Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine

Chen, Shao Liang; Zhang, Junjie; Yei, Fei; Zhu, Zhenfang; Liu, Zhizhong; Lin, Song; Chu, Jun; Yan, Ji; Zhang, Ruiyan; Kwan, Tak

doi:10.1016/j.ijcard.2007.05.004

Cited by 93 publications

(81 citation statements)

References 28 publications

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“…This is corroborated by a recent study where contrast-induced AKI was not independently associated with death and had no effect on other clinical events [6,219]. In patients stratified as high or low risk based on GFR, NAC conferred some benefit when combined with hydration, with multivariate analysis confirming age, volume of contrast, diabetes, and peripheral vascular disease as significant factors for CIN development [232]. However, no benefit was observed in studies using NAC in vascular patients [233,234] nor in diabetic patients when compared with hydration alone [235].…”

Section: Rationalesupporting

confidence: 72%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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Background: Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. Method: A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Conclusions and recommendations: Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood Intensive Care Med (2010) 36:392-411 DOI 10.1007/s00134-009-1678 EXPERT PANEL pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

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Section: Rationalesupporting

confidence: 72%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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“…35 As expected, the presence of a previous renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of 560 mL/min/1.73 m 2 , turned out to be a very sensitive index of CIN. 36,37 Based on the available evidence in the literature the risk of CIN is inversely related to the calculated estimated GFR (eGFR). 38 …”

Section: Discussionmentioning

confidence: 99%

Frequency and risk factors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients: a study among Egyptian patients

et al. 2013

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Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury (AKI) in hospitalized patients. Diabetes mellitus remains a consistent independent predictor of contrast nephropathy. Aim: To determine frequency and predictors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients. Patients and methods: The study included 200 type II diabetic patients who underwent cardiac catheterization; serial measurement of serum creatinine and creatinine clearance (Before contrast exposure and 48 h), creatinine clearance was calculated using Cockcroft-Gault formula. Contrast-induced nephropathy was defined as rise in serum creatinine 48 h after contrast exposure of !0.5 mg/dL or increased425% compared to base line creatinine. Results: incidence of CIN in type II diabetic patients was 21.5%; incidence of CIN in diabetic patients with microalbuminuria was 17%, while incidence of CIN in patients with macroalbuminuria levels was 26%. There was a statistically significant difference between the patients who suffered from CIN post-procedure and patients who did not suffer from CIN regarding the ejection fraction and age with low ejection fraction and older patients in CIN group. Multiple logistic regression analysis for CIN predictors showed that pre-contrast serum creatinine to be the strongest predictor for being at risk of contrast-related, followed by age, and lastly albumin/creatinine ratio. Conclusion: Our findings suggest that diabetic patients, despite having a normal baseline creatinine are at an increased risk of developing CIN post-coronary angiography, patients at risk of CIN are older patients with high pre-contrast serum creatinine and high urine albumin/creatinine ratio.

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“…32 As expected, the presence of a previous renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m 2 , turned out to be a very sensitive index of CIN. 6,33 Based on the available evidence in the literature the risk of CIN is inversely related to the calculated estimated GFR (eGFR). 15 Studies have shown that diuretics and mannitol have no beneficial effects and may be harmful 34,35 and their use cannot be recommended for CIN prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for contrast induced nephropathy: A study among Italian patients

Evola

Lunetta

Macaione

et al. 2012

Indian Heart Journal

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Atherosclerosis Percutaneous coronary intervention Coronary angiography a b s t r a c tThis study aimed to make a profile of patients at highest risk of developing contrast induced nephropathy (CIN) in order to take appropriate prevention measures. 591 patients undergoing coronary procedures were divided into two groups: patients with (CIN-group) and without (no-CIN) an increase in creatinine level equal or more than 25% from baseline values within 24e48 h after the coronary procedure. All patients underwent an accurate anamnesis, objective exam, hematochemical measurements, and diagnostic exams. The results of this study while confirming that, average age ( p ¼ 0.01), diabetes mellitus IntroductionContrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute renal failure, accounting for 10% of all cases of hospital-acquired renal failure. 1 It is commonly defined as an acute deterioration of the renal function characterized by a significant increase in serum creatinine levels, usually more than 0.5 mg/dl (44 mmol/L) or 25% of baseline levels, within 24e48 h after exposure to a contrast agent compared to baseline serum creatinine values, when alternative explanations for renal impairment have been excluded. 2 The CIN is associated with increased mortality and morbidity and costs, 3e5 in fact, although usually transient, its resolution needs 1e3 weeks on average, the impairment of renal function may be permanent in some cases with the risk of progression towards chronic renal failure and the necessity of a temporary or permanent dialysis. 6 Prevention is the key to reduce the incidence of CIN and it begins with identification of the high risk patient coupled with appropriate peri-procedural management. Many studies have been conducted to identify the main risk factors for CIN, in fact many score systems have been proposed 7e12 and increasing number of guidelines have been suggested in literature 13,14 to help lessen the complication of CIN. Available online at www.sciencedirect.com journal homepage: w ww.el sevier.com/locate /ihj i n d i a n h e a r t j o u r n a l 6 4 ( 2 0 1 2 ) 4 8 4 e4 9 1

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Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine

Cited by 93 publications

References 28 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Frequency and risk factors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients: a study among Egyptian patients

Risk factors for contrast induced nephropathy: A study among Italian patients

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