronary syndrome or chronic kidney disease, showed higher risk for the CIAKI. [2], [3] Investigators have examined several strategies to prevent CIAKI, such as fenolopam, mannitol, theophylline, iloprost, furosemide, dopamine, hemofiltration, ascorbic acid, and N-acetylcystein (NAC). [4] However, none of the agents were proved to be effective in preventing CIAKI.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Acute Kidney Injury: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials

et al. 2014

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BackgroundThere have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI.Methods and ResultsRandomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2–5days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35–0.57, p<0.001, I2 = 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34–0.65, p<0.001, I2 = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21–0.58, p<0.001, I2 = 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥60years), regardless of osmolality of contrast or administration of N-acetylcystein.ConclusionsHigh-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

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“…Klein et al . [18] showed that in the diabetic population, CIN developed every fifth, fourth, and second patient who received 200–400, 400–600, >600 ml contrast study, respectively. In our study, no significant association was found between patients who received contrast volume >100 ml and CIN.…”

Section: Discussionmentioning

confidence: 99%

N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease: A randomized controlled trial

et al. 2017

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Contrast media administration can lead to acute deterioration in renal function particularly in patients with pre-existing chronic kidney disease. This prospective, randomized controlled open-label parallel group study was undertaken at Nizam's Institute of Medical Sciences, Hyderabad, from June to December 2015. A total of 95 patients were included, of which 35 received n-acetylcysteine (NAC) + normal saline (NS), 30 patients received allopurinol (ALL) + NS, and 30 patients received placebo. In our study, the overall incidence of CIN was 24%. Incidence of CIN in NAC + NS, ALL + NS, and placebo group were 20%, 16%, and 36%, respectively. The major finding of this study was there was no significant difference between NAC and allopurinol in the prevention of contrast nephropathy. However, only allopurinol was superior to placebo. In our study, hyperuricemia and baseline serum creatinine were the only risk factors associated with CIN.

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The use of radiographic contrast media during PCI: A focused review

Cited by 45 publications

References 99 publications

Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence

Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence

Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Acute Kidney Injury: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials

N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease: A randomized controlled trial

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