Ethanol extract of Abelmoschus manihot suppresses endoplasmic reticulum stress in contrast-induced nephropathy

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.

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Radiocontrast-induced nephropathy(RCIN) is an acute and severe complication after coronary angiography,particularly for patients with pre-existing chronic kidney disease(CKD).It has been associated with both short-and long-term adverse outcomes,including the need for renal replacement therapy,increased length of hospital stay,major cardiac adverse events,and mortality.RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25%above baseline within 48 h after contrast administration.There is no effective therapy once injury has occurred,therefore,prevention is the cornerstone for all patients at risk for acute kidney injury(AKI).There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes.The optimal strategy for preventing RCIN has not yet been established.This review discusses the principal risk factors for RCIN,evaluates and summarizes the evidence for RCIN prophylaxis,and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

Contrast Agents and Contrast-Induced Nephropathy

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.

Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy

BACKGROUND Contrast-induced nephropathy(CIN)is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material.CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12%of such cases.Risk factors for CIN development can be divided into patientand procedure-related.The former includes pre-existing chronic renal insufficiency and diabetes mellitus.The latter includes high contrast volume and repeated exposure over 72 h.The incidence of CIN is relatively low(up to 5%)in patients with intact renal function.However,in patients with known chronic renal insufficiency,the incidence can reach up to 27%.AIM To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic(CT)images obtained immediately following hepatic artery embolization with development of CIN.METHODS Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011(n=162)was performed.Patients without intraprocedural CT imaging(n=51),combined embolization/ablation(n=6)and those with chronic kidney disease(n=21)were excluded.The study group comprised of 84 patients with 106 procedures.CIN was defined as 25%increase above baseline serum creatinine or absolute increase≥0.5 mg/dL within 72 h post-embolization.Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications.The association between noncontrast CT findings and CIN development was examined by Fisher’s Exact Test.RESULTS CIN occurred in 11/106(10.3%)procedures(Group A,n=10).The renal enhancement pattern in patients who did not experience CIN(Group B,n=74 with 95/106 procedures)was late excretory in 93/95(98%)and early excretory(EE)in 2/95(2%).However,in Group A,there was a significantly higher rate of EE pattern(6/11,55%)compared to late excretory pattern(5/11)(P<0.001).A significantly higher percentage of patients that developed CIN had renal artery calcifications(6/11 vs 20/95,55%vs 21%,P=0.02).CONCLUSION A hyperdense renal parenchyma relative to surrounding skeletal muscle(EE pattern)and presence of renal artery calcifications on immediate post-HAE noncontrast CT images in patients with low risk for CIN are independently associated with CIN development.

Contrast-Induced Nephropathy in Patients with Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

Purpose: The purpose of this retrospective study was to assess the incidence and the risk factors of contrast-induced nephropathy (CIN) following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: We performed a retrospective review of 186 sessions of TACE in 122 patients with HCC. We examined the incidence and factors associated with risk of CIN, defined as an increase of at least 0.5 mg/dl (44.2 μmol/l) or 25% of the baseline serum creatinine level between 48 and 72 hours after TACE. Results: CIN developed in 14 (7.5%) of the 186 sessions after TACE. A univariate analysis showed that the Child-Pugh class B or C [10/14 (71%) vs. 70/172 (41%), P = 0.046], a low albumin level (3.0 ± 0.5 vs. 3.4 ± 0.6, P = 0.018), and a low hemoglobin level (10.6 ± 2.0 vs. 11.8 ± 2.0, P = 0.035) were significantly associated with the development of CIN. Multivariate analysis revealed that the hemoglobin value was associated with CIN [odds ratio (OR) 1.6;P = 0.038]. Conclusions: CIN after TACE is closely associated with the severity of liver cirrhosis, and with low levels of albumin and hemoglobin. Effective preventive methods remain to be considered in patients with HCC and advanced LC who are undergoing TACE.

Contrast-Induced Nephropathy in Patients Undergoing Elective Coronary Angiography： Incidence and Risk Factors

Contrast-Induced Nephropathy （CIN） is a considerable complication in cardiac procedures. Several conditions for CIN have been identified after Coronary Angiography （CA）. The purpose of this study was to assess the incidence and clinical predictors of CIN 24 h after Coronary Angiography. A total of 1,137 consecutive patients with coronary artery syndrome undergoing CA were prospectively enrolled the study. Serum creatinine （Cr） at baseline and 24 h after CA, as well as demographic and clinical characteristics of patients were measured. Contrast-induced nephropathy was defined as a rise in Cr _0.3 mg/dL after CA. Univariable and multivariable logistic regression analysis were performed to identify independent predictors of CIN. The overall incidence rate was 56 （4.9%） in total study population. In multivariate analysis, baseline Cr 〉 1.5 （odds ratio [OR] 4.8, 95% confidence interval [CI] 1.04 to 8.3; P〈 0.001）, Contrast volume 〉 100 mmL （OR 3.4, 95% CI 0.7 to 8.1; P〈 0.002）, Baseline GFR 〈 30 （OR 14.2, 95% CI 8 to 2; P 〈 0.000）; Baseline GFR 30-60 （OR 8.7, 95% CI 2.3 to 13.8; P 〈 0.000） were predictors for CIN. CIN was more frequent in older patients, with higher serum creatinine level and Grater usage of contrast media, and diuretic. N-acetylcysteine （NAC） and hydration cannot prevent the occurrence of CIN.

Navigating nephrotoxic waters:A comprehensive overview of contrast-induced acute kidney injury prevention

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.

Preventive effects of anisodamine against contrast-induced nephropathy in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty

Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation. We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy （CIN） in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty. Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate （eGFR） of 60 ml^-1 - min^-1·1.73 m^-2 or less, who were undergoing coronary angiography or angioplasty, were randomly assigned to receive an infusion of either sodium chloride （control group, n=128） or anisodamine （treatment group, n=132）. Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 μg · kg^-1 · min^-1 from 12 hours before to 12 hours after coronary angiography or angioplasty, while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group. All patients received intravenous sodium chloride hydration. CIN was defined as a 25% increase in serum creatinine from baseline or an absolute increase of 〉0.5 mg/dl within three days after contrast exposure. The primary end point was the incidence of CIN. The secondary end point was a 25% or greater reduction in eGFR. Results There were no significant differences between the two groups with regard to age, gender, risk factors, laboratory results, medications and interventions. The incidence of CIN was 9.8% （13/132） in the treatment group and 20.3% （26/128） in the control group （P 〈0.05）. The secondary end point was 6.0% （8/132） in the treatment group and 16.4% （21/128） in the control group （P〈0.05）. Conclusion These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty.

Prevention of iodinated contrast-induced nephropathy

Objective To lessen the occurrence of contrast-induced nephropathy （CIN）, the preventive measures of CIN were reviewed. Data sources The data used in this review were from PubMed with relevant English articles and from Chinese Knowledge Information （CNKI） published from 1989 to 2009. The search terms were ＂contrast medium＂, ＂contrast-induced nephropathy＂ and ＂prevention＂. Articles involved in prevention of CIN were selected. Study selection CIN is the third most common cause of acute kidney injury and is associated with an unfavorable prognosis. The best treatment is prophylaxis because CIN can not be reversed or ameliorated. Results Thirty articles were included. Among various preventive measures, pericatheterization hydration is almost universally accepted as an appropriate and safe measure to prevent CIN, although there is no agreement as to composition, amount, and timing of hydration. Based on the use of concomitant nephrotoxic agents or high doses of contrast medium （CM） is one of risk factors for CIN, discontinuation of potentially nephrotoxic drugs 2-3 days before and after the procedure until renal function recover, and using the lowest possible dose of CM can decrease the risk of CIN. It is promising that removing the majority of CM from the coronary sinus, before it enters the systemic circulation, during coronary angiography can reduce the risk for CIN in animal studies and in limited clinical trials. Inconsistent data exist with respect to application of some vasodilators （endothelin antagonists and adenosine antagonists） and antioxidants （N-acetylcysteine and statins） in preventing CIN in high-risk patients, and new vasodilators and antioxidants continue to be tested. Conclusions Pericatheterization hydration, discontinuation of nephrotoxic drugs, and using the lowest possible dose of CM are effective measures to lessen the risk for CIN. Other prophylactic strategies and some drugs are promising, but further confirmation is required.

Prediction of contrast-induced nephropathy in diabetics undergoing elective percutaneous coronary intervention： role of the ratio of contrast medium volume to estimated glomerular filtration rate

Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate （CMV/eGFR） in diabetic patients undergoing elective PCI who developed ClN.Methods We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index （BMI）, left ventricular ejection fraction （LVEF）, hemoglobin （Hb）, fasting plasma glucose （FPG）, hemoglobin A1c （HbA1c）, volume of contrast medium, basic levels of serum creatinine （Scr）, the number of treated vessels and the number of stents used.We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.Results The incidence of CIN was 18.4% （21/114）. There were no significant differences in age, gender, BMI, LVEF, Hb,FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction （AMI） in patients between the CIN （n=21） and the non-CIN （n=93） groups. However, the eGFR was significantly lower （（72.0±12.5） ml·min-1·1.73 m-2 vs.（82.0±16.5）ml·min-1·1.7m-2, P=0.010）, and the basic serum creatinine level （（1.07±0.12） mg/dl vs.（0.97±0.19） mg/dlP=0.014） was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger （（253±75）ml vs. （211±71）ml, P=0.017） and the CMV/eGFR ratio was significantly greater （3.64±1.26 vs.2.70±1.11, P=0.001） in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor for the development of CIN （P=0.001）. At a cut-off point of 〉3.1, the CMV/eGFR ratio exhibited 71% sensitivity and 70% specificity for detecting CIN.Conclusion The CMV/eGFR ratio could be a valuable predictor of CIN for diabetic patients after elective PCI. At a cut-off point of〉3.1, the CMV/eGFR ratio was an optimal predictor for the incidence of CIN.

Role of Dongchongxiacao (Cordyceps) in prevention of contrast-induced nephropathy in patients with stable angina pectoris

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.

Effect of Dongchongxiacao(Cordyceps) therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography

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.

Recent Advances in Chinese Medicine for Contrast-Induced Nephropathy

Contrast-induced nephropathy （CIN）, also called contrast-induced acute kidney injury （CI-AKI）, is a leading cause of hospital-acquired AKI as a possible complication of intravenous contrast media administration.

Contrast-Induced Nephropathy--Time for Western Medicine and Chinese Medicine to Team Up

The cornerstones of the clinical management are prevention and identification of patients at risk, e.g. patients with diabetes, renal failure or heart failure.Hydration therapy is the main line of prevention, and in addition several drugs have been investigated for prophylactic effects in high-risk patients： statins, ascorbic acid.

Volume-to-creatinine clearance ratio:a predictor for contrast-induced nephropathy in chronic kidney disease after primary percutaneous coronary intervention

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.

Association of klotho protein with contrast-induced nephropathy in patients with ST elevation myocardial infarction undergoing percutaneous coronary intervention

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.

Relationship between postoperative mean systolic blood pressure and contrast-induced nephropathy in patients undergoing cardiac catheterization

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.

Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

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.

Relationship between hyperuricemia and contrast-induced nephropathy in patients after emergent percutaneous coronary intervention

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.

The SYNTAX score as a predictor of contrast-induced nephropathy patients with chronic total occlusion undergoing percutaneous coronary intervention

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.