A prospective study on prevention of contrast – induced nephropathy in Croatia (original) (raw)
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Nephrology Dialysis Transplantation, 2007
Background. The aim of the present study was to assess the influence of diabetic and pre-diabetic state on the development of contrast-induced nephropathy (CIN) in chronic kidney disease patients undergoing coronary angiography. Methods. A total of 421 patients with Cockcroft clearance between 15 and 60 ml/min were divided into three groups [diabetes mellitus (DM), n ¼ 137; pre-diabetes (pre-DM), n ¼ 140; and normal fasting glucose (NFG), n ¼ 144]. CIN was defined as an increase of !25% in creatinine over baseline within 48 h of angiography, DM as glucose !126 mg/dl, pre-DM as glucose between 100 and 125 mg/dl and NFG as glucose <100 mg/dl. Results. CIN occurred in 20% of the DM [relative risk (RR) 3.6, P ¼ 0.001], 11.4% of the pre-DM (RR 2.1, P ¼ 0.314) and 5.5% of the NFG group. The decrease of glomerular filtration rate (GFR) was higher in DM and pre-DM (P ¼ 0.001 and P ¼ 0.002, respectively). GFR 30 ml/min (RR 19.22), multivessel involvement (RR 7.59), hyperuricaemia (RR 3.95), use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker (RR 2.70) and DM (RR 2.34) were predictors of CIN. Length of hospital stay was 2.45 AE 1.45 day in DM, 2.27 AE 0.68 day in pre-DM and 1.97 AE 0.45 day in NFG (P < 0.001, DM vs NFG and P ¼ 0.032, pre-DM vs NFG). The rate of major adverse cardiac events was 8.7% in DM, 5% in pre-DM and 2.1% in NFG (P ¼ 0.042, DM vs NFG). Haemodialysis was required in 3.6% of DM and 0.7% in pre-DM (P ¼ 0.036, DM vs NFG), and the total number of haemodialysis sessions during 3 months was higher in DM and pre-DM (P < 0.001). Serum glucose !124 mg/dl was the best cut-off point for prediction of CIN.
African Journal of Pharmacy and Pharmacology
N-Acetylcysteine (NAC) is used in the prevention of contrast-induced nephropathy (CIN) in our institution. The variation in clinical effects as a result of dosage differences between intravenous (IV) and oral administration warrants further investigation. This study primarily aimed to evaluate the incidence of CIN in patients with renal impairment, comparing those who received IV NAC with those receiving oral NAC. This was an observational, retrospective study conducted from 1st January, 2007 to 31st March, 2010. The study included 94 renally impaired patients (baseline glomerular filtration rate (eGFR) < 70 ml/min/1.73 m 2) who had undergone iodinated-contrast procedure, and received either IV NAC (150 mg/kg pre-procedure, then 50 mg/kg post-procedure) or oral NAC (600 mg twice daily for one day before the procedure, then for two days after the procedure). The changes in serum creatinine (SCr) over time: pre-procedure, post-procedure 24, 48 and 72 h for both regimens were recorded and analysed. The overall incidence of CIN was 22% in IV NAC group versus 28.0% in the oral group (P = 0.403). CIN was found to be significantly associated with unstable renal function but not route of NAC administration. In patients with stable renal function, the incidence of CIN was 8.3% in the IV group versus 11.9% in the oral group; P = 1.000. In patients with unstable renal function, the incidence of CIN was 46.2 and 42.9% in the IV and oral groups, respectively; P = 0.863. Diabetes mellitus (odds ratio (OR) = 10.704, P = 0.018) and unstable renal status (OR = 6.800, P = 0.015) were the independent predictors of CIN by multivariate analysis. Both IV and oral NAC had comparable effects on the incidence of CIN in patients with stable renal status. However, both routes of NAC administration were less effective in preventing CIN in patients with unstable renal status.
The American Journal of Cardiology, 2008
Contrast-induced nephropathy (CIN) is associated with adverse outcomes. Strategies for its prevention have been evaluated for patients undergoing invasive coronary and peripheral angiography, including treatment with N-acetylcysteine, sodium bicarbonate, and use of iso-osmolar nonionic contrast. Recently, multidetector computed tomographic angiography (MDCTA) of the coronary and peripheral arteries has been introduced as an accurate method for assessing vascular stenosis and has been widely adopted for assessment of outpatients with suspected coronary artery disease or peripheral arterial disease. To date, the incidence of CIN in outpatients with chronic renal insufficiency (CRI) treated with CIN-preventive strategies undergoing MDCTA remains unknown. Thus, we evaluated the incidence of CIN in outpatients with CRI (creatinine 1.5 to 2.5 mg/dl) undergoing MDCTA using CIN-preventive measures; 400 patients with CRI (78.5% men, mean age 76 years, 41% with diabetes) underwent MDCTA with iodixanol for detection of coronary artery disease or peripheral arterial disease (mean contrast volume 101 cc). CIN was defined as a nonallergic creatinine increase of >0.5 mg/dl. Creatinine levels were obtained before and 3 to 5 days after MDCTA; the average creatinine levels were 1.80 mg/dl and 1.75 mg/dl, respectively (p ؍ NS), with an average change of ؊0.03 mg/dl. In the study cohort, only 7 patients (1.75%) experienced a creatinine increase >0.5 mg/dl, satisfying the definition of CIN. In conclusion, multivariate analysis, diabetes was the only predictor for CIN (odds ratio 5.9, 95% confidence interval 1.0 to 33.3, p ؍ 0.045). No patient required hemodialysis. In conclusion, in patients with CRI undergoing MDCTA and receiving CIN-preventive measures, the incidence of CIN is low.
Nephrology Dialysis Transplantation, 2006
Background. Contrast nephropathy (CN) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide. Whether oral saline hydration is as efficient as intravenous saline hydration is unknown. The preventive efficacy of theophylline and furosemide for CN remains controversial. The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN. Methods. We prospectively studied 312 patients with chronic renal failure (serum creatinine 201±81 mmol/l, Cockcroft clearance 37±12 ml/min/1.73 m 2), who were undergoing various radiological procedures with a non-ionic, low osmolality contrast agent. Patients were randomly assigned to four arms. In arm A, patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure. In arm B, patients received 0.9% saline intravenously at a rate of 15 ml/kg for 6 h before the procedure. In arm C, patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure. In arm D, patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure. Results. Patients were well-matched with no significant differences at baseline in any measured parameters. Acute renal failure, defined as an increase in serum creatinine of 44 mmol/l (0.5 mg/dl), occurred in 27 out of 312 patients (8.7%). There was no significant difference between the rate of renal failure in the different arms of the study: five out of 76 (6.6%) in arm A, four out of 77 (5.2%) in arm B, six out of 80 (7.5%) in arm C and 12 out of 79 (15.2%) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure. The independent predictors of CN were diabetes mellitus, high baseline serum creatinine and high systolic blood pressure. Conclusions. Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases. Furosemide and theophylline were not protective.
Journal of National Institute of Neurosciences Bangladesh, 2018
Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute renal failure.Objective: The purpose of the present study was to compare the incidence and associated risk factors of contrast induced nephropathy in diabetes and non-diabetic patients.Methodology: This was cross-sectional study performed in the Department of Nephrology at National Institute of Kidney Diseases and Urology, Sher-E-Bangla Nagar, Dhaka and Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2016 to July 2016. Contrast induced nephropathy (CIN) is defined as increase in serum creatinine of ≥25% from baseline value and/ or an absolute increase of ≥0.5 mg/dl in serum creatinine from baseline. Patients were divided in to two groups Group A (Patients with Diabetes mellitus) and Group B (Patients without Diabetes mellitus). To identify independent characteristics associated with CIN, multivariable logistic regression analysis ...
International Urology and Nephrology, 2010
We randomized patients with chronic kidney disease (serum creatinine C 1.5 mg/dl or glomerular filtration rate (GFR)\60 ml/min/1.73 m 2) in a double-blind fashion to receive saline or sodium bicarbonate prior to and after cardiac or vascular angiography. The primary endpoint was contrastinduced nephropathy (CIN), defined as an increase in serum creatinine by 25% or by 0.5 mg/dl from baseline. Patients with congestive heart failure (CHF), cardiac ejection fraction (EF) \30%, or GFR \ 20 ml/min/ 1.73 m 2 were excluded. The study was discontinued (after 142 patients were randomized) due to a low incidence of CIN (1.5%). We retrospectively identified all cases of CIN (n = 30) at our institution during the same time period to see if these patients differed from our trial sample. There was no difference in serum creatinine (1.7 ± 0.4 vs. 1.7 ± 0.6 mg/dL), GFR (42.7 ± 9.7 vs. 45.3 ± 3.2 ml/min), incidence of diabetes (51.8% vs. 63.3%), contrast volume (121.7 ± 63.8 vs. 122.7 ± 68.3 ml), ACE inhibitor or angiotensin receptor blocker use (54.0% vs 63.3%), and periprocedure diuretic use (33.1% vs 26.7%). On multivariate analysis, only a cardiac ejection fraction (EF) of less than 40% was significantly associated with CIN (odds ratio, 4.52; 95% confidence interval, 1.30-15.71; P = 0.02). In all, 22/30 patients (73.3%) who developed CIN had at least one or more characteristics that would have excluded their enrollment in our randomized trial including evidence of congestive heart failure (17/30 patients), EF less than 30% (9 patients), age greater than 85 years (2 patients), or advanced renal failure with a baseline GFR of less than 20 cc/min (1 patient). In summary, patients with CKD without evidence of CHF who receive adequate hydration appear to have a very low risk of CIN associated with angiography. A low EF (less than 40%) appeared to be the most significant risk factor for CIN in our population.
Indian Heart Journal
To study the incidence and predictors of Contrast induced nephropathy (CIN) in high risk patients undergoing coronary angioplasty. To study the applicability of the Mehran Risk Score (MRS) in the prediction of CIN in our population. Methods: This was a prospective observational study where patients with an estimated glomerular filtration rate (eGFR) between 30 and 60 ml/mt undergoing elective percutaneous coronary intervention (PCI) over a period of 15 months were evaluated prospectively for the development of CIN. The patients who developed CIN were then analysed for the presence of specific risk factors. The patients were categorized into the 4 risk groups based on the MRS. Results: 100 high risk patients underwent PCI during the study period. The incidence of CIN was 29%. On multivariate analysis, the presence of anemia (p = 0.007), increased contrast volume usage (as defined by >5* B.Wt/S.cr) (p = 0.012) and usage of loop diuretics (p = 0.033) were independently found to confer a significant risk of CIN. In patients belonging to the high Mehran risk group (MRS10-15) and very high risk group (MRS >15) the risk of CIN was 3 fold (OR: 3.055, 95% CI: 1.18-7.94, p = 0.022) and 24 fold (OR: 24, 95% CI: 2.53-228.28, p = 0.006) higher respectively when compared to intermediate and low risk patients (MRS <10). Conclusion: The incidence of CIN in high risk patients undergoing PCI is substantially higher in our population compared to similar studies in the west. The MRS risk prediction is pertinent even in an Indian population.
The American Journal of Cardiology, 2011
Few studies have compared the ability of sodium bicarbonate plus N-acetylcysteine (NAC) and sodium chloride plus NAC to prevent contrast-induced nephropathy (CIN) in diabetic patients with impaired renal function undergoing coronary or endovascular angiography or intervention. Diabetic patients (n ؍ 382) with renal disease (serum creatinine >1.1 mg/dl and estimated glomerular filtration rate <60 ml/min/1.73 m 2 ) were randomly assigned to receive prophylactic sodium chloride (saline group, n ؍ 189) or sodium bicarbonate (bicarbonate group, n ؍ 193) before elective coronary or endovascular angiography or intervention. All patients received oral NAC 1,200 mg 2 times/day for 2 days. The primary end point was CIN, defined as an increase in serum creatinine >25% or an absolute increase in serum creatinine >0.5 mg/dl within 48 hours after contrast exposure. There were no significant between-group differences in baseline characteristics. The primary end point was met in 10 patients (5.3%) in the saline group and 17 (9.0%) in the bicarbonate group (p ؍ 0.17), with 2 (1.1%) and 4 (2.1%), respectively, requiring hemodialysis (p ؍ 0.69). Rates of death, myocardial infarction, and stroke did not differ significantly at 1 month and 6 months after contrast exposure. In conclusion, hydration with sodium bicarbonate is not superior to hydration with sodium chloride in preventing CIN in patients with diabetic nephropathy undergoing coronary or endovascular angiography or intervention.