PP162 Use Of The RenalGuard® System To Prevent Contrast-Induced Nephropathy

2021 ◽  
Vol 37 (S1) ◽  
pp. 23-23
Author(s):  
Perizat Bektassova ◽  
Valeriy Benberin ◽  
Andrey Avdeyev ◽  
Nasrulla Shanazarov ◽  
Ruslan Akhmedullin ◽  
...  
Keyword(s):  
Contrast Media ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Contrast Induced Nephropathy ◽  
Management Guidelines ◽  
Forced Diuresis ◽  
Risk Patients ◽  
Intravenous Hydration ◽  
Clinical Advantage ◽  
Meta Analyses

IntroductionContrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI) following the administration of contrast media for coronary interventions or procedures such as diagnostic coronary angiography. The optimal way of preventing CIN remains uncertain. However, preliminary intravenous hydration, minimizing the volume of contrast media, and avoiding the use of nephrotoxic drugs are recommended in current management guidelines. The aim of this analysis was to compare the RenalGuard® system with standard care.MethodsA comprehensive literature search was conducted in PubMed and Google Scholar to identify evidence on the clinical and economic effectiveness of forced diuresis with matched hydration using the RenalGuard system for preventing CIN. Multiple criteria decision analysis (MCDA) was used to assess the performance of the method in hospital settings, compared with alternative options.ResultsSeveral systematic reviews with meta-analyses demonstrated that forced diuresis with matched hydration using the RenalGuard system was associated with a significantly lower relative risk of CIN among high-risk patients with chronic kidney disease. However, the evidence supporting the advantage of the proposed method over current forced diuresis techniques with manual calculation of the volumes for matched hydration in the hospital setting was limited.ConclusionsAlthough the effectiveness of the RenalGuard system has been demonstrated in meta-analyses, its clinical advantage over forced diuresis with manual hydration calculation is uncertain. It is also worth noting the lack of evidence to date on this technology, the fact that it is still at the research stage in some countries, and that it is not included in CIN management guidelines.

scholarly journals ACE-I/ARB Therapy prior to Contrast Exposure: What Should the Clinician Do?

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Robert Kalyesubula ◽  
Peace Bagasha ◽  
Mark A. Perazella
Keyword(s):  
Contrast Media ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Current Evidence ◽  
Contrast Induced Nephropathy ◽  
Contrast Exposure ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Prolonged Hospital

Contrast-induced nephropathy (CIN) is now one of the three leading causes of acute kidney injury in the world. A lot is known about the risk factors of CIN, yet it remains a major cause of morbidity, end stage renal disease, prolonged hospital stay, and increased costs as well as a high mortality. Many patients undergoing contrast-based radiological investigations are treated with angiotensin converting inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) for their cardiac and renal benefits and their known mortality benefits. However, controversy exists among clinicians as to whether ACE-Is and ARBs should be continued or discontinued prior to contrast media exposure. In this paper we review the current evidence on ACE-I/ARB therapy for patients undergoing procedures involving use of contrast media and provide recommendations as to whether these drugs should be continued or held prior to contrast exposure.

scholarly journals P0645EDARAVONE MAY DECREASE THE INCIDENCE OF CONTRAST INDUCED ACUTE KIDNEY INJURY (CI-AKI)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dmytro Ivanov ◽  
Mariia Ivanova ◽  
Illia Burlachenko
Keyword(s):  
Contrast Media ◽  
Kidney Injury ◽  
Peroxyl Radicals ◽  
Controlled Study ◽  
Control Group ◽  
Ckd Stage ◽  
Intravenous Hydration ◽  
Group A ◽  
Group B ◽  
And Control

Abstract Background and Aims Edaravone is a low-molecular-weight antioxidant drug targeting peroxyl radicals of reactive oxygen species and has shown clinical efficacy in patients with acute ischemic stroke. We have conducted a multicenter open prospective randomized controlled study to evaluate the efficacy of edaravone in preventing AKI in patients with CKD 3b-4 stages. Method The study included 2 groups of patients aged 46 to 68 (55 ± 3): group A (n=16) with CKD stage 3b or 4 (eGFR EPI 32 ± 4 ml/min) that received intravenous edaravone 30 mg bid on 0,1,2 day of contrast media infusion and control group B (n=20) with CKD stage 3b or 4 (eGFR EPI 33 ± 3 ml/min) with no edaravone intervention during CT coronarography. Patients of both groups received intravenous hydration with 0.9% sodium before CT. Primary endpoint: CIN onset in 48 hours after contrast media infusion and need for RRT. Secondary endpoint: serum potassium level above 5.5 mmol/l. Results CIN onset was obtained in 4 patients of group A and 12 patients of group B (p>0,05, RR 0.417, RRR 0.583, RD 0.350, NNT 2.857). Other results are presented in table

scholarly journals Contrast Media Viscosity versus Osmolality in Kidney Injury: Lessons from Animal Studies

2014 ◽  
Vol 2014 ◽  
pp. 1-15 ◽  
Author(s):  
Erdmann Seeliger ◽  
Diana C. Lenhard ◽  
Pontus B. Persson
Keyword(s):  
Clinical Trials ◽  
Contrast Media ◽  
Glomerular Filtration ◽  
Animal Studies ◽  
Kidney Injury ◽  
Renal Tubules ◽  
Fluid Viscosity ◽  
Iodinated Contrast ◽  
Tubular Flow ◽  
Meta Analyses

Iodinated contrast media (CM) can induce acute kidney injury (AKI). CM share common iodine-related cytotoxic features but differ considerably with regard to osmolality and viscosity. Meta-analyses of clinical trials generally failed to reveal renal safety differences of modern CM with regard to these physicochemical properties. While most trials’ reliance on serum creatinine as outcome measure contributes to this lack of clinical evidence, it largely relies on the nature of prospective clinical trials: effective prophylaxis by ample hydration must be employed. In everyday life, patients are often not well hydrated; here we lack clinical data. However, preclinical studies that directly measured glomerular filtration rate, intrarenal perfusion and oxygenation, and various markers of AKI have shown that the viscosity of CM is of vast importance. In the renal tubules, CM become enriched, as water is reabsorbed, but CM are not. In consequence, tubular fluid viscosity increases exponentially. This hinders glomerular filtration and tubular flow and, thereby, prolongs intrarenal retention of cytotoxic CM. Renal cells become injured, which triggers hypoperfusion and hypoxia, finally leading to AKI. Comparisons between modern CM reveal that moderately elevated osmolality has a renoprotective effect, in particular, in the dehydrated state, because it prevents excessive tubular fluid viscosity.

scholarly journals THE INCIDENCE AND RISK FACTORS OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOPLASTY.

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Mukesh Kumar Sharma ◽  
Pradeep Kurmi ◽  
Deepak Ameta ◽  
Chandra Bhanu Chandan
Keyword(s):  
Risk Factors ◽  
Contrast Media ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Absolute Increase ◽  
Increased Risk ◽  
Adequate Hydration

Background: Contrast induced nephropathy remains important cause of hospital-acquired acute kidney injury and affects between 2% of the general population to 50% of high-risk subgroups following coronary intervention. Objectives: To determine the incidence and to study the various risk factors associated with CIN. Patients and Methods: In our study, total of 212 patients (154 males and 58 females) who received non ionic iso osmolar contrast media during percutaneous transluminal coronary intervention (PCI) were included. We diagnosed CIN by a relative increase of >25% or an absolute increase of >0.5 mg/dl in serum creatinine levels two days after procedure. Results: The incidence of CIN in our study was 15.1%. In univariate analysis: age >75 years, hypertention diabetes mellitus (DM), heart failure, hypotension, CKD [creatinine  >1.5mg/dl] and increased contrast volume were associated with increased  risk of CIN whereas,  gender, anemia and use of IABP failed to reach statistical significance. As the number of risk factor and/or volume of contrast increases, the incidence of CIN increases exponentially. Conclusion: Since there is no established treatment for CIN, all possible efforts should be taken to prevent it from occurring by identifying patients at risk. CIN is related with many risk factors, so whenever multiple risk factors are present in an individual patient, lowest dose of contrast should be used and adequate hydration should be given. Key Words: Contrast-induced nephropathy, Non ionic iso-osmolar contrast media, percutaneous coronary intervention.

scholarly journals Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
D. Patschan ◽  
I. Buschmann ◽  
O. Ritter
Keyword(s):  
Contrast Media ◽  
Clinical Studies ◽  
Preventive Measures ◽  
Severe Complication ◽  
Iodinated Contrast Media ◽  
Preventive Strategies ◽  
Contrast Induced Nephropathy ◽  
The Past ◽  
Iodinated Contrast ◽  
Meta Analyses

Contrast-induced nephropathy (CIN) is a frequent and severe complication in subjects receiving iodinated contrast media for diagnostic or therapeutic purposes. Several preventive strategies were evaluated in the past. Recent clinical studies and meta-analyses delivered some new aspects on preventive measures used in the past and present. We will discuss all pharmacological and nonpharmacological procedures. Finally, we will suggest individualized recommendations for CIN prevention.

scholarly journals Why Is Diabetes Mellitus a Risk Factor for Contrast-Induced Nephropathy?

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Samuel N. Heyman ◽  
Christian Rosenberger ◽  
Seymour Rosen ◽  
Mogher Khamaisi
Keyword(s):  
Reactive Oxygen Species ◽  
Contrast Media ◽  
A Priori ◽  
Reactive Oxygen ◽  
Kidney Injury ◽  
Oxygen Species ◽  
Contrast Induced Nephropathy ◽  
Predisposing Factor ◽  
And Oxidative Stress ◽  
Regulation Of Vascular Tone

Contrast-induced nephropathy (CIN) remains a leading cause of iatrogenic acute kidney injury, as the usage of contrast media for imaging and intravascular intervention keeps expanding. Diabetes is an important predisposing factor for CIN, particularly in patients with renal functional impairment. Renal hypoxia, combined with the generation of reactive oxygen species, plays a central role in the pathogenesis of CIN, and the diabetic kidney is particularly susceptible to intensified hypoxic and oxidative stress following the administration of contrast media. The pathophysiology of this vulnerability is complex and involves various mechanisms, including a priori enhanced tubular transport activity, oxygen consumption, and the generation of reactive oxygen species. The regulation of vascular tone and peritubular blood flow may also be altered, particularly due to defective nitrovasodilation, enhanced endothelin production, and a particular hyperresponsiveness to adenosine-related vasoconstriction. In addition, micro- and macrovascular diseases and chronic tubulointerstitial changes further compromise regional oxygen delivery, and renal antioxidant capacity might be hampered. A better understanding of these mechanisms and their control in the diabetic patient may initiate novel strategies in the prevention of contrast nephropathy in these susceptible patients.

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