Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Moro, André Brusamolin; Strauch, João Gabriel Nakka; Groto, Anderson Dillmann; Toregeani, Jeferson Freitas

doi:10.1590/1677-5449.200161

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…Hypotension was defined as systolic blood pressure of <80 mmHg for at least 1 h necessitating inotropic support with drugs or an intra-aortic balloon pump within 24 h following the procedure. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to the baseline value within 48 h after PCI (16). The primary endpoint was defined as the development of CIN and the secondary endpoint was inhospital mortality.…”

Section: Definitions End Endpointmentioning

confidence: 99%

ST segment yükselmeli miyokard enfarktüsü olan hastalarda kontrast maddeye bağlı nefropati ile CANLPH skoru arasındaki ilişki

Çelebi

DOĞANAY

2023

Anatolian Current Medical Journal

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Aim: Contrast-induced nephropathy (CIN), a significant complication of percutaneous coronary intervention (PCI), is related to increased morbidity and mortality. It has been suggested that inflammation plays an important role in the development of CIN. This study aimed to investigate the prognostic role of the CANLPH score, a new indicator of inflammation, in predicting CIN and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI. Material and Method: This retrospective study included 1475 patients with STEMI undergoing PCI. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to the baseline value within 48 h after PCI. The preprocedural modified Mehran score was calculated for each patient. The CANLPH score was derived from the cut-off points of the platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and platelet/hemoglobin ratio to predict CIN. Results: The mean age of the patients was 62.0±14.3 years and the majority were male (69.8%). The incidence of CIN was determined as 11.5%. Multivariable regression analysis showed that increased CANLPH score (OR=4.49, p

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Section: Definitions End Endpointmentioning

confidence: 99%

ST segment yükselmeli miyokard enfarktüsü olan hastalarda kontrast maddeye bağlı nefropati ile CANLPH skoru arasındaki ilişki

Çelebi

DOĞANAY

2023

Anatolian Current Medical Journal

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SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis

Meregildo-Rodriguez,

Asmat-Rubio,

Vásquez-Tirado

2023

Front. Endocrinol.

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IntroductionSGLT2 inhibitors (SGLT2Is) have demonstrated cardioprotective and nephroprotective effects in patients with and without diabetes. Recent studies suggest that SGLT2Is may reduce the risk of contrast-induced nephropathy (CIN) in patients with diabetes undergoing coronary arteriography (CAG) or percutaneous coronary interventions (PCI). However, the evidence is still inconclusive. We aimed to systematically review the evidence regarding the potential nephroprotective role of SGLT2Is in preventing CIN in this population.MethodsWe searched for studies in six databases published up to September 30, 2023, following a PECO/PICO strategy. Initially, we meta-analyzed five studies, but due to several reasons, mainly methodological concerns, we excluded one RCT. In our final meta-analysis, we included four observational studies.ResultsThis meta-analysis comprised 2,572 patients with diabetes undergoing CAG or PCI, 512 patients treated with SGLT2Is, and 289 events of CIN. This is the first meta-analysis demonstrating that SGLT2Is may reduce the risk of developing CIN by up to 63% (RR 0.37; 95% CI 0.24–0.58) in patients with diabetes undergoing CAG or PCI, compared to not using SGLT2Is. Statistical heterogeneity was not significant (I2 = 0%, p = 0.91). We assessed the certainty of the evidence of this systematic review and meta-analysis, according to the GRADE criteria, as moderate.ConclusionSGLT2Is significantly reduce the risk of CIN by up to 63% in patients with diabetes undergoing CAG or PCI. Clinical trials are needed; several are already underway, which could confirm our findings and investigate other unresolved issues, such as the optimal dose, type, and duration of SGLT2 inhibitor therapy to prevent CIN.Systematic ReviewPROSPERO, identifier CRD42023412892.

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Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

Santosa¹,

Harca²,

Yuwono³

et al. 2022

Cureus

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Introduction: Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary intervention (PCI) procedures, as it induces acute kidney injury (AKI), especially in previously diagnosed chronic kidney disease (CKD) patients, particularly in those who also have diabetes. Adequate hydration and using a minimal volume of contrast media are the recommended measures to decrease CI-AKI in CKD patients. A combination of sodium bicarbonate and N-acetylcysteine (NAC) may be a superior strategy for preventing CI-AKI. This study is aimed to evaluate the safety of PCI in moderate to severe CKD patients.Method: This was a prospective, single-center study, from 2019 to 2021. We included all chronic kidney disease who undergo PCI procedures. The kidney level was measured on admission and 24 hours after the PCI procedure. The patients received 75 meq/500 mL of sodium bicarbonate one to six hours before procedures, oral acetylcysteine 600 mg bid for three days, and rehydration with 1000 ml of normal saline infusion for eight hours in patients without congestive heart failure. SPSS Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0., IBM Corp., Armonk, NY) was used to input and process the data.Results: This study included 118 subjects, with baseline characteristics of age 58.77 ± 9.08 years, 80.5% male, 47.5% diabetic, 50% hypertension, and 59.5% congestive heart failure. From the coronary angiogram, we found most of our subjects (57.6%) had three-vessel disease, 28.8% had two-vessel disease, and 15.6% had one-vessel disease. About 67.8% of subjects used <50 ml of low molecular contrast. The baseline creatinine level was 2.46 ± 1.04 mg/dL and the estimated glomerular filtration rate (eGFR) was 30 ± 12.65 mL/min. There were 19 (16.1%) patients with stage 3A CKD, 45 (38.1%) stage 3B, 41 (34.7%) stage 4, and 41 (34.7%) stage 5. The kidney function test after 24 hours of contrast admission showed a creatinine level of 2.37 ± 1.20 mg/dL (P<0.05) and the eGFR of 34.74 ± 16.10 mL/min. There was no significant difference in creatinine levels between stage 3A and stage 5 CKD. There was a significant reduction in creatinine in stage 3B CKD, from 1.917 ± 0.22 to 1.71 ± 0.37 mg/dL (P = 0.001); and stage 4 CKD, from 2.77 ± 0.55 to 2.72 ± 0.94 mg/dL (P = 0.013).Discussion: CKD is a risk factor for developing CI-AKI after PCI, which is a marker of poor long-term outcomes. The development of CI-AKI is a strong predictor of post-PCI bleeding, which aggravates hemodynamic instability. The combination of NAC and NaHCO 3 exerts a better antioxidative effect, which reduces the harmful short-term and long-term consequences of contrast media. Previous studies revealed the use of low-to-zero contrast media was safer in CKD patients who had undergone PCI. By applying these measures, our study showed a good outcome of PCI with no worsening renal function in CKD patients.Conclusion: With good prophylaxis measures, such as using minimal volume contrast media, adequate rehydration, and the combi...

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Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Cited by 3 publications

References 28 publications

ST segment yükselmeli miyokard enfarktüsü olan hastalarda kontrast maddeye bağlı nefropati ile CANLPH skoru arasındaki ilişki

ST segment yükselmeli miyokard enfarktüsü olan hastalarda kontrast maddeye bağlı nefropati ile CANLPH skoru arasındaki ilişki

SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis

Is It Safe to Do Percutaneous Coronary Intervention in Moderate to Severe Chronic Kidney Disease Patients? A Prospective Cohort Study

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