Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease

Sigterman, Tim A.; Krasznai, A; Snoeijs, Maarten G.; Heijboer, Roel J.J.; Schurink, G.W.H.; Bouwman, Lee H.

doi:10.1016/j.ejvs.2015.08.023

Cited by 34 publications

(15 citation statements)

References 14 publications

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“…However there are few studies about the long-term renal prognosis of patients who developed CI-AKI. In a prospective study performed on patients with symptomatic peripheral artery disease undergoing PTCA, patients with CI-AKI were found to be at increased risk of long-term loss of renal function, cardiovascular events, and death[88]. In this study, one year after the procedure, decline in eGFR was significantly higher in patients with CI-AKI compared with patients without CI-AKI (12.4 mL/min vs 6.2 mL/min).…”

Section: Prognosis Of Ci-akimentioning

confidence: 99%

Contrast-induced acute kidney injury: A review of practical points

Özkök¹,

Özkök²

2017

WJN

113

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Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of AKI in clinical practice. CI-AKI has been found to be strongly associated with morbidity and mortality of the patients. Furthermore, CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease. Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies. CI-AKI is an active research area thus clinicians should be updated periodically about this topic. In this review, we aimed to discuss the indications of contrast-enhanced imaging, types of contrast media and their impact on nephrotoxicity, major pathophysiological mechanisms, risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.

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Section: Prognosis Of Ci-akimentioning

confidence: 99%

Contrast-induced acute kidney injury: A review of practical points

Özkök¹,

Özkök²

2017

WJN

113

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“…(chi-squared=47.171, p=1.42 x 10 -7 ). As there is considerate evidence in literature that CI-AKI also impacts long-term outcome [6-8], model D was furthermore adjusted for the occurrence of CI-AKI. An addition of CI-AKI to the covariates only mildly affected the independent association between plasma kynurenine and MAKE.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, due to technical improvements, many patients undergoing CM interventions are likely to be discharged within 24 hours, complicating an assessment of plasma creatinine concentrations for more than 24 hours after CM exposure [5]. Most patients who experienced CI-AKI usually display a partial or complete recovery of kidney function by the time of hospital discharge [6], but several recent cohort studies have shown that CI-AKI is associated with long-term loss of kidney function, cardiovascular events, and death [6-8]. There is increasing consensus that ultimate clinical outcomes should be moved in the focus of studies investigating contrast media associated nephrotoxicity [9].…”

Section: Introductionmentioning

confidence: 99%

Pre-Interventional Kynurenine Predicts Medium-Term Outcome after Contrast Media Exposure Due to Coronary Angiography

Reichetzeder

Heunisch

Einem

et al. 2017

Kidney Blood Press Res

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Background/Aims: Contrast induced acute kidney injury (CI-AKI) remains a serious complication of contrast media enhanced procedures like coronary angiography. There is still a lack of established biomarkers that help to identify patients at high risk for short and long-term complications. The aim of the current study was to evaluate plasma kynurenine as a predictive biomarker for CI-AKI and long-term complications, measured by the combined endpoint "major adverse kidney events" (MAKE) up to 120 days after CM application. Methods: In this prospective cohort study 245 patients undergoing coronary angiography were analyzed. Blood samples were obtained at baseline, 24h and 48h after contrast media (CM) application to diagnose CI-AKI. Patients were followed for 120 days for adverse clinical events including death, the need for dialysis, and a doubling of plasma creatinine. Occurrence of any of these events was summarized in the combined endpoint MAKE. Results: Preinterventional plasma kynurenine was not associated with CI-AKI. Patients who later developed MAKE displayed significantly increased preinterventional plasma kynurenine levels (p<0.0001). ROC analysis revealed that preinterventional kynurenine is highly predictive for MAKE (AUC=0.838; p<0.0001). The optimal cutoff was found at ≥3.5 µmol/L Using this cutoff, the Kaplan-Meier estimator demonstrated that concentrations of plasma kynurenine ≥3.5 µmol/L were significantly associated with a higher prevalence of MAKE until follow up (p<0.0001). This association remained significant in multivariate Cox regression models adjusted for relevant factors of long-term renal outcome. Conclusion: Preinterventional plasma kynurenine might serve as a highly predictive biomarker for MAKE up to 120 days after coronary angiography.

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“…12,13 CIN is associated with risk of end-stage renal failure, worse clinical outcomes including prolonged hospitalization, increased cost, revascularization, and mortality. 14,15 Recent studies have extended these associations between CIN and cardiovascular diseases. 16,17 Patients who were experienced chronic kidney disease and diabetes mellitus and age over 75 are found to be the most important risk factors for CIN.…”

Section: Introductionmentioning

confidence: 97%

Perkütan Koroner Girişim Yapılan Koroner Yavaş Akım Olgularında, Serum Urotensin II Düzeyi ve Kontrast Kaynaklı Nefropati Gelişimi ile Bir Yıllık Klinik Takip Bulguları Arasındaki İlişki

Huyut¹

2019

Sakarya Medical Journal

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Objective Coronary slow-reflow phenomenon (CSFP) and Contrast-Induced Nephropathy (CIN) are associated with an increased risk of major cardiovascular adverse events. This study aimed to evaluate the relationship between serum Urotensin II molecule (U-II) levels and CIN in patients with CSFP undergoing percutaneous coronary intervention (PCI). ( Sakarya Med J 2019, 9(3):442-454 ). Materials and MethodsWe enrolled 227 patients (161 male and 66 female; mean age: 61,44 ± 12,44 years) with angiographically diagnosed CSFP. The patients were divided into two groups according to CIN development (Non-CIN (n=206) and CIN group (n=21)).Results CIN was observed in 9,25%(n=21) of the CSFP patients. Serum U-II level was significantly higher in CIN group than in non-CIN group (6,79±2,20 vs. 3,00±1,29, p<0,001).One year clinical follow-up findings including all-cause mortality (7(33,30%) vs. 24(11,70%), p=0,013), cardiovascular death(7(33,30%) vs. 18(8,70%), p=0,003) and Major Adverse cardiovascular events (MACE) (10(47,60%) vs. 46(22,40%), p=0,011) were significantly higher in CIN group. We also performed forward conditional logistic regression analysis and found that U-II (Odds ratio (OR)=3,983; 95% confidence interval (CI): 2,25 to 7,052; p <0,001) and Mehran score (OR=1,228, 95% CI: 1,083-1,393, p=0,001) were independently predicted CIN development, in patients with CSFP.Conclusion Baseline serum U-II concentrations and higher Mehran scores are independently associated with CIN in CSFP patients. One-year clinical follow-up findings including all-cause mortality, cardiovascular death and MACE were significantly higher in CIN group, but stroke and myocardial infarction rates were similar in both groups. ÖzAmaç Koroner yavaş akım fenomeni (CSFP) ve kontrast kaynaklı nefropati (CIN), artmış major advers kardiyovasküler olay ile ilişkilidir. Bu çalışmada, CSFP'li perkütan koroner girişim (PCI) yapılan hastalarda, serum ürotensin II (U-II) düzeyi ile CIN arasındaki ilişkiyi değerlendirmeyi amaçladık. ( Sakarya Tıp Dergisi 2019, 9(3):442-454 ) Gereç ve YöntemlerAnjiyografik olarak CSFP tanısı almış 227 hasta (161 erkek, 66 kadın; ortalama yaş 61,44±12,44) çalışmaya alındı. Hastalar CIN gelişmesine (CIN olmayan (n = 206) ve CIN grubu (n = 21)) göre iki gruba ayrıldı.Bulgular CSFP hastalarının %9,25'inde (n=21) CIN gözlendi. Serum U-II düzeyi, CIN grubunda CIN olmayan gruba göre anlamlı derecede yüksek saptandı (6,79±2,20 vs. 3,00±1,29, p<0,001). Tüm nedenlere bağlı mortalite (7(%33,30) vs. 24(%11,70), p=0,013), kardiyovasküler ölüm (7(%33,30) vs. 18(%8,70), p=0,003) ve major advers kardiyovasküler olay (MACE) (10(%47,60) vs. 46(%22,40), p=0,011) CIN grubunda anlamlı derecede yüksek saptandı. Ayrıca çalışmamızda ileri koşullu lojistik regresyon analizi yapıldı ve CSFP'li hastalarda CIN gelişimininin bağımsız öngördürücülerinin, yüksek serum U-II konsantrasyonları (Odss oranı(OR)=3,983; %95 güven aralığı(CI):2,25-7,052; p<0,001) ve yüksek Mehran skoru (OR=1,228, %95 CI: 1,083-1,393, p=0,001) olduğu saptandı. Sonuç Yaptığımız çalışma...

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Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease

Abstract: Exposure to iodinated contrast media during endovascular procedures for symptomatic PAD frequently results in CIN. Patients with CIN are at increased risk of long-term loss of renal function, cardiovascular events, and death.

Cited by 34 publications

References 14 publications

Contrast-induced acute kidney injury: A review of practical points

Contrast-induced acute kidney injury: A review of practical points

Pre-Interventional Kynurenine Predicts Medium-Term Outcome after Contrast Media Exposure Due to Coronary Angiography

Perkütan Koroner Girişim Yapılan Koroner Yavaş Akım Olgularında, Serum Urotensin II Düzeyi ve Kontrast Kaynaklı Nefropati Gelişimi ile Bir Yıllık Klinik Takip Bulguları Arasındaki İlişki

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