Contrast-induced acute kidney injury

Briguori, Carlo; Donnarumma, Elvira; Quintavalle, Cristina; Fiore, Danilo; Condorelli, Gerolama

doi:10.1097/mnh.0000000000000106

Cited by 25 publications

(14 citation statements)

References 86 publications

(84 reference statements)

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“…This means that tolvaptan increases renal blood flow without reducing the serum sodium level and could prevent renal medullary ischemia/hypoxia as a result of increased renal blood flow without aggravating heart failure if used for the prophylaxis of CI-AKI. Despite reports that diuretics can prevent CI-AKI, the effect of these drugs remains controversial [22]. Majumdar et al [23] found that forced euvolemic diuresis with saline, mannitol, and furosemide was associated with a significantly higher incidence of CI-AKI than saline hydration (50 vs. 28%, p = 0.03).…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Tolvaptan for the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Heart Failure and Chronic Kidney Disease

et al. 2018

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Background: Tolvaptan is a promising drug for the prevention of contrast-induced acute kidney injury (CI-AKI) because it induces aquaresis without adversely affecting renal hemodynamics. CI-AKI is a major cause of acute renal failure associated with increased morbidity and mortality. Objective: To investigate the effectiveness of different doses of tolvaptan for the prevention of CI-AKI. Method: Ninety-one consecutive patients with congestive heart failure (CHF) and chronic kidney disease (CKD) were prospectively enrolled as the tolvaptan group in this study (T-group; 7.5-mg: n = 42, 15-mg: n = 49). In addition, 91 consecutive patients with CHF and CKD were collected retrospectively as a control group (C-group, n = 91). All patients received continuous intravenous infusion of isotonic saline, and tolvaptan was administered to the T-group. Results: One patient developed CI-AKI in the T-group versus 3 in the C-group (1.1 vs. 3.3%, p = 0.61). On the other hand, the change of serum creatinine in the T-group was lower than that in the C-group. Additionally, in the 7.5-mg group, serum creatinine was unchanged up to 72 h after contrast administration, showing a significant difference from the 15-mg group (–0.00 ± 0.09 vs. 0.05 ± 0.12 mg/dL, p = 0.009). Similarly, the change of eGFR was significantly smaller in the 7.5-mg group than that in the 15-mg group (0.7 ± 5.4 vs. –2.8 ± 5.1 mL/min/1.73 m², p = 0.002). No patient required hemodialysis and there was no prolongation of hospitalization due to exacerbation of heart failure. Conclusions: Compared to hydration alone, tolvaptan combined with hydration could be a safer method for preventing CI-AKI while avoiding exacerbation of heart failure, and a dosage of 7.5-mg might be safer than 15-mg.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Tolvaptan for the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Heart Failure and Chronic Kidney Disease

et al. 2018

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“…TMZ is a piperazine derivative, which is a inhibitor of mitochondrial long-chain 3-acyl coenzyme A. Basic research [29,30] confirmed that TMZ can inhibit the production of oxygen-free radical, reduce apoptosis, prevent mitochondrial swelling, enhance mitochondrial activity, and prevent cell lysis, thereby protecting the cell function. In addition, TMZ can improve the concentration of intracellular SOD, which is a part of the main substances in removing oxygen-free radicals.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency

Lü

et al. 2017

Medicine

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Background:With the continuous development of cardiac interventional medicine, the incidence of contrast-induced nephropathy (CIN) is increasing every year, which is a serious threat to people's physical and mental health. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can significantly reduce the incidence of CIN. At present, a systematic review and meta-analysis was conducted to evaluate the clinical effect of TMZ on prevention of CIN in patients with renal insufficiency. However, the study did not include patients from other countries and speaking different languages. So we conducted this study to update the previous meta-analysis that investigated the effects of TMZ on prevention of CIN in patients with renal insufficiency, and provided some theoretical reference for clinical.Methods:By searching PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, VIP database, and Wang Fang database for randomized controlled trial, which is comparing TMZ versus conventional hydration for prevention of CIN. Two researchers independently screened literature, and then evaluated the quality of literature and extracted the relevant data. Stata 11.0 software was used for statistical analysis.Results:Finally, this updated review showed that 3 studies that were not included in the previous meta-analysis were included in our study (3 articles were published in the Chinese Journal, 1 study for CIN, 1 study for CIN, serum creatinine (Scr), and superoxide dismutase, 1 study for CIN and Scr), and 1 outcome (Scr) reflecting the change of renal function was additionally included in our study. Of the 932 studies, 6 randomized controlled trials met the criteria, including 377 patients in TMZ group and 387 patients in control group. This meta-analysis for all studies showed that TMZ can significantly reduce the incidence of CIN (relative risk 0.27, 95% confidence interval [CI] 0.16, 0.46, P = 0.000), and can decrease the level of Scr after operation, including Scr of postoperative 24 hours (standardized mean difference [SMD] −0.30, 95% CI −0.51, −0.09, P = 0.005), Scr of postoperative 48 hours (SMD −0.66, 95% CI −1.23, −0.10, P = 0.022), and Scr of postoperative 7 days (SMD −0.74, 95% CI −1.36, −0.11, P = 0.021). However, the Scr of postoperative 72 hours between TMZ group and control group has no statistical significance (P = 0.362).Conclusion:Our study showed that when comparing with conventional hydration, TMZ can significantly reduce the incidence of CIN and the level of postoperative Scr. Therefore, we could suggest that TMZ was superior to conventional hydration for the treatment of CIN in patients with renal insufficiency. However, due to the restriction of quality and number of included articles, it still needs to carry out multicenter, randomized, double-blind clinical trials to confirm this conclusion in the future.

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“…This discovery is a significant advance in efforts to find a way to mitigate the serious medical problem of CI‐AKI in interventional neurology and cardiology, and all other uses of iodinated contrast agents. Although there have been attempts to alter the molecular structure of iodinated contrast, none of these changes in the structure of low ionic or isoionic iodinated contrast agents have made a significant impact on the incidence of CI‐AKI …”

Section: Discussionmentioning

confidence: 99%

Preclinical Studies of a Kidney Safe Iodinated Contrast Agent

Rowe¹,

Rowe

Biswas

et al. 2016

Journal of Neuroimaging

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BACKGROUND AND PURPOSEContrast‐induced acute kidney injury (CI‐AKI) is a serious complication of the use of iodinated contrast agents. This problem is particularly acute in interventional neurology and interventional cardiology, probably due to the intra‐arterial route of injection, high contrast volumes, and preexisting risk factors of these patients. In an attempt to develop a contrast agent that is less damaging to the kidneys, we have studied the effects of adding a small amount of the substituted cyclodextrin, sulfobutyl‐ether‐β‐cyclodextrin (SBECD), to iohexol in rodent models of renal toxicity.METHODSRenally compromised mice and rats were injected with iohexol and iohexol‐SBECD via the tail vein. The renal pathology, creatinine clearance, and survival benefits of iohexol‐SBECD were studied. The safety of direct intra‐arterial injection of the iohexol‐SBECD formulation was studied in a dog heart model system. Mechanism of action studies in cell culture model using a human kidney cell line was performed using flow cytometry.RESULTSNephrotoxicity was significantly reduced using iohexol‐SBECD compared to iohexol alone, at mole ratios of iohexol:SBECD of 1:0.025. SBECD increased survival from 50% to 88% in a rat survival study. In the dog heart model, iohexol‐SBECD was safe. Cell culture studies suggest that SBECD interferes with the early stages of contrast‐induced apoptosis in a human renal cell line.CONCLUSIONWe have shown that the addition of a small amount of SBECD (one molecule of SBECD per 40 iohexol molecules) significantly protects rodent kidneys from CI‐AKI. Further development of this new formulation of iodinated contrast is warranted.

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Contrast-induced acute kidney injury

Abstract: Hydration still represents the most reliable strategy to prevent CI-AKI. New prophylactic strategies for acute kidney injury are still under investigation.

Cited by 25 publications

References 86 publications

Safety and Efficacy of Tolvaptan for the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Heart Failure and Chronic Kidney Disease

Safety and Efficacy of Tolvaptan for the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Heart Failure and Chronic Kidney Disease

Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency

Preclinical Studies of a Kidney Safe Iodinated Contrast Agent

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