Background

Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes.

Objectives

To prospectively assess predictors of CIN and long-term outcomes of affected patients.

Methods

Four hundred twelve consecutive patients with serum creatinine levels of 115 μmol/L to 309 μmol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus one-time hemodialysis or hydration plus N-acetylcysteine.

Results

Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 μmol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96).

Conclusion

From the present prospective trial, performance of post-procedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for patients’ long-term survival.

Historique

Parmi les nombreuses études portant sur la néphropathie induite par un agent de contraste (NIC), il n’existait pas d’essai prospectif sur les issues à long terme.

Objectifs

Évaluer de manière prospective les prédicteurs de la NIC et les issues à long terme chez les patients touchés.

Méthodologie

Quatre cent douze patients consécutifs dont le taux de créatinine sérique oscillait entre 115 μmol/L et 309 μmol/L (1,3 mg/dL et 3,5 mg/dL) ayant subi une coronarographie non urgente ont participé à l’étude. Les patients étaient répartis au hasard entre l’hydratation péri-intervention, l’hydratation associée à une seule hémodialyse ou l’hydratation associée à de la N-acétylcystéine.

Résultats

Grâce à la régression logistique multivariée, les auteurs ont dépisté que les éléments suivants sont des prédicteurs de NIC dans les 72 heures suivant l’intervention (équivalant à une augmentation d’au moins 44,2 μmol/L [0,5 mg/dL] de la créatinine) : hémodialyse prophylactique postintervention (RRR 2,86, 95% IC 1,07 à 7,69), utilisation d’inhibiteurs de l’enzyme de conversion de l’angiotensine (RRR 6,16, 95% IC 2,01 à 18,93); taux de filtration glomérulaire de départ (RRR 0,94, 95% IC 0,90 à 0,98) et quantité d’agent de contraste (RRR 1,01, 95% IC 1,00 à 1,01). Étant donné l’issue à long terme (suivi moyen de 649 jours), les modèles de régression de Cox multivariés ont révélé des taux de créatinine élevés à 30 jours (ratio de l’indice de risque [RIR] 5,48, 95% IC 2,85 à 10,53), mais pas de NIC dans les 72 heures (RIR 1,12, 95% IC 0,63 à 2,02), associés à une augmentation de la mortalité. De plus, les prédicteurs indépendants de décès pendant le suivi incluaient une fraction d’éjection ventriculaire gauche inférieure à 35% (RIR 4,01, 95% IC 2,22 à 7,26), du phosphate sérique (RIR 1,64, 95% IC 1,10 à 2,43) et de l’hémoglobine (RIR 0,80, 95% IC 0,67 à 0,96).

Conclusion

D’après le présent essai prospectif, l’effet de l’hémodialyse postintervention, le recours à des inhibiteurs de l’enzyme de conversion de l’angiotensine, le taux réduit de filtration glomérulaire de départ et la quantité d’agent de contraste étaient des prédicteurs indépendants de NIC dans les 72 heures suivant le cathétérisme. L’évaluation de la fonction rénale au bout de 30 jours, plutôt que de 72 heures, semblait être plus prédictive de la survie à long terme des patients.

Purpose: Contrast induced nephropathy (CIN) is defined as a decrease in renal function following administration of contrast media. The aim of this meta-analysis was to asses the overall risk of CIN, chronic loss of kidney function and the need for renal replacement therapy (RRT) after intravenous contrast enhanced CT-scan. Secondly, we aimed to identify subgroups at increased risk for CIN.
Materials and methods: A literature search in Pubmed, Medline, Embase and Cochrane databases was performed. Data extraction was carried out independently by two reviewers. Meta-analysis and meta-regression were performed using an exact likelihood approach.
Results: Forty studies evaluating the incidence of CIN after CT were included. The pooled incidence of CIN was 6.4% (95% CI 5.0-8.1). The risk of RRT after CIN was low, 0.06% (95% CI 0.01-0.4). The decline in renal function persisted in 1.1% of patients (95% CI 0.6-2.1%). Patients with chronic kidney disease (odds ratio 2.26, p < 0.001) or diabetes mellitus (odds ratio 3.10, p < 0.001) were at increased risk for the development of CIN.
Conclusion: CIN occurred in 6% of patients after contrast enhanced CT. In 1% of all patients undergoing contrast enhanced CT the decline in renal function persisted. (C) 2011 Elsevier Ireland Ltd.

BACKGROUND: We report the incidence of contrast-induced acute kidney injury (CI-AKI) following administration of iodixanol or low-osmolar contrast media (LOCM) in patients for suspected peripheral arterial occlusive disease (PAOD) undergoing intra-arterial digital angiography (IA-DSA). METHODS: IA-DSA was performed according to site standard for contrast agent type and volume following computed tomography (CT) of the abdominal aortoiliac and lower extremity arteries and a washout period of at least 3 days. Serum creatinine was measured at baseline and 24 +/- 4 hours after contrast administration. CI-AKI was defined as laboratory increase of serum creatinine value =25% from baseline measurement at 24 hours. The incidence of CI-AKI was analyzed with chi-square statistics. RESULTS: Of the 250 patients who underwent IA-DSA with complete data for analysis, 147 (58.8%) received iodixanol and 103 (41.2%) received LOCM (iopamidol, 91; ioversol, 7; iohexol, 3; iopromide, 2). Baseline mean serum creatinine was statistically higher for iodixanol compared with LOCM (100 vs. 82.7 micromol/L; p=0.0124). CI-AKI occurred in 8 patients (5.4%) with iodixanol and 14 patients (13.6%) with LOCM (p=0.025). Further analysis showed that iopamidol administration was responsible for the 13 out of 14 cases of CI-AKI in LOCM patients. CONCLUSIONS: In patients with suspected PAOD undergoing IA-DSA, the incidence of CI-AKI at 24 hours following contrast administration was significantly less for patients who received iodixanol compared with various LOCM; this difference was primarily driven by iopamidol.

Previously published equations to estimate glomerular filtration rate (GFR) have limited accuracy in Asian populations. We aimed to develop and validate a more accurate equation for estimated GFR (eGFR) in the Chinese population, using data from 8571 adults who were referred for direct measurement of GFR by renal dynamic imaging (mGFR) at 3 representative hospitals in China. Patients from the Third Xiangya Hospital were included in our development (n=1730) and internal validation sets (n=1042) and patients from the other hospitals comprised the external validation set (n=5799). We excluded patients who were prescribed medications known to influence the tubular secretion of creatinine, patients on dialysis, kidney transplant recipients, and patients with missing creatinine values or with creatinine >700 mumol/l. We derived a novel eGFR equation by linear regression analysis and compared the performance to 12 creatinine-based eGFR equations, including previously published equations for use in Chinese or Asian populations. In the development and internal validation sets, the novel Xiangya equation had high accuracy (accuracy within 30% [P30], 79.21% and 84.33%, respectively), low bias (mean difference between mGFR and eGFR, -1.97 and -1.85 ml/min per 1.73 m(2), respectively), and high precision (interquartile range of the differences, 21.13 and 18.88 ml/min per 1.73 m(2), respectively). In external validation, the Xiangya equation had the highest P30 among all eGFR equations, with P30 [本文引用:2]

BACKGROUND: The purpose of this meta-analysis was to evaluate the epidemiology of contrast-induced acute kidney injury (CI-AKI) in the elderly. METHODS: A literature review was undertaken to determine the incidence of CI-AKI in individuals receiving intravascular contrast medium in the hospital setting. RESULTS: Twenty-two studies with 186,455 patients were identified. The pooled incidence of CI-AKI was 13.6% in 67,831 patients older than 65 years of age (95% confidence interval [CI] 10.1-18.2, I(2) =0.496). The pooled odds ratio of CI-AKI in the elderly was 2.55 (95% CI 1.85-3.52, I(2) =0.34). The high incidence of CI-AKI in the elderly was consistent across different administration route subgroups (intracoronary contrast medium group, 15.5% [95% CI 10.3-22.6]; intravenous contrast medium group, 12.4% [95% CI 8.0-18.8]). CONCLUSION: Elderly patients are at greater risk for developing CI-AKI.

BACKGROUND: Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). PURPOSE: To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. DATA SOURCES: PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. STUDY SELECTION: Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. DATA EXTRACTION: Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. DATA SYNTHESIS: None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk. LIMITATIONS: Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. CONCLUSION: No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.