Left Ventricular End-Diastolic Pressure Versus Urine Flow Rate–Guided Hydration in Preventing Contrast-Associated Acute Kidney Injury

Briguori, Carlo; D’Amore, Carmen; Micco, Francesca De; Signore, Nicola; Esposito, Giovanni; Visconti, Gabriella; Airoldi, Flavio; Signoriello, Giuseppe; Focaccio, Amelia

doi:10.1016/j.jcin.2020.04.051

Cited by 32 publications

(17 citation statements)

References 23 publications

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“…Briguori et al compared these two tailored hydration regimens in an RCT with 708 patients scheduled for coronary or peripheral angiography or angioplasty [ 113 ]. The total hydration volume was significantly higher in the UFR-guided group than in the LVEDP-guided group and UFR-guided hydration was superior to LVEDP-guided hydration in preventing CIN and 1-month major adverse events.…”

Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

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Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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“…The primary endpoint was CA-AKI, defined as an increase in the Scr level of >0.5 mg/dL or >25% from the baseline level within the first 48h after procedure. 11 The secondary endpoints were long-term all-cause mortality after admission (the median follow-up period was 6.1 years [interquartile range: 3.0–8.8]). Systemic immune-inflammation index (SII) was calculated as total platelets count× neutrophil-to-lymphocyte ratio.…”

Section: Methodsmentioning

confidence: 99%

Elevation of Preprocedural Systemic Immune Inflammation Level Increases the Risk of Contrast-Associated Acute Kidney Injury Following Coronary Angiography: A Multicenter Cohort Study

Lai¹,

Zhao²,

Huang³

et al. 2022

JIR

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Background Inflammation and immune responses play an important role in the pathophysiology of contrast-associated acute kidney injury (CA-AKI), and systemic immune inflammation index (SII) has recently emerged as a new parameter for immune and inflammatory response evaluation. However, limited research has been undertaken to explore the relationship between SII and CA-AKI following coronary angiography (CAG). Patients and Methods From January 2007 to December 2020, 46,333 patients undergoing CAG were included from 5 Chinese tertiary hospitals. SII was calculated as total peripheral platelets count × neutrophil-to-lymphocyte ratio. Patients were categorized by preprocedural SII quartiles: Q1 ≤404.5, Q2 >404.5 and ≤631.7, Q3 >631.7 and ≤1082.8, Q4 >1082.8. Univariable and multivariable logistic regression were used to reveal the link between preprocedural SII and CA-AKI. Results A total of the 46,333 patients (62.9 ± 11.5 years, female 28.1%) were included in the study. The incidence of CA-AKI was 8.4% in Q1 group, 8.7% in Q2 group, 9.4% in Q3 group, 15.1% in Q4 group. In the multivariable model, comparing the highest (Q4 group) to lowest (Q1 group) SII level categories, preprocedural SII was related to a higher risk of CA-AKI after fully adjusting for well-known confounders, and there was no statistically difference in the other two SII level categories (Q2 and Q3 groups) compared with Q1 group (adjusted model 3: Q2 group: OR: 0.98, 95% CI: 0.87–1.11, P = 0.771; Q3 group: OR: 1.04, 95% CI: 0.92–1.18, P = 0.553; Q4: OR: 1.65, 95% CI: 1.45–1.88, p < 0.001; P for trend < 0.001). Similar results were found for all the subgroups analysis except for patients undergoing PCI, and the interaction analyses for age, PCI and AMI were significant. In addition, Kaplan–Meier curves demonstrated that the lowest quartile group showed the worst all-cause mortality in a significant SII level-dependent manner among the four groups (Log rank test; p < 0.0001). Conclusion Elevated preprocedural SII level was a significant and independent risk factor for CA-AKI following CAG. Higher-quality prospective studies are needed to validate the predictive value of SII for CA-AKI.

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“…highlighted the superiority of RenalGuard system with a urine rate of over 300ml/hour compared to a LVEDP-guided hydration regimen, as demonstrated by a statistically significant decrease in CI-AKI incidence as well as reduced 1-month major adverse events (death, dialysis-dependent renal failure, pulmonary edema or sustained kidney injury) in patients undergoing coronary and peripheral vessel procedures [45]. Patients on RenalGuard exhibited a higher hypokalemia rate, however.…”

Section: Pharmacological Strategiesmentioning

confidence: 99%

Contemporary Modalities in the Prevention of Contrast-Induced Acute Kidney Injury

Theofilis¹,

Vordoni

2021

BJSTR

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Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of acute kidney injury deriving from the intravascular administration of contrast media in diagnostic and therapeutic procedures and leading to longer in-hospital stay and increased short and long-term mortality. Its pathophysiology, although not well-established, revolves around medullary hypoxia paired with the direct toxicity of the substance to the kidney. Critically ill patients, as well as those with pre-existing renal disease and cardiovascular comorbidities, are more susceptible to CI-AKI. Despite the continuous research on the field of CI-AKI prevention, clinical practice is based mostly on periprocedural hydration. In this review, all the investigated methods of prevention are being presented, with the potency of RenalGuard and contrast-removal systems being stressed as the method of choice for CI-AKI prevention in high-risk individuals.

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Left Ventricular End-Diastolic Pressure Versus Urine Flow Rate–Guided Hydration in Preventing Contrast-Associated Acute Kidney Injury

Cited by 32 publications

References 23 publications

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Elevation of Preprocedural Systemic Immune Inflammation Level Increases the Risk of Contrast-Associated Acute Kidney Injury Following Coronary Angiography: A Multicenter Cohort Study

Contemporary Modalities in the Prevention of Contrast-Induced Acute Kidney Injury

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