Sex-Based Differences in the Risk of Contrast-Induced Nephropathy and Clinical Outcomes in Patients Undergoing Coronary Angiography and/or Percutaneous Coronary Intervention.

Background: There is still controversial or limited evidence on whether sex differences exist in clinical characteristics, the risk of contrast-induced nephropathy (CIN), and other clinical outcomes of patients who received coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The aim of this study was to characterize the effect of sex on clinical characteristics and outcomes of patients undergoing CAG and/or PCI. Methods: A total of 3,340 consecutive patients undergoing CAG and/or PCI from May 2017 to December 2022 were assessed in this retrospective study. Subgroup analyses by sex were performed. Clinical characteristics, treatments, the risk of CIN, and other clinical outcomes, including in-hospital and follow-up, were compared between females and males. Results: Females undergoing CAG and/or PCI tended to have an advanced age (65.8 versus 63.3 years, p < 0.001), a higher burden of complications, and received PCI less frequently compared with males (43.2% versus 64.2%, p < 0.001). After adjustment, female sex was associated with a higher incidence of CIN [adjusted odds ratio (aOR) 1.47; 95% CI 1.08-2.01; p = 0.015] and a higher all-cause readmission rate (aOR 1.26; 95%CI 1.02-1.56; p = 0.031). Meanwhile, females undergoing CAG alone demonstrated a higher risk of severe arrhythmia compared with males after controlling for potential confounders (aOR 1.52; 95% CI 1.12-2.04; p = 0.006). Conclusion: Sex disparities exist in the clinical characteristics, treatments, the risk of CIN, and other clinical outcomes among patients undergoing CAG and/or PCI. Female sex was identified as an independent predictor of risk for CIN, all-cause readmission rate, and severe arrhythmia.

Predictive value of combining urinary N-acetyl-ß-D-glucosaminidase and serum homocysteine for contrast-induced nephropathy in patients after percutaneous coronary intervention.

Background: Contrast-induced nephropathy (CIN) can lead to serious complications following percutaneous coronary intervention (PCI). Urine N-Acetyl-ß-D-glucosaminidase (uNAG) and serum homocysteine (sHCY) are both potential predictors for CIN detection, but their combination has not been explored. We aimed to combine uNAG and sHCY as predictors for the early detection of CIN and for prognosis prediction in patients after PCI. Methods: A total of 232 consecutive patients who underwent PCI at a university hospital were recruited for this study. According to the European Society of Urology and Reproduction (ESUR) criterion, CIN is defined as an elevation of serum creatinine (sCr) by ≥25% or ≥0.5 mg/dl from baseline within 48 h. We assessed the use of individual biomarkers (uNAG and sHCY) measured around PCI and their combinations for CIN detection and prognosis prediction. Receiver operating characteristic curves (ROC) and area under the curve (AUC) were used to evaluate the predictive efficiency of potential predictors. Results: In total, 54 (23.28%) patients developed CIN. Concentrations of uNAG and sHCY increased significantly in CIN subjects (p < 0.05) than non-CIN. CIN could be predicted by uNAG and sHCY but not by creatinine at an early stage. At pre-PCI, 0, 12, 24, and 48 h after PCI, the AUC-ROC value of uNAG in calculating total CIN was 0.594, 0.603, 0.685, 0.657, and 0.648, respectively. The AUC-ROC value of sHCY in calculating total CIN was 0.685, 0.726, 0.771, 0.755, and 0.821, respectively. The panel of uNAG plus sHCY detected CIN with significantly higher accuracy than either individual biomarker alone and earlier than sCr. For detecting total CIN, this panel yielded AUC-ROCs of 0.693, 0.754, 0.826, 0.796, and 0.844 at pre-PCI, 0, 12, 24, and 48 h after PCI, respectively, which were superior to those of the individual biomarkers. For predicting the incidence of major adverse cardiovascular events (MACE) within 30 days to 12 months, the AUC-ROC values for uNAG and sHCY measured before discharge were 0.637 and 0.826, respectively. The combined panel yielded an AUC-ROC of 0.832. The combined detection did not significantly enhance the predictive capability for MACE in patients with CIN. The CIN group and the non-CIN group showed no significant difference in the Coronary Heart Disease Intensive Care Unit (CCU) stay time, hospital stay time, demand for renal replacement therapy, CCU mortality rate, and in-hospital mortality rate. Conclusions: The uNAG and sHCY panel demonstrated better sensitivity and specificity for predicting the diagnosis and prognosis of CIN in patients after PCI, earlier than sCr. The combination of these biomarkers revealed a significantly superior discriminative performance for CIN detection and prognosis compared to using uNAG or sHCY alone.

TRPA1 protects against contrast-induced renal tubular injury by preserving mitochondrial dynamics via the AMPK/DRP1 pathway.

Mitochondrial dysfunction and oxidative stress are involved in the development of contrast-induced acute kidney injury (CI-AKI). The present study aimed to reveal the role of transient receptor potential ankyrin 1 (TRPA1), an oxidative sensor, in CI-AKI. Trpa1PT-/- mice with Trpa1 conditionally knocked out in renal proximal tubular (PT) cells, Trpa1 overexpression mice (Trpa1-OE), and TRPA1 agonists and antagonists were used to study its function in a mouse model of iohexol-induced CI-AKI. We found that TRPA1 was functionally expressed in PT cells. Activation of TRPA1 with cinnamaldehyde or overexpression of Trpa1 remarkably ameliorated renal tubular injury and dysfunction in a mouse model of CI-AKI, while CI-AKI was significantly exacerbated in Trpa1PT-/- mice. Proteomics demonstrated that mouse kidneys with CI-AKI had downregulated proteins involved in mitochondrial dynamics and upregulated mitophagy-associated proteins. The beneficial effects of TRPA1 activation/overexpression on CI-AKI were associated with improved mitochondrial function, decreased mitochondrial fission and oxidative stress, enhanced mitophagy, and less apoptosis of renal tubular cells. TRPA1-induced decreases in mitochondrial fission were linked to upregulated fusion-related proteins (mitofusin 1, mitofusin 2 and optic atrophy 1) and downregulated fission mediator, phosphorylated dynamin-related protein 1 (Drp1). Importantly, inhibition of Drp1 with mitochondrial division inhibitor 1 improved CI-AKI. In addition, the decreased mitochondrial fission was also mediated by inactivation of AMP-activated protein kinase which mediates mitochondrial biogenesis. The findings suggest that TRPA1 plays a protective role in CI-AKI through regulating mitochondrial fission/fusion, biogenesis, and dysfunction. Activating TRPA1 may become novel therapeutic strategies for the prevention of CI-AKI.

Preoperative Vascular Imaging in Lower Extremity Free Flap Reconstruction: Comparison Between Imaging Modalities.

BACKGROUND: Adequate vascular anatomy and perfusion status are essential for successful lower extremity free tissue transfer. Computed tomography angiography (CTA) is widely available, minimally invasive, and enables visualization of soft tissues and bones. Angiography permits temporal evaluation of flow, identifies potential needs for concurrent endovascular interventions, and enhances visibility in the setting of hardware. Despite widespread availability of these imaging modalities, no standardized algorithm for preoperative imaging prior to lower extremity free flap reconstruction exists. METHODS: Current Procedural Terminology (CPT) codes identified patients undergoing free flap reconstruction of the lower extremity over an 18-year period (2002-2020). Electronic medical records were reviewed for patient, treatment, and imaging characteristics, and pre- and post-imaging laboratory values. Outcomes included imaging findings and related complications and surgical outcomes. RESULTS: In total, 405 patients were identified, with 59% (n = 238) undergoing preoperative imaging with angiography, 10% (n = 42) with CTA, 7.2% (n = 29) with both imaging modalities, and 24% (n = 96) with neither performed. Forty percent (122 of 309) of patients who underwent preoperative imaging had less than 3-vessel runoff. Four patients developed contrast-induced nephropathy (CIN) after angiography only and one after having both CTA and angiography. Vessel runoff on CTA and angiography demonstrated moderate correlation. CONCLUSION: Most patients undergoing lower extremity free tissue transfer underwent preoperative imaging with angiography and/or CTA, 40% of which had less than 3-vessel runoff. Both angiography and CTA had low complication rates, with no statistically significant risk factors identified. Specifically, the incidence of CIN was not found to be significant using either modality. We discuss our institutional algorithm to aid in decision-making for preoperative imaging prior to lower extremity free flap reconstruction. Specifically, we recommend angiography for patients with peripheral vascular disease, internal hardware, or distal defects secondary to trauma.

Reduction in the risk of contrast-induced nephropathy using enhanced external counter-pulsation in patients with chronic kidney disease.

OBJECTIVE: To evaluate the efficacy of EECP in the prevention of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). METHODS: A prospective trial was undertaken in the participants. A total of 280 patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 who underwent percutaneous coronary artery procedures were enrolled and divided into two groups: the control group (n = 100) and the EECP group (n = 180). All patients received extracellular fluid volume expansion therapy with 0.9% normal saline, and patients in the EECP groups were also treated with EECP. The renal function indexes of the two groups were determined 48-72 h after coronary artery procedures. RESULTS: In the EECP group, the BUN and serum creatinine (Scr) after coronary artery procedures were significantly lower than those before coronary artery procedures (BUN: 8.4 ± 3.5 vs. 6.6 ± 2.7 mmol/L, p < 0.001; Scr: 151.9 ± 44.7 vs. 144.5 ± 48.3 µmol/L, p < 0.001), while the eGFR was significantly increased (43.6 ± 11.4 vs. 47.1 ± 13.9 ml/min/1.73 m2, p < 0.001). The degree of Scr elevation was lower in the EECP group than in the control group (12.4 ± 15.0 vs. 20.9 ± 24.8 µmol/L, p = 0.026). Additionally, the EECP group had a lower incidence of post-procedures Scr elevation than the control group (36.5 vs. 48.0%, p = 0.042), a higher incidence of post-procedures eGFR elevation (62.2 vs. 48.0%, p = 0.021), and a lower risk of CIN (1.1 vs. 6.0%, p = 0.019). CONCLUSION: EECP therapy has a protective effect on renal function and can reduce the risk of CIN in patients with CKD.

Clinical Audit in the Elderly by Assessing Hydration and Renal Functions Before and After Contrast CT Scans at District Headquarters Hospital, Dera Ismail Khan, Pakistan.

Introduction Contrast-induced nephropathy (CIN) is a serious risk involved in computed tomography (CT) scans, particularly for older people. The main idea of this clinical audit was to assess current practices regarding renal function tests (RFTs) and hydration status before and after contrast CT scans in older patients at District Headquarters Hospital (DHQ), Dera Ismail Khan, Pakistan, and to implement recommendations for improvement. CIN is a form of acute kidney injury that occurs after the administration of contrast dye used in imaging procedures and is characterized by a sudden deterioration in renal functions. Methods This clinical audit checked adherence to renal protection protocols in elderly patients undergoing contrast CT scans. Conducted over three cycles from July 5 to August 15, 2022, this clinical audit included 30 patients aged 75 and above. Each cycle had 10 patients, divided equally between males and females, and further categorized into age groups of 75-85 years and 86-95 years. Data collection involved reviewing patient files, medication charts, and CT scan reports. Compliance with RFT documentation and hydration before and after the CT scan was assessed against the standards set by Basildon and Thurrock University Hospitals NHS Foundation Trust. Data were analyzed using Microsoft Excel 2023 (Microsoft® Corp., Redmond, WA), and graphs were created using Microsoft Word 2023 (Microsoft® Corp., Redmond, WA). Results The mean age ± standard deviation (SD) for males was 81.8 ± 5.01 in the first cycle, 83.4 ± 6.46 in the second cycle, and 82.4 ± 4.72 in the third cycle. For females, the mean age ± SD was 83.2 ± 5.80 in the first cycle, 85.2 ± 6.41 in the second cycle, and 83.0 ± 6.12 in the third cycle. The first audit cycle revealed that, while all patients (100%) had their RFTs documented before the CT scan, only 20% were adequately hydrated pre-scan, and none (0%) had RFTs performed post scan. Post-scan hydration was also low at 20%. These findings highlighted gaps in adherence to renal protection protocols. The second cycle showed improvements, with pre-scan hydration adherence increasing to 80%, post-scan RFTs to 60%, and post-scan hydration to 70%. By the third cycle, full compliance (100%) was achieved across all standards, including pre- and post-scan renal functions test and hydration. Conclusion The clinical audit at District Headquarters Hospital, Dera Ismail Khan, addressed gaps in renal protection protocols for elderly patients undergoing contrast CT scans. The audit improved adherence over three cycles through targeted interventions, including staff training, implementation of checklists, patient education, modifying the reporting format, and providing instructions in the local language. It also highlighted the importance of continuous education and regular monitoring. The clinical audit would be expanded to another hospital within the medical teaching institute, Dera Ismail Khan. This measure will maintain and enhance patient care, prevent CIN, and improve the renal health of elderly patients.

Zero-contrast transcatheter closure of sinus venosus defect in advanced renal failure.

Transcatheter closure of sinus venosus defect (SVD) is an emerging intervention that utilizes a covered stent to redirect the right upper pulmonary vein to the left atrium. Preprocedural computed tomography analysis, as well as the interventional procedure, necessitates the use of radiographic contrast media. Contrast use is prohibited in patients with advanced kidney disease, who also carry high surgical risks of cardiopulmonary bypass. Transesophageal echocardiography-guided catheter intervention with zero contrast use is presented in this report, along with technical details about planning the procedure. Covered stent exclusion of SVD without contrast use has not been reported in the literature so far.

Vitamin E for the Prevention of Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis.

Contrast-induced nephropathy (CIN) is a serious condition that may develop in patients undergoing diagnostic radiologic procedures. Several treatments have been assessed to prevent CIN development. This study aims to assess the efficacy and safety of vitamin E in the prevention of CIN compared to intravenous (IV) saline hydration. The literature search included MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, the Web of Science, ProQuest, and Scopus for articles published until May 11, 2024, without language or time limits. The outcomes included the incidence of CIN, new-onset dialysis, and death (primary), as well as the change in serum creatinine and glomerular filtration rate (GFR) (secondary). Numerical and dichotomous outcomes were presented as standardized mean difference (SMD) and risk ratio (RR), respectively, with 95% confidence intervals (CI). Six clinical trials were included. Vitamin E was administered orally in varying doses, but one study used IV infusion. Vitamin E decreased the risk of developing CIN by 59% (n=5; pooled RR: 0.41; 95% CI: 0.25, 0.65; P<0.001) compared to IV hydration. None of the patients required renal replacement therapy. One patient on vitamin E died due to the occurrence of acute coronary syndrome. Vitamin E is a promising effective prophylaxis against CIN. However, the number of included studies and their sample sizes are small. The studies showed several limitations. There is a need for further high-quality clinical trials to ascertain the effectiveness of vitamin E compared to IV hydration and to compare vitamin E to other therapies, such as N-acetyl cysteine.

Anisodamine for the prevention of contrast-induced nephropathy in patients with acute coronary syndrome: a pilot systematic review and meta-analysis of randomized controlled trials.

Introduction: Contrast-induced nephropathy (CIN) is a common post-procedural complication of percutaneous coronary intervention for acute myocardial infarction (AMI). Anisodamine hydrobromide is an alkaloid that has demonstrated efficacy in improving microcirculation. This meta-analysis aims to evaluate the reno-protective effects of Anisodamine in patients undergoing percutaneous coronary intervention (PCI) for AMI. Methods: PubMed, Embase, Cochrane Library, Scopus, and clinicaltrials.gov were searched from inception to January 2024 for randomized controlled trials (RCTs) comparing the efficacy of Anisodamine in preventing the development of CIN. Outcomes of interest included the incidence of CIN, serum creatinine levels, and estimated glomerular filtration rate (eGFR). A random-effects model was used for pooling standard mean differences (SMDs) and odds ratios (ORs) with a 95% CI. Statistical significance was considered at a P less than 0.05. Results: Three RCTs involving 563 patients were included. Anisodamine was associated with a reduction in the incidence of CIN [OR: 0.44; 95% CI: 0.28, 0.69; P=0.0003], a reduction in serum creatinine levels at 48 [SMD: -6.78; 95% CI: -10.54,-3.02; P=0.0004] and 72 h [SMD: -6.74; 95% CI: -13.33,-0.15; P=0.03], and a higher eGFR at 24 [SMD: 5.77; 95% CI: 0.39, 11.14; P=0.03], and 48 h [SMD: 4.70; 95% CI: 2.03,7.38; P=0.0006]. The levels of serum creatinine at 24 h and eGFR value at 72 h were comparable between both groups. Conclusions: Anisodamine has demonstrated clinical efficacy in ameliorating the development of CIN post-PCI in AMI patients. Large, multi-centric RCTs are warranted to evaluate the robustness of these findings.

Association between Pan-Immune-Inflammation Value and Contrast-Induced Nephropathy with Coronary Angiography.

Background: Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. Considering the pivotal role of inflammation in CIN development, the use of peripheral blood-based indexes may be an easily available biomarker to predict CIN risk. Therefore, in the present study, we evaluated the association between the pan-immune-inflammation value (PIV) and the risk of CIN. Patients and Methods: A total of 1343 patients undergoing coronary angiography (CAG) were included. The PIV was calculated with the following equation: (neutrophil count × platelet count × monocyte count)/lymphocyte count. Multivariable regression analyses were used to determine the association between clinical and laboratory parameters and CIN development. Results: The median age of the cohort was 58 (IQR 50-67), and 48.2% of the patients were female. CIN developed in 202 patients (15%) in follow-up. In multivariate analyses, older age (OR: 1.015, 95% CI: 1.002-1.028, p = 0.020) and higher PIV levels (OR: 1.016, 95% CI: 1.004-1.028, p = 0.008) were associated with a higher CIN risk, while the use of antiplatelet agents was associated with a lower risk of CIN (OR: 0.670, 95% CI: 0.475-0.945, p = 0.022). Conclusions: We demonstrated that the risk of CIN was significantly higher in patients with higher PIV and older patients in a large cohort of patients undergoing CAG for stable ischemic heart disease. If supported with prospective evidence, PIV levels could be used as a minimally invasive reflector of CIN.

Dysregulation of ferroptosis may participate in the mitigating effect of CoCl2 on contrast-induced nephropathy.

BACKGROUND: Contrast agents can directly or indirectly induce renal tubular ischemia and hypoxic damage. Given that cobalt chloride (CoCl2) can protect renal tubules, the protective effect and potential mechanism of action of CoCl2 on contrast-induced nephropathy (CIN) warrant investigation. METHODS: A CIN mouse model was established to determine the protective effect of CoCl2 on renal injury in vivo. Then, TMT-based proteomics was performed to determine the differentially expressed proteins (DEPs), following which, enrichment analyses of gene ontology and the KEGG pathway were performed. In vitro, a CIN model was constructed with renal tubular epithelial cells (HK-2) to determine the effect of CoCl2 on potential targets and the role of the key protein identified from the in vivo experiments. RESULTS: CoCl2 treatment decreased the levels of BUN and serum creatinine (sCr), while increasing the levels of urea and creatinine (Cr) in the urine of mice after CIN injury. Damage to the renal tubules in the CoCl2 treatment group was significantly less than in the CIN model group. We identified 79 DEPs after treating the in vivo model with CoCl2, and frequently observed ferroptosis-related GO and KEGG pathway terms. Of these, Hp (haptoglobin) was selected and found to have a strong renoprotective effect, even though its expression level in kidney tissue decreased after CoCl2 treatment. In HK-2 cells, overexpression of Hp reduced the ferroptosis caused by erastin, while knocking down Hp negated the attenuation effect of CoCl2 on HK-2 cell ferroptosis. CONCLUSION: CoCl2 attenuated kidney damage in the CIN model, and this effect was associated with the decrease in ferroptosis mediated by Hp.

Safety of ultra-low contrast coronary angiography in patients with acute kidney injury.

BACKGROUND: Ultra-low contrast administration during coronary angiography has been previously shown to be feasible and safe among patients with stable chronic kidney disease. In the present study, we investigate the safety of ultra-low contrast coronary angiography in patients with pre-existing acute kidney injury (AKI). METHODS: The study was a retrospective single-center evaluation of hospitalized patients who had AKI and required coronary angiography. Ultra-low contrast use was defined as ≤18 mL of contrast media. RESULTS: The cohort consisted of a case series of eight inpatients with AKI who required coronary angiography. The mean age was 57 (±16) years and half were females. All patients had chronic kidney disease with a mean baseline estimated glomerular filtration rate of 34 (±17) mL/min/1.73 m2. The mean creatinine before angiography was 3 (±1) mg/dL and volume of contrast administered was 14 (±4) mL. One patient had a 0.1 mg/dL increase in creatinine during admission, and no patients had further AKI up to 1-week postprocedure. CONCLUSIONS: The current data suggest that ultra-low contrast coronary angiography can be safely performed in patients with pre-existing AKI The study should be viewed as hypothesis-generating due to its small sample size. A larger cohort is required to validate the results.

Association between Systolic Pulmonary Artery Pressure and Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction.

Introduction: The objective of this study was to examine whether there is an elevated risk of developing contrast induced nephropathy (CIN) in patients with high systolic pulmonary artery pressure (SPAP) in ST-segment elevation myocardial infarction (STEMI). Methods: A total of 213 patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention were enrolled in the study. The patients were stratified into two groups based on the presence of CIN. Comparisons between these groups included an assessment of demographic characteristics, laboratory findings, and risk factors. SPAP was calculated for each patient upon admission through echocardiography, and subsequent comparisons were performed between the groups. Results: The distribution of the study population was as follows: 33 (15.5%) were CIN(+) and 180 (84.5%) were CIN(-). SPAP [odds ratio (OR) = 1.295, 95% confidence interval (CI): 1.157-1.451, p < 0.001], and diabetes (OR = 1.241, 95% CI: 1.194-1.287, p = 0.013) were identified as independent factors associated with CIN development. In receiver operating characteristic curve analysis, SPAP above a cut-off level of 31.5 mmHg could determine the presence of CIN with a sensitivity of 91.0% and specificity of 90.0% (p < 0.001). Conclusions: SPAP on echocardiography is an independent predictor of the development of CIN in patients with STEMI. Its ease of calculation renders it a valuable tool for predicting CIN among STEMI patients.

The Effect of Contrast Rationing on the Development of Acute Kidney Injury During the Global Contrast Shortage.

BACKGROUND: In April of 2022, the COVID-19 pandemic resulted in a global shortage of intravenous contrast media (ICM), which led our health care system to implement rationing measures. STUDY OBJECTIVES: We set out to determine if the reduction in ICM use was associated with a change in the incidence of acute kidney injury (AKI). METHODS: We conducted a multicenter retrospective cohort analysis to compare the incidence of AKI in patients who presented before and after ICM rationing. Adult patients who had a CT of the abdomen performed who had at least 2 creatinine measurements, at least 24 h apart, were included. The maximum increase in creatinine was determined by subtracting the maximal creatinine obtained within 7 days with the initial creatinine. The primary outcome was the development of AKI. RESULTS: A total of 2168 patients met inclusion criteria (1082 before; 1086 after). There was no significant difference in age, gender, comorbid conditions, disposition, or initial estimated glomerular filtration rate between groups. In the prerationing group, 87.7% of patients received ICM compared to 42.7% after. There was no significant difference in the development of AKI between groups (11.1% vs. 11.0%), including when stratified by baseline renal function and adjusted for age, sex, race, comorbid conditions, and emergency severity index. CONCLUSIONS: The dramatic reduction in ICM use that resulted from the global shortage was not associated with a change in the incidence of AKI. This reinforces the results of previous studies which have failed to find evidence of a relationship between ICM administration and AKI.

Spironolactone for Preventing Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Chronic Kidney Disease.

Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5 mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, P < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; P < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; P = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.

Evaluating biomarkers for contrast-induced nephropathy following coronary interventions: an umbrella review on meta-analyses.

BACKGROUND: Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. METHODS: A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. RESULTS: Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86-9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85-6.65), 3.58 (95% CI 2.75-4.66), and 2.85 (95% CI 2.13-3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17-0.37), ES: 0.25 (95% CI 0.13-0.50), ES: 0.26 (95% CI 0.17-0.41), and ES: 0.39 (0.28-0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05). CONCLUSION: NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN.

The effect of the concurrent use of Dexmedetomidine (DEX) during the perioperative period on the renal function of patients following craniocerebral interventional surgery.

BACKGROUND: Craniocerebral interventional surgery is a common and essential treatment for cerebrovascular diseases. Despite continuous progress in interventional diagnosis and treatment technology, there is no effective method to alleviate contrast-induced kidney injuries. In this retrospective cohort study, we investigated the effect of the concurrent use of Dexmedetomidine (DEX) during the perioperative period on the renal function of patients following craniocerebral interventional surgery. METHODS: We identified 228 cases of patients underwent craniocerebral interventional surgery from January 2018 to March 2022. Patients who used DEX during general anesthesia were in the DEX group (DEX group) or that did not use dexmedetomidine as the control group (CON group). The markers of kidney injury were recorded before and within 48 h after surgery. RESULTS: Compared with CON group, the urea nitrogen (BUN) of the DEX group decreased significantly on the first day and the second day after surgery (p < 0.05). The serum cystatin-C and the blood urea nitrogen/creatinine ratio (BUN/Cr) was significantly lower than that in CON group on the second day (p < 0.05). The urine output in the DEX group increased significantly, and the mean arterial pressure (MAP) was higher than the CON group (p < 0.01). There was no difference in postoperative complications, ICU stay time and hospitalization time between the two groups. CONCLUSION: The combined use of dexmedetomidine in general anesthesia for craniocerebral interventional surgery can reduce BUN levels within 48 h after surgery, significantly increase intraoperative urine volume, maintain intraoperative circulation stability.