Contrast induced nephropathy after percutaneous coronary intervention： risk factors and preventive strategy

Objective To analyze the risk factors and clinical outcome of contrast induced nephropathy （CIN） in patients with coronary artery disease （CAD） after percutaneous coronary intervention （PCI） and discuss its prevention. Methods Fifty-four patients with C1N among 729 patients who received PCI were retrospectively studied and the related risk factors, cardiovascular events and preventive strategy were analyzed. Results C1N was strongly associated with pre-procedure chronic renal failure, diabetes mellitus and large-dose contrast. The incidence of cardiac mortality and major adverse cardiac events 1 year after PCI in CIN group was higher than that in group without CIN. Conclusion Chronic renal failure, diabetes mellitus and dosage of contrast agent were three independent risk factors of CIN. CIN could affect the patients＇ prognosis. A well overall perioperative management of CAD patients following PCI, especially hydration therapy, is the most important strategy for prevention of CIN.

Safety and efficacy of anisodamine on prevention of contrast induced nephropathy in patients with acute coronary syndrome

Background Previous studies have proved the renal protective effects of anisodamine in patients with septic shock. The aim of this study was to investigate anisodamine for the prevention of contrast induced nephropathy （CIN） in patients with acute coronary syndrome （ACS）. Methods Consecutive ACS patients undergoing elective percutaneous coronary intervention （PCI） were randomly assigned to one of two groups： patients in the anisodamine group （ANI group） were assigned to receive intravenous infusions of anisodamine by an adjusted-dose （0.1-0.2 μg·kg^-1·min^-1） from the PCI procedure to 24 hours after PCI, and the control group （CON group） received 0.9% isotonic saline of the same volume. All patients were hydrated for 6 to 12 hours before and 12 hours after PCI. Blood samples were taken on the day of PCI and at 24, 48 and 72 hours after PCI to measure the serum creatinine （SCr）. Results A total of 177 patients were involved in the study, 88 in the ANI group and 89 in the CON group. In both groups, the SCr concentrations significantly increased after PCI, with the peak value occurring at 48 hours. At 72 hours, the SCr concentration in the ANI group retuned to the baseline level （P 〉0.05）, but the SCr concentration in CON group was still higher than baseline level （P 〈0.01）. The SCr concentrations at 48 and 72 hours after PCI were much lower in the ANI group than those in the CON group （both P 〈0.01）. The estimated glomerular filtration rate （eGFR） significantly decreased after PCI, the lowest value occurred at 48 hours. In the ANI group, the eGFR at 72 hours was similar to the baseline level. In the CON group, the eGFR failed to return to baseline at 72 hours （P〈0.01）. The eGFR at 24, 48 and 72 hours after PCI were higher in the ANI group （all P 〈0.05）. The incidence of CIN in the ANI group was lower than that in the CON group within 72 hours after PCI （P〈0.05）. The results of multiple Logistic regression proved that both diabetes and left ventricular ejection fraction （LVEF） were independent predictors of CIN, and treatment with anisodamine was an independent preventive factor of CIN （OR 0.369 and 95% Cl 0.171 to 0.794, P=0.011）. No serious side effects were found in the ANI group. Conclusion Intravenous infusion of anisodamine during and after elective PCI may safely prevent the occurrence of CIN in ACS patients.

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.

Comparison of isotonic and hypotonic contrast agent in inducing contrast induced nephropathy after percutaneous coronary intervention

Background The incidence of contrast induced nephropathy （CIN） is increasing while patients are more and more frequently undertaking coronary angiography and percutaneous coronary intervention （PCI）. CIN correlates with the later cardiovascular events, the rising mortality risks and the increasing one-year target vessel revascularization. At present, few articles reported on whether the incidence of CIN induced by isotonic and hypotonic contrast agent after PCI is different or not. Objectives To investigate the different effect of isotonic and hypotonic contrast agent in inducing CIN in patients with coronary artery disease after PCI. Methods We enrolled 355 patients with coronary artery disease who undertook PCI from January 2007 to December 2008 as subjects. Renal functions of all 355 patients were normal. Patients were randomly divided into isotonic group and hypotonic group. Concentrations of serum creatinine （SCr） were measured before, 48～72 hours and 7 days （if needed） after PCI. The glomerular filtration rate （eGFR） was calculated according to MDRD formula. The incidence of CIN was defined as the concentration of SCr ≥0.5 mg/dL（44.2 μmol/L）. Hemodialysis rates and mortality were recorded in the hospital. Results There was no significant difference in the basline eGFR （79.52±5.28 vs 81.03±6.09, P0.05）, dosages of contrast agent （125.68±15.88 mL vs 123.51±16.38 mL, P0.05）, eGFR of 48-72 hours after PCI （70.26±9.48 vs 69.06±9.59, P0.05） and incidences of CIN （5.56% vs 5.78%, P0.05） between the two groups. eGFR and concentrations of SCr 7 days after PCI showed no significant difference between the two groups （P0.05）. No patient was dead or needed hemodialysis in hospital. Conclusions The effect of isotonic and hypotonic contrast agent in inducing CIN in patients with coronary artery disease after PCI has no difference.

Computed tomography pulmonary angiography using a 20% reduction in contrast medium dose delivered in a multiphasic injection

AIM To evaluate the feasibility of reducing the dose of iodinated contrast agent in computed tomography pulmonary angiography(CTPA). METHODS One hundred and twenty-seven patients clinically suspected of having pulmonary embolism underwent spiral CTPA, out of whom fifty-seven received 75 mL and the remaining seventy a lower dose of 60 mL of contrast agent. Both doses were administered in a multiphasic injection. A minimum opacification threshold of 250 Hounsfield units(HU) in the main pulmonary artery is used for assessing the technical adequacy of the scans. RESULTS Mean opacification was found to be positively correlated to patient age(Pearson's correlation 0.4255, P < 0.0001) and independent of gender(male:female, 425.6 vs 450.4,P = 0.34). When age is accounted for, the study and control groups did not differ significantly in their mean opacification in the main(436.8 vs 437.9, P = 0.48),left(416.6 vs 419.8, P = 0.45) or the right pulmonary arteries(417.3 vs 423.5, P = 0.40). The number of sub-optimally opacified scans(the mean opacification in the main pulmonary artery < 250 HU) did not differ significantly between the study and control groups(7 vs 10).CONCLUSION A lower dose of iodine contrast at 60 mL can be feasibly used in CTPA without resulting in a higher number of sub-optimally opacified scans.

Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy

Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.