Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam

Kini, Annapoorna; Mitre, Cristina A.; Kamran, Mazullah; Suleman, Javed; Kim, Michael; Duffy, Mary E.; Marmur, Jonathan D.; Sharma, Sanjeev

doi:10.1016/s0002-9149(02)02259-2

Cited by 70 publications

(67 citation statements)

References 17 publications

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“…9,19 However and have observed higher mean age which may be due to increased life expectancy in western country. 20,21 The majority of patient were male 82% in group I and 88% in group II and remaining female, with a male to female ratio 5.66:1 in the whole study population No significant (p>0.05) difference was found regarding sex distribution between two groups. Almost similar male female ratio (6.9:1) was observed in a study conducted by M Akhtaruzzaman in NICVD.…”

Section: Discussionmentioning

confidence: 74%

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

et al. 2013

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Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The association between pre-procedural blood glucose levels and CI-AKI risk (regardless of pre-existing diabetes) is unknown. The present study was conducted to evaluate the incidence of CI-AKI in patients with admission hyperglycemia in non-diabetic ACS patients. Methods: This is Prospective, observational study done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Considering inclusion and exclusion criteria, 50 patients were non diabetic with ACS with normal blood glucose (d7.8 mmol/l or d140 mg/dl) in (Group I) and 50 patients were non diabetic with ACS with high blood glucose (>7.8 mmol/l or >140 mg/dl) undergoing percutaneous coronary intervention in (Group II). On admission random blood glucose was measured. Non- ionic low osmolar contrast agents (lopamidol) was used in all patients. Serum creatinine, serum electrolytes was measured and creatinine clearance rate was determined within 24 hours before PCI and day 1 and 2 after PCI. Results: The incidence of CIN was 24% in high blood glucose group and 4% in normal blood glucose group (p=0.004). It was also observed that gradual incremental increase in risk of CIN associated with higher admission blood glucose level. There was positive correlation between s. creatinine and admission blood glucose but it showed negative correlation between CCr and admission blood glucose after PCI in ACS patients not known to be diabetic. Conclusion: The present study reveals that index admission high blood glucose in acute coronary syndrome patients not known to be diabetic is associated with increased incidence of contrast induced nephropathy after percutaneous coronary intervention. Cardiovascular Journal Volume 6, No. 1, 2013, Page 23-30 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16111

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Section: Discussionmentioning

confidence: 74%

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

et al. 2013

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“…25 The benefit of fenoldopam for the prevention of contrast-medium nephropathy has been demonstrated in a dog model and in nonrandomized clinical studies. 25,[59][60][61] In a small double-blind, randomized controlled pilot trial, fenoldopam plus normal saline was found to attenuate reductions in renal blood flow induced by contrast media; it was also associated with a lower incidence of contrast-medium nephropathy than was normal saline alone, although the difference between the 2 groups was not significant. 62 The benefit of fenoldopam was not validated in a large multicentre randomized placebo-controlled double-blind trial.…”

Section: Vasodilatorsmentioning

confidence: 99%

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Goldenberg

Matetzky²

2005

Canadian Medical Association Journal

317

300

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WITH THE INCREASING USE OF CONTRAST MEDIA in diagnostic and interventional procedures, nephropathy induced by contrast media has become the third leading cause of hospital-acquired acute renal failure. It is also associated with a significant risk of morbidity and death. The current understanding of the pathogenesis indicates that contrast-medium nephropathy is caused by a combination of renal ischemia and direct toxic effects on renal tubular cells. Patients with pre-existing renal insufficiency, diabetes mellitus and congestive heart failure are at highest risk. Risk factors also include the type and amount of contrast medium administered. Therapeutic prevention strategies are being extensively investigated, but there is still no definitive answer. In this article, we review the current evidence on the causes, pathogenesis and clinical course of contrast-medium nephropathy as well as therapeutic approaches to its prevention evaluated in clinical trials.

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“…21 Several nonrandomized studies have shown a lower incidence of contrast nephropathy with fenoldopam and hydration compared with historical controls in stenting procedures. 22,23 The only large randomized study on the preventive effects of fenoldopam in these high-risk subjects did not show any reduction in the incidence of ARF. 14 In the present prospective, double-blind, randomized clinical trial, fenoldopam mesylate did not prevent ARF in a high-risk population of cardiac surgical patients.…”

Section: Discussionmentioning

confidence: 93%

Renoprotective Action of Fenoldopam in High-Risk Patients Undergoing Cardiac Surgery

et al. 2005

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Background— Acute renal failure is a serious complication of cardiac surgery causing high morbidity and mortality. The aim of this study was to evaluate the usefulness of fenoldopam, a specific agonist of the dopamine-1 receptor, in patients at high risk of perioperative renal dysfunction. Methods and Results— A prospective single-center, randomized, double-blind trial was performed after local ethical committee approval and after written consent was obtained from 80 patients undergoing cardiac surgery. Patients received either fenoldopam at 0.05 μg/kg per minute or dopamine at 2.5 μg/kg per minute after the induction of anesthesia for a 24-hour period. All these patients were at high risk of perioperative renal dysfunction as indicated by Continuous Improvement in Cardiac Surgery Program score >10. Primary end point was defined as 25% creatinine increase from baseline levels after cardiac surgery. The 2 groups (fenoldopam versus dopamine) were homogeneous cohorts, and no difference in outcome was observed. Acute renal failure was similar: 17 of 40 (42.5%) in the fenoldopam group and 16 of 40 (40%) in the dopamine group ( P =0.9). Peak postoperative serum creatinine level, intensive care unit and hospital stay, and mortality were also similar in the 2 groups. Conclusions— Despite an increasing number of reports of renal protective properties from fenoldopam, we observed no difference in the clinical outcome compared with dopamine in a high-risk population undergoing cardiac surgery.

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Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam

Cited by 70 publications

References 17 publications

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Renoprotective Action of Fenoldopam in High-Risk Patients Undergoing Cardiac Surgery

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