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.

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.

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

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.

Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis

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.

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.

左卡尼汀预防急性冠脉综合征(ACS)患者冠状动脉造影(CAG)和/或经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的意义

目的探讨左卡尼汀对于预防急性冠脉综合征(acute coronary syndromes,ACS)患者冠状动脉造影(coronary artery angiography,CAG)和/或经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后发生对比剂肾病(contrast-induced nephropathy,CIN)的意义。方法连续入选2016年1—12月复旦大学附属中山医院心内科诊断为ACS并接受CAG及PCI,并于围手术期接受左卡尼汀治疗的患者共416例,选取同期年龄、性别、基础肾功能匹配且未接受左卡尼汀治疗的ACS患者416例,探讨两组患者的CIN发生率。结果左卡尼汀组CIN发生率(46/416,11.1%)与对照组(62/416,14.9%)差异无统计学意义。亚组分析中,肾功能正常患者的CIN发生率在左卡尼汀组(26/249例,10.4%)与对照组(28/252,11.1%)之间差异无统计学意义;肾功能轻中度异常(30 mL · min^-1 · 1.73 m^-2 ≤eGFR<90 mL · min^-1 · 1.73 m^-2 )患者的CIN发生率在左卡尼汀组(20/167,13.2%)显著低于对照组(36/164,18.3%)( P =0.016)。整体研究人群中,低LVEF值、eGFR、HCT和对比剂用量是CIN的独立危险因素,肾功能轻中度异常人群中,低LVEF值、eGFR、HCT、HbA 1C、对比剂用量和左卡尼汀使用情况是CIN的独立危险因素。结论左卡尼汀未能显著降低肾功能正常的ACS患者的CIN发生率,但对于轻中度肾功能不全的ACS患者,在术前充分水化的基础上围手术期联合使用左卡尼汀可以显著降低CIN的发生率。

Acupuncture and moxibustion for the prevention of contrast induced nephropathy in diabetic rats by inhibiting Notch signaling pathway

Objective Apoptosis is recognized as an important mechanism in contrast-induced nephropathy(CIN).Acupuncture and moxibustion,the auxiliary treatment in China,are effective interventions for cell apoptosis in many ischemic diseases.In our previous study,we found acupuncture and moxibustion could prevent CIN.The objective of this research is to study the mechanism of acupuncture and moxibustion on tubular epithelial cell apoptosis in diabetic CIN rats.

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.

Role of serum cystatin C in the prediction of contrast-induced nephropathy after intra-arterial interventions

Background:The diagnosis of contrast-induced nephropathy(CIN)is usually based on changes in serum creatinine(sCr).However,sCr has poor sensitivity as a biomarker of kidney injury.The aim of this study was to investigate the usefulness of serum cystatin C(sCysC)to predict CIN after intra-arterial interventions.Methods:A total of 360 consecutive patients underwent intra-arterial procedures using digital subtraction angiography.SCr,sCysC,and estimated glomerular filtration rate were measured at 1 to 2 days before and at 48,72 h,and 7 days after the procedure.Results:Thirty-one patients(8.61%)developed CIN.Receiver operating characteristic(ROC)curve analysis showed that preoperative sCysC levels had good discriminatory power(area under the curve[AUC]=0.634;95%confidence interval[CI]=0.526-0.743)for evaluating the risk of CIN after an endovascular procedure,with a sensitivity of 53.33%and specificity of 73.70%.ROC analysis showed that sCysC at 48 h after contrast medium administration was predictive of CIN after an endovascular procedure(AUC=0.735;95%CI=0.647-0.822)with satisfactory sensitivity of 74.20%and specificity of 63.90%.Diabetes mellitus was an independent risk factor for CIN(odds ratio=2.778;95%CI=1.045-7.382;P=0.040).Conclusions:SCysC is an appropriate biomarker to predict the occurrence of CIN.Baseline sCysC before an intervention is useful to obtain a preliminary estimate of the risk of CIN.A 48-h cut-off value of sCysC of 0.99 mg/L after an endovascular procedure may help to rule out patients at lower risk of CIN.

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.

Relationship between different definitions of contrast-induced nephropathy and adverse outcomes in ST-elevation myocardial infarction

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]

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.

Early diagnostic value for contrast-induced nephropathy in patients undergoing coronary angiography:Serum cystatin C might not be superior to serum creatinine

Background Contrast induced nephropathy（CIN） is associated with increased mortality. serum creatinine（sCr） and serum cystatin C（sCys C） have diagnostic value for CIN in patients taking coronary angiography（CAG）. However, whether sCys C is superior to sCr is still controversial. Methods All 280 patients undergoing PCI from July 2015 to July 2017 in Shunde Hospital, Southern Medical University were enrolled in this prospective study. The plasma levels of sCr and sCys C were measured in fasting blood samples in the morning before angiography and at 48 hours and 72 hours after the procedure. Receiver operating characteristic curve（ROC）analysis was performed for sCr and sCys C 48 hours after procedure. Results According to sCys C criteria, CIN occurred in 85 patients（30.4%） after contrast exposure, while, CIN occurred in 22 patients（7.9%）. ROC curve analysis found that AUC for sCr and sCys C was 0.741（P〈0.05, 95% CI = 0.613-0.869） and 0.720（P〈0.05, 95%CI = 0.590-0.851）, respectively without significantly different（P=0.412）. Conclusion The sCys C is not superior to s Cr for predicting CIN in angiography patients.

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.

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.

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.

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.