Contrast-induced acute kidney injury(CI-AKI)is a major concern in clinical practice,particularly among high-risk patients with preexisting renal and cardiovascular conditions.Although periprocedural hydration has long...Contrast-induced acute kidney injury(CI-AKI)is a major concern in clinical practice,particularly among high-risk patients with preexisting renal and cardiovascular conditions.Although periprocedural hydration has long been the primary approach for CI-AKI prevention,recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems.This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention.By incorporating the latest evidence into clinical practice,health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.展开更多
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 lo...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 in the field of CI-AKI prevention,clinical practice is based mostly on periprocedural hydration.In this review,all the investigated methods of prevention are presented,with an emphasis on the latest evidence regarding the potential of RenalGuard and contrast removal systems for CI-AKI prevention in high-risk individuals.展开更多
Objective:To explore the efficacy and potential mechanisms of the ethanol extract of Abelmoschus manihot(L.)Medic in contrast-induced nephropathy(CIN).Methods:CIN rat models and human renal proximal tubular cells(HK-2...Objective:To explore the efficacy and potential mechanisms of the ethanol extract of Abelmoschus manihot(L.)Medic in contrast-induced nephropathy(CIN).Methods:CIN rat models and human renal proximal tubular cells(HK-2)with iopromide-induced injury were employed to mimic CIN conditions.The effect of Abelmoschus manihot extract on the rat models and HK-2 cells was evaluated.In rat models,kidney function,histology,oxidative stress and apoptosis were determined.In HK-2 cells,cell viability,apoptosis,mitochondrial membrane potential,and endoplasmic reticulum stress were assessed.Results:Abelmoschus manihot extract significantly improved structural and functional impairments in the kidneys of CIN rats.Additionally,the extract effectively mitigated the decline in cellular viability and reduced iopromide-induced oxidative stress and lipid peroxidation.Mechanistic investigations revealed that Abelmoschus manihot extract prominently attenuated acute endoplasmic reticulum stress-mediated apoptosis by downregulating GRP78 and CHOP protein levels.Conclusions:Abelmoschus manihot extract can be used as a promising therapeutic and preventive agent in the treatment of CIN.展开更多
OBJECTIVE： To study the preventative effects of Dongchongxiacao （Cordyceps） on contrast-induced nephropathy （CIN） in patients with stable angina pectoris （SAP）. METHODS： One-hundred and three SAP inpatients we...OBJECTIVE： To study the preventative effects of Dongchongxiacao （Cordyceps） on contrast-induced nephropathy （CIN） in patients with stable angina pectoris （SAP）. METHODS： One-hundred and three SAP inpatients were divided randomly into two groups： basic treat- ment （n=51） and Dongchongxiacao （Cordyceps） treatment （n=52）; corbrin capsules （3 g; t.d.s.） were used 3 days before angioplasty and 3 days after an- gioplasty）. Serum creatinine （Scr） was assessed at the time of hospital admission and 1, 2, and 3 days after angioplasty. Values of kidney injury mole- cule-1 （KIM-1）, neutrophil gelatinase-associated li- pocalin （NGAL） and interleukin （IL） 18 in the kidney were detected before angioplasty and 1 day after angioplasty in the patients of both groups. The prevalence of CIN between the two groups was then compared. RESULTS： CIN occurred in 9 of 103 patients （8.74%）. The prevalence of CIN in the Dongchongxiacao （Cordyceps） treatment group was lower than that of the basic treatment group （5.77% vs 11.76%） but the difference was not significant （P〉0.05）. The post-procedure mean peak of Scr, post-procedure increase in Scr levels from baseline, and urine levelsof KIM-1, NGAL and IL18 after the procedure in the Dongchongxiacao （Corclyceps） treatment group were significantly lower than those in the basic treatment group （P〈0.05）. CONCLUSION： Prophylactic treatment with Dongchongxiacao （Cordyceps） in SAP patients who undergo coronary angiography or coronary inter- vention could prevent contrast-induced renal im- pairment.展开更多
Contrast-induced acute kidney injury(CI-AKI) is oneof 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 ...Contrast-induced acute kidney injury(CI-AKI) is oneof 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 contrastenhanced 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.展开更多
OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A t...OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rate(e GFR) was ≤ 60 m L/minee grou·1.73 m2,were divided randomly into thrps,basic treatment group(n = 41),standard DCXC therapy group(n = 39,2-g corbrin capsules,3 times/d,3 days before and after angiography),and intensive DCXC therapy group(n = 40,3-g corbrin capsules,3 times/d,3 days before and after angiography). Serum creatinine(Scr)and e GFR were assessed at the time of admission to hospital,and on days 1,2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipocalin(NGAL),kidney injury molecule-1(KIM-1) and interleukin-18(IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in e GFR.RESULTS: CIN occurred in 11 of 120 patients(9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group(P < 0.05),with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group(P < 0.01). Compared with the basic treatment group,a lower proportion of patients in the DCXC treatment groups had an e GFR decrease of 25% or greater(P < 0.05); patients with an e GFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group(P < 0.01). Within 1 day of the procedure,urine levels of KIM-1,NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group(P < 0.05).CONCLUSION: DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography,with intensive DCXC therapy being more effective.展开更多
Background:None of study mentioned about contrast-induced acute kidney injury(CI-AKI)in people who have received contrast agents twice within in a short period of time.This study is trying to identify the predictors.M...Background:None of study mentioned about contrast-induced acute kidney injury(CI-AKI)in people who have received contrast agents twice within in a short period of time.This study is trying to identify the predictors.Methods:We enrolled 607 patients between Oct.2010 and Jul.2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region.The primary outcome was CI-AKI within 72 h after contrast agent exposure.Patients were divided into groups A(n=559)and group B(n=48)according to whether CI-AKI occurred after the second agent.Results:Patients in group B(CI-AKI occurred after the second agent)had a more rapid heart rate and more usage of diuretics and digitalis.In group B,CI-AKI occurred more frequently after the first agent.Multivariate logistic regression showed that diuretic(P=0.006)and intra-aortic balloon pump(IABP)usage(P=0.012)were independent predictors of CI-AKI after the first agent.Angiotensin-converting enzyme inhibitor/AngiotensinⅡreceptor antagonist(ACEI/ARB)usage(P=0.039),IABP usage(P=0.040)and CI-AKI occurring after administration of the first agent(P=0.015)were independent predictors of CI-AKI after the second.Furthermore,dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1–3 days after the first exposure than within 4–6 days(12.4%vs.5.0%,P=0.008)or≥7 days(12.4%vs.6.4%,P=0.039).Conclusions:Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent.The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure,ACEI/ARB usage,and IABP usage.More importantly,a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.展开更多
AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Re...AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a randomeffects model to estimate the incidence of CIAKI.RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6%(95%CI: 4.5%-16.3%) and 0.4%(95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0%(95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1%(95%CI: 6.6%-28.4%), 10.1%(95%CI: 4.2%-18.0%), and 6.1%(95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.展开更多
Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred s...Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred seventy-nine patients with T2DM undergonging elective cardiac catheterization from Dongguan Kanghua Hospital were recruited. Patients were classified into quartiles based on HbAlc （ 〈 6.30%, 6.30- 6.70%, 6.71-7.70, and 〉 7.70%）. Baseline data, CI-AKI incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between HbAlc and CI-AKI. Results CI-AKI occurred in 26 （9.3%）patients. CI-AKI incidences of HbAlc quartiles were 4.6 %（3/65）, 2.8%（2/71）, 12.3%（9/73） and 17.1%（12/70） （P = 0.003）, respectively. There were no significant differences in in-hospital death or required renal replacement therapy among the four groups. Univariate logistic analysis showed that HbAlc was related with CI-AKI （OR = 1.319, 95%CI： 1.078-1.615, P = 0.007）. Multivariate analysis found that after adjusting eGFR 〈 60 ml/min/1.73 m2, age 〉 70 years and anemia, I-IbAlc 〉17% was still a significant independent risk factor for CI-AKI in patients with T2DM. Conclusions HbAlc is significantly associated with CI-AKI. HbAlc ≥ 7% may increase the risk of CI-AKI in patients with T2DM undergoing elective cardiac catheterization.展开更多
Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharm...Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.展开更多
Background Contrast-induced nephropathy(CIN)is a frequent and serious complication in ST-elevation myocardial infarction(STEMI)patients undergoing percutaneous coronary intervention(PCI). However,there is no consensus...Background Contrast-induced nephropathy(CIN)is a frequent and serious complication in ST-elevation myocardial infarction(STEMI)patients undergoing percutaneous coronary intervention(PCI). However,there is no consensus on the best definition of CIN in order to identify patients at risk. Methods In this retrospective,observational study,all patients with STEMI referred for PCI were included. The relationship between different CIN definitions and adverse events were analyzed. Results Totally 492 patients were enrolled. The incidence rate of CIN varied according to different definitions:10.4% when defined as an absolute increase in SCr≥0.5 mg/d L while 24.2% as elevation of SCr by 25%. In-hospital MACEs rate was significantly higher in SCr≥0.5 mg/d L(54.9% vs. 31.3%,P=0.003). Multivariate analysis showed that CIN defined as an absolute increase of SCr≥0.5 mg/d L(OR=5.03,P<0.001)or elevations of SCr by 25%(OR=2.71,P=0.003)was a strong significant predictor of in-hospital MACEs. Kaplan-Meier analysis showed that cumulative long-term survival rate was significantly lower in patients with an absolute increase in SCr≥0.5 mg/d L(Log-rank=60.84,P<0.001)or elevation of SCr by 25%(Log-rank=15.66,P<0.001). Conclusion CIN is a frequent and serious complication of STEMI treated by PCI. The definition by absolute increase of SCr≥0.5 mg/d L is better in identifying patients with CIN at high risk of poor outcomes.[S Chin J Cardiol 2019;20(3):163-167]展开更多
We report a case of contrast-induced encephalopathy after endovascular embolization of an anterior communicating artery aneurysm.A 59-year-old woman was admitted to Tongliao Hospital for neurointerventional treatment ...We report a case of contrast-induced encephalopathy after endovascular embolization of an anterior communicating artery aneurysm.A 59-year-old woman was admitted to Tongliao Hospital for neurointerventional treatment due to a left anterior communicating artery aneurysm.She had a history of hypertension,which was controlled by regular medication.The contraindications were eliminated following a preoperative examination,and head computed tomography(CT)showed no abnormalities.After evaluation,interventional embolization was performed.Three hours postoperatively,the patient complained of a headache on the right side,which was accompanied by frequent nausea.Emergency head CT showed no intracranial hemorrhage,obvious brain tissue edema in the right cerebral hemisphere,blurred sulcus/gyrus,or metal artifacts(spring coils)in the left frontal lobe.The patient was diagnosed with contrast-induced encephalopathy(CIE).This patient achieved good prognosis through timely and reasonable treatment.CIE is very rare clinically,improper treatment may lead to irreversible clinical outcomes;it should cause alarm to doctors.展开更多
The volume of contrast media to the creatinine clearance （V/CrCl） ratio correlate with the contrast-induced nephropathy （CIN）. The chronic kidney disease （CKD） more likely to develop CIN after primary percutaneo...The volume of contrast media to the creatinine clearance （V/CrCl） ratio correlate with the contrast-induced nephropathy （CIN）. The chronic kidney disease （CKD） more likely to develop CIN after primary percutaneous coronary intervention （PCI）. Objectiv has been shown to patients would be e To determine a relatively safe V/CrCl cutoff value to avoid CIN in CKD patients undergoing primary PCI. Methods We enrolled a total of 114 patients with CKD and calculated V/CrCl. Receiver-operator characteristic methods were used to identify the optimal sensitivity and specificity for the observed range of V/CrCl for CIN. We used multivariable logistic regression to assess the predictive value of V/CrCl for the risk of CIN in CKD patients. Results Overall, there were 24 cases （21%） of CIN. The baseline mean and median V/CrCl values were significantly greater among patients with CIN （mean 5.08 ±2.01, median 4.81, and interquartile range 3.53-6.33） than among those without CIN （mean 3.35 ±1.48, median 3.12, and interquartile range 2.27-4.14, P 〈 0.001）. The receiveroperator characteristic curve analysis indicated that a V/CrCl ratio of 3.62 was a fair discriminator for CIN （Cstatistic of 0.75） in CKD patients. After adjusting for other known predictors of CIN,a V/CrCl ratio 〉3.62 remained significantly associated with CIN in CKD patients（odds ratio 8.46,95% confidence interval 2.37-30.19, P 〈 0.001）. medium dose Conclusions based on the AV/CrCl ratio〉3.62 is a simple,useful indicator for determining the safe contrast pre-PCI CrCl values in CKDs.展开更多
Background The relationship between contrast-induced acute kidney injury(CI-AKI)and long-term mortality of anemia patients still remain controversial.Previous researches indicated that inconsistent definition may cont...Background The relationship between contrast-induced acute kidney injury(CI-AKI)and long-term mortality of anemia patients still remain controversial.Previous researches indicated that inconsistent definition may contributed to this problem.Methods This study conducted a retrospective cohort study enrolling 5,406 patients with anemia undergoing coronary angiography or percutaneous coronary intervention between January 2007 and December 2018 in Guangdong Provincial People’s Hospital.The CI-AKI was evaluated according to two definitions:1.CI-AKIA:With a serum creatinine(SCr)elevation of 25%or 0.5 mg/d L from baseline in the first 72 hours after procedure;2:CI-AKIB:With a SCr elevation of 50%or 0.3 mg/d L from baseline in the first 72 hours after procedure.The endpoint was all-cause mortality.Univariable and multivariable Cox regression model were used to explore association between long-term all-cause mortality and CI-AKI.Population attributable risks(PARs)based on two different CI-AKI definitions for mortality were calculated.Results CI-AKIAwas associated with 1.36 fold risk of long-term death(HR:1.36,95%CI:1.18-1.57),while CI-AKIBwas associated with 1.32 fold risk of long-term death(HR:1.32,95%CI:1.13-1.54).Between two definitions,the prevalence of CI-AKI was higher for CI-AKIA(16.7%),compared with CI-AKIB(12.6%).For the PARs,PAR based on CI-AKIA(PAR:5.65,95%CI:2.91-8.67),was higher than that based on CI-AKIB(PAR:3.87,95%CI:1.61-6.36).Conclusions Patients complicated with CI-AKI had a higher risk of mortality than those without CI-AKI in all definitions.The prevalence and PAR of CI-AKI were higher when it was defined as CI-AKIA.CI-AKIAwas considered as a better definition to identify anemia patients with higher risk of CI-AKI and higher risk of CI-AKI-associated mortality.展开更多
Background Serum Klotho protein level is a novel marker for various types of renal injury. However, the association of Klotho protein with contrast-induced nephropathy（CIN） in patients with ST elevation myocardial i...Background Serum Klotho protein level is a novel marker for various types of renal injury. However, the association of Klotho protein with contrast-induced nephropathy（CIN） in patients with ST elevation myocardial infarction（STEMI） with percutaneous coronary intervention（PCI） is unclear. Methods According to predefined criteria, 143 STEMI patients undergoing PCI were included in this analysis. Clinical data were compared and multivariate logistic regression analysis was performed to detect the risk factors of CIN. Results24 patients were diagnosed with CIN（16.8%）. Serum Klotho protein level was significant lower in the CIN group（0.35 ± 0.16 vs. 0.47 ± 0.18, P = 0.004）. Multivariate logistic regression analysis showed that serum Klotho protein was independently associated with decreased risk of CIN（OR = 0.03, 95% CI： 0.00-0.57, P = 0.019）.Conclusions Serum Klotho protein may be a useful marker for diagnosis of CIN in patients with STEMI undergoing PCI.展开更多
Background Few studies have investigated the role of serum uric acid （SUA） on the risk of contrast-in- duced nephropathy（CIN） in patients with acute coronary syndrome （ACS） after emergent percutaneous coronary i...Background Few studies have investigated the role of serum uric acid （SUA） on the risk of contrast-in- duced nephropathy（CIN） in patients with acute coronary syndrome （ACS） after emergent percutaneous coronary intervention（PCI）. The present study was conducted to investigate the relationship between hyperuricemia （HUA） and CIN in patients after emergent PCI. Methods A total of 558 consecutive patients with ACS undergoing emergent PCI in Fujian Provincial Hospital were enrolled in this study. Patients were divided into hyperuricemic group （n=136） and normouricemic group （n=422）. Hyperuricemia was defined as SUA 〉420 μmol/L for male, 〉 360 txmol/L for female. CIN was defined as an absolute ≥44.2 μmol/L（0.5 mg/dL） increase inthe serum creati- nine （SCr） level within 72 hours after contrast medium exposure. In hospital incidences of CIN and the major adverse cardiac events were compared between the two groups. The relationship between the incidence of CIN and HUA was evaluated by multivariate logistic regression analysis. Results Among the 558 patients, CIN was observed in 34（6.1%） patients, and incidence of CIN was significantly higher in the HUA group than in the normou- ricemic group [13.2% （18/136） vs. 3.8%（16/422）, P 〈 0.001]. SUA concentration was significantly higher in CIN group compared with that in non - CIN group [ （490.21±76.48 μmol/L） vs. （307.00±65.37μmol/L）, P 〈 0.001]. Need for renal replacement therapy （RRT）, congestive heart failure （CHF）, in hospital mortality after PCI were significantly higher in the HUA group compared with Normouricemic group （all P〈0.05）. Patients who devel- oped CIN had higher in hospital mortality [44.1% （15/34） vs. 2.9 % （15/524）, P 〈 0.001 ]. Multivariate analysis in- dicates that HUA（OR=3.020, 95% CI： 1.3340- 6.805, P 〈 0.001）, Intra- aortic balloon pump （IABP） use （OR= 15.724,95% CI： 3.913-63.179, P 〈 0.001） and Perioperative hypotension（OR=3.342, 95% CI： 1.373-8.138, P 〈 0.01） were predictors of CIN in patients after emergent percutaneous coronary intervention. Conclusion Hyper- uricemia is the independent risk predictor of CIN in patients with ACS undergoing emergent PCI.展开更多
Background There were few studies to explore the relationship between postoperative mean systolic blood pressure （PMSBP） within 6 h after cardiac catheterization and contrast-induced nephropathy （CIN）. Methods Fr...Background There were few studies to explore the relationship between postoperative mean systolic blood pressure （PMSBP） within 6 h after cardiac catheterization and contrast-induced nephropathy （CIN）. Methods From June 2010 to February 2013, 299 consecutive patients undergoing cardiac catheterization were recruited. Patients were classified into quartiles based on PMSBP （ 〈 112, 112-120, 121-131, and 〉 132 mmHg）. Baseline data, CIN incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between PMSBP and CIN. Results CIN occurred in 26（8.7%） patients. The incidence of CIN in PMSBP quartiles were 15.3% （11/72）, 15.1% （11/73）, 2.4% （2/82） and 2.8% （2/72） （P = 0.001） respectively. There were no significant difference in in-hospital death, renal replacement therapy and intra-aortic balloon pump （IABP） support between the groups （P 〉 0.05）. Univariate logistic regression analysis showed that PMSBP was significantly associated with CIN （OR = 0.956, 95% CI： 0.928-0.986, P = 0.004）. Multivariate logistic regression analysis found that after adjusting baseline estimate glomerular filtration rate, age 〉 75 years and acute myocardial infarction, PMSBP 〈 120 mmHg was still an independent risk factor for CIN （OR = 5.049, 95% CI： 1.820-14.009, P = 0.002）. Conclusions Lower PMSBP was significantly associated with an increased risk of CIN. PMSBP 〈 120 mmHg was an independent risk factor for CIN. Intensive blood-pressure control after cardiac catheterization might increase the risk of CIN.展开更多
Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy（CIN） in patients with STelevat...Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy（CIN） in patients with STelevation myocardial infarction（STEMI） and non-STEMI（NSTEMI）. However, the relationship between SYNTAX score and CIN of patients with CTO undergoing PCI has been unclear. Methods We retrospectively enrolled 667 patients with CTO who underwent our institution′s basic PCI protocol between January 2010 and September 2012. The patients were divided into 3 groups： a low-risk group（SYNTAX score 〈 23; n = 231）, a moderate-risk group（SYNTAX score = 23-32; n = 214）, and a high-risk group（SYNTAX score〉32; n = 222）. CIN was defined as an absolute increase in SCr of ≥ 0.5 mg/d L over baseline values within 48-72 h after administration of contrast medium. We observed the correlation between SYNTAX score and the CIN rates. Results CIN developed in 74（11.09%） of the 667 study patients. The CIN rate showed a positive trend in the 3 groups based on the SYNTAX score, the higher SYNTAX score corresponds to the higher incidence of CIN（6.93%,13.08%,13.51%P = 0.044）. In the multivariate analysis, SYNTAX score was identified as an independent predictor of CIN（OR：1.956,95% CI： 1.014-3.773; P = 0.045; OR： 1.942,95% CI： 1.005-3.752; P = 0.048）. The incidence of in-hospital（1.3% vs. 4, 21% vs. 5.86%, P = 0.035） and long-term MACE（4.59% vs. 7.88% vs. 11.66%, P = 0.046） rates were more frequent in the higner SYNTAX score groups. Conclusions SYNTAX score is an independent predictor of CIN among patients with CTO undergoing PCI.展开更多
Background Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy （CIN） in patients with chronic kidney disease （CKD）. However, there is no well-defined protocol r...Background Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy （CIN） in patients with chronic kidney disease （CKD）. However, there is no well-defined protocol regarding the optimal rate and duration of normal saline administration. Methods Patients with CKD （estimated glomerular filtration rate [eGFR] 〈60 mL/min/1.73 m^2） undergoing PCI with hydration at the speed recommend-ed by the current guidelines （1 mL/kg/h [0.5 ml/kg/h for left ventricular ejection fraction 〈40% or severe conges-tive heart failure]） were included in the study （n=631）. CIN was defined as an increase in serum creatinine of I〉 0.5 mg/dL or 25% from the baseline within 48-72 hours after contrast exposure. Results Individuals with high-er adequate hydration （HV/W ratios） were more likely to develop CIN （Q1, Q2, Q3, and Q4： 6.33%, 18.4%, 12.5%, and 21.52%, respectively; P=0.001）, acute heart failure （5.7%, 6.13%, 9.21%, and 13.92%, respectively; P=0.035）. Multivariate analyses showed that higher hydration volume was not significantly associated with a re-duced risk of CIN （HV/W ratio Q2 vs. QI： odds ratio [OR]： 2.36, 95% confidence interval [CI]： 1.08-5.16; Q3 vs. QI： OR： 1.47, 95% CI： 0.63-3.4; Q4 vs. QI：OR： 2.32, 95% CI： 1.05-5.11）. Conclusion Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with CKD undergoing PCI.intravascular hydration volume at routine speed may not decrease the risk of CIN in patients with chronic kidney disease Undergoing percutaneous coronary intervention.展开更多
Background Data are limited regarding the risk of contrast-induced nephropathy （CIN） for patients after the second contrast exposure. Objective To examine the risk of CIN after the second contrast exposure in patien...Background Data are limited regarding the risk of contrast-induced nephropathy （CIN） for patients after the second contrast exposure. Objective To examine the risk of CIN after the second contrast exposure in patients of acute coronary syndrome （ACS） with chronic kidney disease （CKD）. Methods Patients of ACS scheduled for a second elective PCI. Patients were required to have an estimated creatinine clearance （CrCl） between 15 and 60 ml/min. The value of serum creatinin （sCr） prior to the second contrast exposure must not be ≥ 25% or ≥ 88.4 μmol/L compared to baseline. CIN was defined as an increase of sCr ≥ 25% from baseline within 45-72h after the second contrast exposure. The primary end-point was risk of developing CIN. Results Thirty-nine patients completed the study. The average of interval between contrast exposures was 116 ± 64 h, contrast volume was 266 ± 100 mL and length of hospitalization was 8.3 ± 4.7 days. The incidence of CIN in the overall study population was 10.3%. There was not change significantly in average sCr and CrC1 after the second contrast exposure （sCr 1.52±0.62 vs. 1.54 ± 0.60 mg/dL baseline, P = 0.75; CrC1 （40.68 ± 14.46 vs. 39.16 ± 12.10 mL/min baseline, P = 0.26）. None of the patient was death in 30 days. One （2.6%） of the patients who developed CIN required dialysis in-hospital. Conclusion Our findings suggest that patients with prior renal dysfunction are not increased risk of developing CIN after the second contrast exposure. This cohort may be benefit from sufficient prophylaxis.展开更多
文摘Contrast-induced acute kidney injury(CI-AKI)is a major concern in clinical practice,particularly among high-risk patients with preexisting renal and cardiovascular conditions.Although periprocedural hydration has long been the primary approach for CI-AKI prevention,recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems.This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention.By incorporating the latest evidence into clinical practice,health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.
文摘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 in the field of CI-AKI prevention,clinical practice is based mostly on periprocedural hydration.In this review,all the investigated methods of prevention are presented,with an emphasis on the latest evidence regarding the potential of RenalGuard and contrast removal systems for CI-AKI prevention in high-risk individuals.
基金supported by the National Natural Science Foundation of China(No.81973762).
文摘Objective:To explore the efficacy and potential mechanisms of the ethanol extract of Abelmoschus manihot(L.)Medic in contrast-induced nephropathy(CIN).Methods:CIN rat models and human renal proximal tubular cells(HK-2)with iopromide-induced injury were employed to mimic CIN conditions.The effect of Abelmoschus manihot extract on the rat models and HK-2 cells was evaluated.In rat models,kidney function,histology,oxidative stress and apoptosis were determined.In HK-2 cells,cell viability,apoptosis,mitochondrial membrane potential,and endoplasmic reticulum stress were assessed.Results:Abelmoschus manihot extract significantly improved structural and functional impairments in the kidneys of CIN rats.Additionally,the extract effectively mitigated the decline in cellular viability and reduced iopromide-induced oxidative stress and lipid peroxidation.Mechanistic investigations revealed that Abelmoschus manihot extract prominently attenuated acute endoplasmic reticulum stress-mediated apoptosis by downregulating GRP78 and CHOP protein levels.Conclusions:Abelmoschus manihot extract can be used as a promising therapeutic and preventive agent in the treatment of CIN.
文摘OBJECTIVE： To study the preventative effects of Dongchongxiacao （Cordyceps） on contrast-induced nephropathy （CIN） in patients with stable angina pectoris （SAP）. METHODS： One-hundred and three SAP inpatients were divided randomly into two groups： basic treat- ment （n=51） and Dongchongxiacao （Cordyceps） treatment （n=52）; corbrin capsules （3 g; t.d.s.） were used 3 days before angioplasty and 3 days after an- gioplasty）. Serum creatinine （Scr） was assessed at the time of hospital admission and 1, 2, and 3 days after angioplasty. Values of kidney injury mole- cule-1 （KIM-1）, neutrophil gelatinase-associated li- pocalin （NGAL） and interleukin （IL） 18 in the kidney were detected before angioplasty and 1 day after angioplasty in the patients of both groups. The prevalence of CIN between the two groups was then compared. RESULTS： CIN occurred in 9 of 103 patients （8.74%）. The prevalence of CIN in the Dongchongxiacao （Cordyceps） treatment group was lower than that of the basic treatment group （5.77% vs 11.76%） but the difference was not significant （P〉0.05）. The post-procedure mean peak of Scr, post-procedure increase in Scr levels from baseline, and urine levelsof KIM-1, NGAL and IL18 after the procedure in the Dongchongxiacao （Corclyceps） treatment group were significantly lower than those in the basic treatment group （P〈0.05）. CONCLUSION： Prophylactic treatment with Dongchongxiacao （Cordyceps） in SAP patients who undergo coronary angiography or coronary inter- vention could prevent contrast-induced renal im- pairment.
文摘Contrast-induced acute kidney injury(CI-AKI) is oneof 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 contrastenhanced 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.
文摘OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rate(e GFR) was ≤ 60 m L/minee grou·1.73 m2,were divided randomly into thrps,basic treatment group(n = 41),standard DCXC therapy group(n = 39,2-g corbrin capsules,3 times/d,3 days before and after angiography),and intensive DCXC therapy group(n = 40,3-g corbrin capsules,3 times/d,3 days before and after angiography). Serum creatinine(Scr)and e GFR were assessed at the time of admission to hospital,and on days 1,2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipocalin(NGAL),kidney injury molecule-1(KIM-1) and interleukin-18(IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in e GFR.RESULTS: CIN occurred in 11 of 120 patients(9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group(P < 0.05),with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group(P < 0.01). Compared with the basic treatment group,a lower proportion of patients in the DCXC treatment groups had an e GFR decrease of 25% or greater(P < 0.05); patients with an e GFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group(P < 0.01). Within 1 day of the procedure,urine levels of KIM-1,NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group(P < 0.05).CONCLUSION: DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography,with intensive DCXC therapy being more effective.
基金supported by Chinese Medical Doctor Association Discovery-Fund Project,Grant/Award Number(DFCMDA201417)National Basic Research Program of China,Grant/Award Number(2012CB517804)。
文摘Background:None of study mentioned about contrast-induced acute kidney injury(CI-AKI)in people who have received contrast agents twice within in a short period of time.This study is trying to identify the predictors.Methods:We enrolled 607 patients between Oct.2010 and Jul.2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region.The primary outcome was CI-AKI within 72 h after contrast agent exposure.Patients were divided into groups A(n=559)and group B(n=48)according to whether CI-AKI occurred after the second agent.Results:Patients in group B(CI-AKI occurred after the second agent)had a more rapid heart rate and more usage of diuretics and digitalis.In group B,CI-AKI occurred more frequently after the first agent.Multivariate logistic regression showed that diuretic(P=0.006)and intra-aortic balloon pump(IABP)usage(P=0.012)were independent predictors of CI-AKI after the first agent.Angiotensin-converting enzyme inhibitor/AngiotensinⅡreceptor antagonist(ACEI/ARB)usage(P=0.039),IABP usage(P=0.040)and CI-AKI occurring after administration of the first agent(P=0.015)were independent predictors of CI-AKI after the second.Furthermore,dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1–3 days after the first exposure than within 4–6 days(12.4%vs.5.0%,P=0.008)or≥7 days(12.4%vs.6.4%,P=0.039).Conclusions:Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent.The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure,ACEI/ARB usage,and IABP usage.More importantly,a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.
文摘AIM To evaluate the incidence of contrast-induced acute kidney injury(CIAKI) in kidney transplant recipients. METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a randomeffects model to estimate the incidence of CIAKI.RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6%(95%CI: 4.5%-16.3%) and 0.4%(95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0%(95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1%(95%CI: 6.6%-28.4%), 10.1%(95%CI: 4.2%-18.0%), and 6.1%(95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.
文摘Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred seventy-nine patients with T2DM undergonging elective cardiac catheterization from Dongguan Kanghua Hospital were recruited. Patients were classified into quartiles based on HbAlc （ 〈 6.30%, 6.30- 6.70%, 6.71-7.70, and 〉 7.70%）. Baseline data, CI-AKI incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between HbAlc and CI-AKI. Results CI-AKI occurred in 26 （9.3%）patients. CI-AKI incidences of HbAlc quartiles were 4.6 %（3/65）, 2.8%（2/71）, 12.3%（9/73） and 17.1%（12/70） （P = 0.003）, respectively. There were no significant differences in in-hospital death or required renal replacement therapy among the four groups. Univariate logistic analysis showed that HbAlc was related with CI-AKI （OR = 1.319, 95%CI： 1.078-1.615, P = 0.007）. Multivariate analysis found that after adjusting eGFR 〈 60 ml/min/1.73 m2, age 〉 70 years and anemia, I-IbAlc 〉17% was still a significant independent risk factor for CI-AKI in patients with T2DM. Conclusions HbAlc is significantly associated with CI-AKI. HbAlc ≥ 7% may increase the risk of CI-AKI in patients with T2DM undergoing elective cardiac catheterization.
文摘Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.
文摘Background Contrast-induced nephropathy(CIN)is a frequent and serious complication in ST-elevation myocardial infarction(STEMI)patients undergoing percutaneous coronary intervention(PCI). However,there is no consensus on the best definition of CIN in order to identify patients at risk. Methods In this retrospective,observational study,all patients with STEMI referred for PCI were included. The relationship between different CIN definitions and adverse events were analyzed. Results Totally 492 patients were enrolled. The incidence rate of CIN varied according to different definitions:10.4% when defined as an absolute increase in SCr≥0.5 mg/d L while 24.2% as elevation of SCr by 25%. In-hospital MACEs rate was significantly higher in SCr≥0.5 mg/d L(54.9% vs. 31.3%,P=0.003). Multivariate analysis showed that CIN defined as an absolute increase of SCr≥0.5 mg/d L(OR=5.03,P<0.001)or elevations of SCr by 25%(OR=2.71,P=0.003)was a strong significant predictor of in-hospital MACEs. Kaplan-Meier analysis showed that cumulative long-term survival rate was significantly lower in patients with an absolute increase in SCr≥0.5 mg/d L(Log-rank=60.84,P<0.001)or elevation of SCr by 25%(Log-rank=15.66,P<0.001). Conclusion CIN is a frequent and serious complication of STEMI treated by PCI. The definition by absolute increase of SCr≥0.5 mg/d L is better in identifying patients with CIN at high risk of poor outcomes.[S Chin J Cardiol 2019;20(3):163-167]
文摘We report a case of contrast-induced encephalopathy after endovascular embolization of an anterior communicating artery aneurysm.A 59-year-old woman was admitted to Tongliao Hospital for neurointerventional treatment due to a left anterior communicating artery aneurysm.She had a history of hypertension,which was controlled by regular medication.The contraindications were eliminated following a preoperative examination,and head computed tomography(CT)showed no abnormalities.After evaluation,interventional embolization was performed.Three hours postoperatively,the patient complained of a headache on the right side,which was accompanied by frequent nausea.Emergency head CT showed no intracranial hemorrhage,obvious brain tissue edema in the right cerebral hemisphere,blurred sulcus/gyrus,or metal artifacts(spring coils)in the left frontal lobe.The patient was diagnosed with contrast-induced encephalopathy(CIE).This patient achieved good prognosis through timely and reasonable treatment.CIE is very rare clinically,improper treatment may lead to irreversible clinical outcomes;it should cause alarm to doctors.
基金supported by Guangdong Provincial Cardiovascular Clinical Medicine Research Fund support.Guangzhou,China(2009X41)
文摘The volume of contrast media to the creatinine clearance （V/CrCl） ratio correlate with the contrast-induced nephropathy （CIN）. The chronic kidney disease （CKD） more likely to develop CIN after primary percutaneous coronary intervention （PCI）. Objectiv has been shown to patients would be e To determine a relatively safe V/CrCl cutoff value to avoid CIN in CKD patients undergoing primary PCI. Methods We enrolled a total of 114 patients with CKD and calculated V/CrCl. Receiver-operator characteristic methods were used to identify the optimal sensitivity and specificity for the observed range of V/CrCl for CIN. We used multivariable logistic regression to assess the predictive value of V/CrCl for the risk of CIN in CKD patients. Results Overall, there were 24 cases （21%） of CIN. The baseline mean and median V/CrCl values were significantly greater among patients with CIN （mean 5.08 ±2.01, median 4.81, and interquartile range 3.53-6.33） than among those without CIN （mean 3.35 ±1.48, median 3.12, and interquartile range 2.27-4.14, P 〈 0.001）. The receiveroperator characteristic curve analysis indicated that a V/CrCl ratio of 3.62 was a fair discriminator for CIN （Cstatistic of 0.75） in CKD patients. After adjusting for other known predictors of CIN,a V/CrCl ratio 〉3.62 remained significantly associated with CIN in CKD patients（odds ratio 8.46,95% confidence interval 2.37-30.19, P 〈 0.001）. medium dose Conclusions based on the AV/CrCl ratio〉3.62 is a simple,useful indicator for determining the safe contrast pre-PCI CrCl values in CKDs.
基金supported by Beijing Lisheng Cardiovascular Health Foundation Pilot Fund(No.LHJJ20141751)The National Science Foundation of China(No.81970311 and No.82070360)+1 种基金Study on the Function and Mechanism of the Potential Target for Early Warning of Cardio-renal Syndrome after Acute Myocardial Infarction Based on Translational Medicine(No.DFJH201919)Clinical Medicine Research Fund of Guangdong Province(No.2019ZX01)。
文摘Background The relationship between contrast-induced acute kidney injury(CI-AKI)and long-term mortality of anemia patients still remain controversial.Previous researches indicated that inconsistent definition may contributed to this problem.Methods This study conducted a retrospective cohort study enrolling 5,406 patients with anemia undergoing coronary angiography or percutaneous coronary intervention between January 2007 and December 2018 in Guangdong Provincial People’s Hospital.The CI-AKI was evaluated according to two definitions:1.CI-AKIA:With a serum creatinine(SCr)elevation of 25%or 0.5 mg/d L from baseline in the first 72 hours after procedure;2:CI-AKIB:With a SCr elevation of 50%or 0.3 mg/d L from baseline in the first 72 hours after procedure.The endpoint was all-cause mortality.Univariable and multivariable Cox regression model were used to explore association between long-term all-cause mortality and CI-AKI.Population attributable risks(PARs)based on two different CI-AKI definitions for mortality were calculated.Results CI-AKIAwas associated with 1.36 fold risk of long-term death(HR:1.36,95%CI:1.18-1.57),while CI-AKIBwas associated with 1.32 fold risk of long-term death(HR:1.32,95%CI:1.13-1.54).Between two definitions,the prevalence of CI-AKI was higher for CI-AKIA(16.7%),compared with CI-AKIB(12.6%).For the PARs,PAR based on CI-AKIA(PAR:5.65,95%CI:2.91-8.67),was higher than that based on CI-AKIB(PAR:3.87,95%CI:1.61-6.36).Conclusions Patients complicated with CI-AKI had a higher risk of mortality than those without CI-AKI in all definitions.The prevalence and PAR of CI-AKI were higher when it was defined as CI-AKIA.CI-AKIAwas considered as a better definition to identify anemia patients with higher risk of CI-AKI and higher risk of CI-AKI-associated mortality.
基金supported by the Natural Science Foundation of Guangdong Province(No2016A030313791)
文摘Background Serum Klotho protein level is a novel marker for various types of renal injury. However, the association of Klotho protein with contrast-induced nephropathy（CIN） in patients with ST elevation myocardial infarction（STEMI） with percutaneous coronary intervention（PCI） is unclear. Methods According to predefined criteria, 143 STEMI patients undergoing PCI were included in this analysis. Clinical data were compared and multivariate logistic regression analysis was performed to detect the risk factors of CIN. Results24 patients were diagnosed with CIN（16.8%）. Serum Klotho protein level was significant lower in the CIN group（0.35 ± 0.16 vs. 0.47 ± 0.18, P = 0.004）. Multivariate logistic regression analysis showed that serum Klotho protein was independently associated with decreased risk of CIN（OR = 0.03, 95% CI： 0.00-0.57, P = 0.019）.Conclusions Serum Klotho protein may be a useful marker for diagnosis of CIN in patients with STEMI undergoing PCI.
基金supported by the Youth project of Fujian provincial health and Family Planning Commission(No.2015-1-9)
文摘Background Few studies have investigated the role of serum uric acid （SUA） on the risk of contrast-in- duced nephropathy（CIN） in patients with acute coronary syndrome （ACS） after emergent percutaneous coronary intervention（PCI）. The present study was conducted to investigate the relationship between hyperuricemia （HUA） and CIN in patients after emergent PCI. Methods A total of 558 consecutive patients with ACS undergoing emergent PCI in Fujian Provincial Hospital were enrolled in this study. Patients were divided into hyperuricemic group （n=136） and normouricemic group （n=422）. Hyperuricemia was defined as SUA 〉420 μmol/L for male, 〉 360 txmol/L for female. CIN was defined as an absolute ≥44.2 μmol/L（0.5 mg/dL） increase inthe serum creati- nine （SCr） level within 72 hours after contrast medium exposure. In hospital incidences of CIN and the major adverse cardiac events were compared between the two groups. The relationship between the incidence of CIN and HUA was evaluated by multivariate logistic regression analysis. Results Among the 558 patients, CIN was observed in 34（6.1%） patients, and incidence of CIN was significantly higher in the HUA group than in the normou- ricemic group [13.2% （18/136） vs. 3.8%（16/422）, P 〈 0.001]. SUA concentration was significantly higher in CIN group compared with that in non - CIN group [ （490.21±76.48 μmol/L） vs. （307.00±65.37μmol/L）, P 〈 0.001]. Need for renal replacement therapy （RRT）, congestive heart failure （CHF）, in hospital mortality after PCI were significantly higher in the HUA group compared with Normouricemic group （all P〈0.05）. Patients who devel- oped CIN had higher in hospital mortality [44.1% （15/34） vs. 2.9 % （15/524）, P 〈 0.001 ]. Multivariate analysis in- dicates that HUA（OR=3.020, 95% CI： 1.3340- 6.805, P 〈 0.001）, Intra- aortic balloon pump （IABP） use （OR= 15.724,95% CI： 3.913-63.179, P 〈 0.001） and Perioperative hypotension（OR=3.342, 95% CI： 1.373-8.138, P 〈 0.01） were predictors of CIN in patients after emergent percutaneous coronary intervention. Conclusion Hyper- uricemia is the independent risk predictor of CIN in patients with ACS undergoing emergent PCI.
文摘Background There were few studies to explore the relationship between postoperative mean systolic blood pressure （PMSBP） within 6 h after cardiac catheterization and contrast-induced nephropathy （CIN）. Methods From June 2010 to February 2013, 299 consecutive patients undergoing cardiac catheterization were recruited. Patients were classified into quartiles based on PMSBP （ 〈 112, 112-120, 121-131, and 〉 132 mmHg）. Baseline data, CIN incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between PMSBP and CIN. Results CIN occurred in 26（8.7%） patients. The incidence of CIN in PMSBP quartiles were 15.3% （11/72）, 15.1% （11/73）, 2.4% （2/82） and 2.8% （2/72） （P = 0.001） respectively. There were no significant difference in in-hospital death, renal replacement therapy and intra-aortic balloon pump （IABP） support between the groups （P 〉 0.05）. Univariate logistic regression analysis showed that PMSBP was significantly associated with CIN （OR = 0.956, 95% CI： 0.928-0.986, P = 0.004）. Multivariate logistic regression analysis found that after adjusting baseline estimate glomerular filtration rate, age 〉 75 years and acute myocardial infarction, PMSBP 〈 120 mmHg was still an independent risk factor for CIN （OR = 5.049, 95% CI： 1.820-14.009, P = 0.002）. Conclusions Lower PMSBP was significantly associated with an increased risk of CIN. PMSBP 〈 120 mmHg was an independent risk factor for CIN. Intensive blood-pressure control after cardiac catheterization might increase the risk of CIN.
文摘Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy（CIN） in patients with STelevation myocardial infarction（STEMI） and non-STEMI（NSTEMI）. However, the relationship between SYNTAX score and CIN of patients with CTO undergoing PCI has been unclear. Methods We retrospectively enrolled 667 patients with CTO who underwent our institution′s basic PCI protocol between January 2010 and September 2012. The patients were divided into 3 groups： a low-risk group（SYNTAX score 〈 23; n = 231）, a moderate-risk group（SYNTAX score = 23-32; n = 214）, and a high-risk group（SYNTAX score〉32; n = 222）. CIN was defined as an absolute increase in SCr of ≥ 0.5 mg/d L over baseline values within 48-72 h after administration of contrast medium. We observed the correlation between SYNTAX score and the CIN rates. Results CIN developed in 74（11.09%） of the 667 study patients. The CIN rate showed a positive trend in the 3 groups based on the SYNTAX score, the higher SYNTAX score corresponds to the higher incidence of CIN（6.93%,13.08%,13.51%P = 0.044）. In the multivariate analysis, SYNTAX score was identified as an independent predictor of CIN（OR：1.956,95% CI： 1.014-3.773; P = 0.045; OR： 1.942,95% CI： 1.005-3.752; P = 0.048）. The incidence of in-hospital（1.3% vs. 4, 21% vs. 5.86%, P = 0.035） and long-term MACE（4.59% vs. 7.88% vs. 11.66%, P = 0.046） rates were more frequent in the higner SYNTAX score groups. Conclusions SYNTAX score is an independent predictor of CIN among patients with CTO undergoing PCI.
基金supported by Guangdong Cardiovascular Institute and the Guangdong Cardiovascular Institute's Guangdong Provincial Cardiovascular Clinical Medicine Research Fund(No.2009X41)the Science and Technology Project of Guangzhou City(No.2014Y2-00191)
文摘Background Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy （CIN） in patients with chronic kidney disease （CKD）. However, there is no well-defined protocol regarding the optimal rate and duration of normal saline administration. Methods Patients with CKD （estimated glomerular filtration rate [eGFR] 〈60 mL/min/1.73 m^2） undergoing PCI with hydration at the speed recommend-ed by the current guidelines （1 mL/kg/h [0.5 ml/kg/h for left ventricular ejection fraction 〈40% or severe conges-tive heart failure]） were included in the study （n=631）. CIN was defined as an increase in serum creatinine of I〉 0.5 mg/dL or 25% from the baseline within 48-72 hours after contrast exposure. Results Individuals with high-er adequate hydration （HV/W ratios） were more likely to develop CIN （Q1, Q2, Q3, and Q4： 6.33%, 18.4%, 12.5%, and 21.52%, respectively; P=0.001）, acute heart failure （5.7%, 6.13%, 9.21%, and 13.92%, respectively; P=0.035）. Multivariate analyses showed that higher hydration volume was not significantly associated with a re-duced risk of CIN （HV/W ratio Q2 vs. QI： odds ratio [OR]： 2.36, 95% confidence interval [CI]： 1.08-5.16; Q3 vs. QI： OR： 1.47, 95% CI： 0.63-3.4; Q4 vs. QI：OR： 2.32, 95% CI： 1.05-5.11）. Conclusion Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with CKD undergoing PCI.intravascular hydration volume at routine speed may not decrease the risk of CIN in patients with chronic kidney disease Undergoing percutaneous coronary intervention.
基金supported by Guangdong Provincial Cardiovascular Clinical Medicine Research Fund support.Guangzhou,China(2009X41)
文摘Background Data are limited regarding the risk of contrast-induced nephropathy （CIN） for patients after the second contrast exposure. Objective To examine the risk of CIN after the second contrast exposure in patients of acute coronary syndrome （ACS） with chronic kidney disease （CKD）. Methods Patients of ACS scheduled for a second elective PCI. Patients were required to have an estimated creatinine clearance （CrCl） between 15 and 60 ml/min. The value of serum creatinin （sCr） prior to the second contrast exposure must not be ≥ 25% or ≥ 88.4 μmol/L compared to baseline. CIN was defined as an increase of sCr ≥ 25% from baseline within 45-72h after the second contrast exposure. The primary end-point was risk of developing CIN. Results Thirty-nine patients completed the study. The average of interval between contrast exposures was 116 ± 64 h, contrast volume was 266 ± 100 mL and length of hospitalization was 8.3 ± 4.7 days. The incidence of CIN in the overall study population was 10.3%. There was not change significantly in average sCr and CrC1 after the second contrast exposure （sCr 1.52±0.62 vs. 1.54 ± 0.60 mg/dL baseline, P = 0.75; CrC1 （40.68 ± 14.46 vs. 39.16 ± 12.10 mL/min baseline, P = 0.26）. None of the patient was death in 30 days. One （2.6%） of the patients who developed CIN required dialysis in-hospital. Conclusion Our findings suggest that patients with prior renal dysfunction are not increased risk of developing CIN after the second contrast exposure. This cohort may be benefit from sufficient prophylaxis.
