Clinical and Experimental Evidence for Prevention of Acute Renal Failure Induced by Radiographic Contrast Media

Itoh, Yoshinori; Yano, Tomoaki; Sendo, Toshiaki; Oishi, Ryozo

doi:10.1254/jphs.crj05002x

Cited by 73 publications

(60 citation statements)

References 128 publications

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“…At present, it is the third most important cause of acute renal failure in hospitalized patients, accounting for 12% of all cases and contributing to prolonged hospital stay and increased medical costs. 1 The present evidence indicates that the pathogenesis of CIAKI is mainly related to renal hypoxia, direct nephrotoxicity, and oxidative stress. 2 Oxidative stress seems to play an important role in CI-AKI.…”

Section: Introductionmentioning

confidence: 57%

Mitochondria-targeted peptides prevent on contrast-induced acute kidney injury in the rats with hypercholesterolemia

et al. 2013

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Objective: The objective of this study is to evaluate the effect and mechanism of mitochondriatargeted peptides (MTP131 and SPI20) on contrast-induced acute kidney injury (CI-AKI) in rats with hypercholesterolemia. Method: Forty SD rats were randomly divided into normal diet group (NN, n ¼ 8) and high cholesterol supplemented dietary group (HN, n ¼ 32). At the end of 8 weeks, the group HN was divided into four subgroups. All Rats were given injection of either diatrizoate (10 mL/kg) or equal volume of normal saline, the rats pretreated with MTP131 or SPI20 were given injection with MTP131 or SPI 20 (3 mg/kg) by peritoneal cavity for 3 times. Blood, urine and renal tissue samples were prepared to determine biochemical parameters. The renal pathological changes were evaluated by hematoxylin and eosin staining and scored semiquantitatively, The protein expression of renal NOX4 was also measured by Western blotting. Results: In diatrizoate-injected rats, Serum creatinine (Scr), fractional excretion of sodium (FeNa%), fractional excretion of potassium (FeK%), pathological scores, renal malondialdehyde (MDA) content, the NADPH oxidase activity and the expression of NOX4 in kidney tissue were significantly increased (p50.01). In the groups pretreated with MTP131 or SPI20, the levels of Scr, FeNa%, FeK%, MDA content and NADPH oxidase activity in renal tissue decreased (p50.01), the levels of renal super oxygen dehydrogenises and ATPase activity increased (p50.01). The renal injuries induced by contrast media (CM) were alleviated. Conclusion: MTP131 and SPI20 might protect acute kidney injury induced by CM in rats with hypercholesterolemia.

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Section: Introductionmentioning

confidence: 57%

Mitochondria-targeted peptides prevent on contrast-induced acute kidney injury in the rats with hypercholesterolemia

et al. 2013

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“…13,14 Beraprost, a synthetic analog of prostacy-clin, has also been shown to protect against direct tubular damage and apoptosis induced by contrast media. 15,16 These findings suggest that attenuation of the renal vasodilatory action of prostacyclin may be a critical factor underlying the development of CIN.…”

Section: Editorial See P 1749 Clinical Perspective On P 1799mentioning

confidence: 94%

Iloprost Prevents Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention

et al. 2009

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Background-The prevention of contrast-induced nephropathy, which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast-induced renal vasoconstriction is believed to play a pivotal role in the pathogenesis of contrast-induced nephropathy. The aim of this study was to examine the efficacy of the prostacyclin analog iloprost in preventing contrast-induced nephropathy in patients with renal dysfunction undergoing a coronary procedure. Methods and Results-We conducted a randomized, double-blind, placebo-controlled trial of iloprost in 208 patients with a serum creatinine concentration Ն1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng · kg Ϫ1 · min Ϫ1 or placebo was administered intravenously beginning 30 to 90 minutes before and ending 4 hours after the procedure. Contrast-induced nephropathy was defined by an absolute increase in serum creatinine Ն0.5 mg/dL or a relative increase Ն25% measured 2 to 5 days after the procedure. Contrast-induced nephropathy occurred in 23 of the 105 patients (22%) in the control group and in 8 of the 103 patients (8%) in the iloprost group (odds ratio, 0.29; 95% confidence interval, 0.12 to 0.69; Pϭ0.005). In the control group, the estimated glomerular filtration rate declined from 49.7Ϯ15.5 to 46.6Ϯ16.6 mL · min Ϫ1 · 1.73 m Ϫ2 (Pϭ0.01). In the iloprost group, the estimated glomerular filtration rate increased marginally from 47.5Ϯ14.5 to 48.6Ϯ16.1 mL · min Ϫ1 · 1.73 m Ϫ2 (Pϭ0.26). The mean absolute estimated glomerular filtration rate decline in the control group was greater than its change in the iloprost group (difference, 4.2 mL · min Ϫ1 · 1.73 m Ϫ2; 95% confidence interval, 1.1 to 7.3; Pϭ0.008). Conclusion-Prophylactic

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“…The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease equation (11) In accordance with other studies (1,3,4,9,(12)(13)(14)(15)(16)(17), CIN was defined as an increase in serum creatinine of 44.2 μmol/L (0.5 mg/dL) or more within 72 h after the administration of the contrast agent. Creatinine levels at 30 days, which were 44.2 μmol/L or more above the baseline creatinine level before heart catheterization, were classified as elevated creatinine levels at 30 days.…”

Section: Definitionsmentioning

confidence: 99%

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

Hölscher¹,

Heitmeyer²,

Fobker³

et al. 2008

Canadian Journal of Cardiology

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T he development of radiographic contrast media originated from the use of sodium iodide in radiography in 1918 (1), when Walter Dandy directly injected contrast media into the cerebral ventricles for visualizing the outline of the brain and the ventricular system. Since then, many different types of contrast media have been synthesized, and many improvements in terms of side effects, such as hypersensitivity reactions, have been made. Moreover, associated acute renal failure, currently classified as contrast media-induced nephropathy (CIN), remains a major complication in hospitalized patients undergoing diagnostic or therapeutic interventional procedures using CLINICAL STUDIES ©2008 Pulsus Group Inc. All rights reserved BACKGROUND: Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes. OBJECTIVES: To prospectively assess predictors of CIN and long-term outcomes of affected patients. METHODS: Four hundred twelve consecutive patients with serum creatinine levels of 115 μmol/L to 309 μmol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus onetime hemodialysis or hydration plus N-acetylcysteine. RESULTS: Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 μmol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96). CONCLUSION: From the present prospective trial, performance of postprocedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for patients' long-term survival.

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Clinical and Experimental Evidence for Prevention of Acute Renal Failure Induced by Radiographic Contrast Media

Cited by 73 publications

References 128 publications

Mitochondria-targeted peptides prevent on contrast-induced acute kidney injury in the rats with hypercholesterolemia

Mitochondria-targeted peptides prevent on contrast-induced acute kidney injury in the rats with hypercholesterolemia

Iloprost Prevents Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

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