scholarly journals Kidney Donor Contrast Exposure and Recipient Outcomes

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Shivani Bajpai, MS2 ◽  
Richard S. Mangus, MD MS FACS
Keyword(s):  
Contrast Media ◽  
Kidney Injury ◽  
Kidney Donors ◽  
Post Transplant ◽  
Kidney Recipients ◽  
Hospital Patients ◽  
Transplant Kidney ◽  
Contrast Exposure ◽  
The Impact ◽  
Single Organ

The use of contrast media in hospital procedures has been increasing since its conception in 1923. Despite developments in utility and safety overtime, contrast media has been associated with inducing kidney injury in patients. Several studies have investigated contrast-induced nephropathy (CIN) in hospital patients and kidney recipients post-transplant. However, there are few studies that connect donor contrast exposure to recipient kidney outcomes. This was a single-center, retrospective study on single-organ deceased kidney donors and recipients (n=1585) to explore the impact of pre-transplant contrast procedures on post-transplant kidney outcomes. The results indicated that the first, peak, and last serum creatinine values were not useful markers of CIN in kidney donors. An analysis of those donors who had contrast exposure and those who did not, as well as the amount of contrast exposure in the donor prior to transplant did not conclude significant impact on the recipient kidney outcomes at time points ranging from 7 days to 1-year post transplant. This data provides the largest statistical evidence currently available on this topic; it establishes the foundation for various research developments moving forward. 

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 The Impact of Anti-Microbial Drug-Drug Interactions on Acute Kidney Injury after Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Fumiya Wada ◽  
Yasuyuki Arai ◽  
Junya Kanda ◽  
Toshio Kitawaki ◽  
Masakatsu Hishizawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Drug Interactions ◽  
Antimicrobial Agents ◽  
Hematopoietic Cell Transplantation ◽  
Kidney Injury ◽  
Time Dependent ◽  
Post Transplant ◽  
Increased Risk ◽  
The Impact

Introduction: Acute kidney injury (AKI) is one of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT), and several studies have demonstrated a relationship between poor outcome and the concomitant AKI in the early phase after allo-HCT. Among various post-transplant factors, usage of antimicrobial agents, especially in cases where multiple agents are combined, may be one of the major causes of post-transplant AKI, due the potential nephrotoxicity of each agent and drug-drug interactions. An association between the combination of vancomycin (VCM) with piperacillin/tazobactam (PIPC/TAZ) and increased risk of developing AKI after allo-HCT has been reported; however, no reports have demonstrated the impact of other combinations on post-transplant AKI. Herein, we performed a retrospective analysis to compare the incidence of AKI according to selected antimicrobial agents, using a database with information covering the time-dependent administrative status of all the agents involved. Methods: We included patients with hematological malignancies who received allo-HCT between 2006 and 2018 in Kyoto University, Kyoto, Japan to evaluate the incidence and risk factors of AKI early after transplantation (before Day100). The incidence of AKI was defined according to Acute Kidney Injury Network (AKIN) classification and evaluated, considering early death as a competing risk. Administrative status of each antimicrobial agent was treated as a time-dependent covariate, and the synergetic effects on AKI by multiple agents in combination were evaluated as p for interaction. Results: In total, 465 transplant cases (416 patients) were included. The median age at HCT was 49 years old (range, 17-70). Among these, 104 cases received a related-donor transplant (64 patients received bone marrow and 40 peripheral-blood stem cell grafts), 207 received a transplant from unrelated donors, and 154 received a single-unit cord-blood transplant. The median value for pre-transplant serum creatinine (sCr) was 0.6 (range, 0.20-1.68). The cumulative incidence of AKI at Day100 was 40.0%, and overall survival (OS) at 3 years after HCT was 43.5% in patients with AKI while 70.9% in those without AKI (hazard ratio [HR] = 2.63, 95% confidence interval = 1.95-3.55, p < 0.01). Being male and having a higher pre-transplant sCr were significant risk factors for AKI (HR = 1.53, p < 0.01 and HR = 4.21, p < 0.01, respectively). After HCT, 34 types of oral or intravenous antimicrobial agents (17 antibiotics, 6 antivirals, and 11 antifungals) were utilized across the entire cohort. A higher incidence of AKI was significantly associated with the use of intravenous ciprofloxacin, foscarnet (FCN), ganciclovir (GCV), liposomal amphotericin B (L-AMB), meropenem (MEPM), PIPC/TAZ, and VCM (p < 0.05). Next, we investigated the synergistic impacts of using anti-pseudomonal antibiotics and anti-methicillin resistant staphylococcus aureus (MRSA) agents, because empiric treatment of febrile neutropenia after HCT often relies on this combination, i.e. CFPM, PIPC/TAZ, or MEPM in combination with VCM or teicoplanin (TEIC). As a result, sole administration of VCM was associated with a higher incidence of AKI; this effect was enhanced when VCM was used in combination with PIPC/TAZ (HR = 3.03, p < 0.01 for VCM without PIPC/TAZ; HR = 4.38, p < 0.01 for VCM with PIPC/TAZ), indicating the existence of interaction between VCM and PIPC/TAZ. However, for the concomitant use of VCM plus CFPM or MEPM, no synergistic interaction was observed with regard to the increased incidence of AKI. In addition, administration of TEIC alone and any combination used with TEIC were not associated with an increased risk of AKI. An increased risk of AKI was also confirmed for the combination of MEPM plus GCV or FCN, and GCV plus L-AMB. Conclusions: AKI was significantly associated with poorer OS, and specific antimicrobial combinations were suggested to increase the risk of AKI. Avoidance of such combinations should be considered to preserve renal function and to reduce AKI-related morbidity and mortality. Disclosures No relevant conflicts of interest to declare.

scholarly journals Surgical Complications in Early Post-transplant Kidney Recipients

2017 ◽  
Vol 49 (4) ◽  
pp. 821-823 ◽  
Author(s):  
H. Pinto ◽  
R. Leal ◽  
L. Rodrigues ◽  
L. Santos ◽  
C. Romãozinho ◽  
...  
Keyword(s):  
Surgical Complications ◽  
Post Transplant ◽  
Kidney Recipients ◽  
Transplant Kidney

scholarly journals Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mehdi Maanaoui ◽  
François Provôt ◽  
Sébastien Bouyé ◽  
Arnaud Lionet ◽  
Rémi Lenain ◽  
...  
Keyword(s):  
Renal Function ◽  
Impaired Renal Function ◽  
Cox Model ◽  
Organ Procurement ◽  
Graft Loss ◽  
Post Transplantation ◽  
Kidney Donors ◽  
Very Old ◽  
Kidney Recipients ◽  
The Impact

AbstractAs the use of elderly kidney donors for transplantation is increasing with time, there is a need to understand which factors impact on their prognosis. No data exist on the impact of an impaired renal function (IRF) in such population. 116 kidney recipients from deceased kidney donors over 70 years were included from 2005 to 2015 in a single-center retrospective study. IRF before organ procurement was defined as a serum creatinine above 1.0 mg/dl or a transient episode of oligo-anuria. Mean ages for donors and recipients were respectively 74.8 ± 3.5 and 66.7 ± 8.0. Graft survival censored for death at 5 years was of 77%. Using a multivariate analysis by Cox model, the only predictor of graft loss present in the donor was IRF before organ procurement (HR 4.2 CI95[1.8–9.7]). IRF was also associated with significant lower estimated glomerular filtration rates up to 1 year post-transplantation. By contrast, KDPI score (median of 98 [96–100]), was not associated with the risk of graft failure. Then, IRF before kidney procurement may define a risk subgroup among very-old deceased kidney donors, in whom pre-implantatory biopsies, dual kidney transplantation or calcineurin inhibitor-free immunosuppressive regimen could help to improve outcomes.

Donor acute kidney injury and its effect on 1‐year post‐transplant kidney allograft fibrosis

2020 ◽  
Vol 34 (2) ◽  
Author(s):  
Dirk J. Windt ◽  
Rajil Mehta ◽  
Dana R. Jorgensen ◽  
Patrick Bou‐Samra ◽  
Sundaram Hariharan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Kidney Allograft ◽  
Post Transplant ◽  
Transplant Kidney

P2660Definition of clinically relevant thresholds of acute kidney injury in patients with ST-elevation myocardial infarctions undergoing primary percutaneous coronary interventions

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Schmucker ◽  
A Fach ◽  
R Osteresch ◽  
T Retzlaff ◽  
S Michel ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Contrast Media ◽  
Kidney Injury ◽  
Fold Increase ◽  
Left Ventricular ◽  
Myocardial Infarctions ◽  
Left Ventricular Ejection ◽  
St Elevation ◽  
The Impact

Abstract Background Although the clinical importance of deteriorating kidney function in patients with ST-elevation-myocardial infarctions (STEMI) on overall prognosis is generally accepted, there is conflicting evidence on the importance of small changes in renal function. Aim of the present study was to calculate clincially relevant thresholds for deterioration of renal function after STEMI. Methods From a large registry of patients with STEMI renal function was estimated calculating the glomerular filtration rate (GFR in ml/min/1.73 m2) with the CKD-EPI-equation. To assess acute kidney injury the ratio GFR (at peak creatinine))/ GFR (at admission) was calculated for each patient (with 1 representing no change). Patients were graded by GFR-reduction and assigned to 11 groups (G1 to G11) each representing 5% intervals. Results Of 6583 patients admitted with STEMI between 2006–2017 3518 (53%) had no change or a change <5% during hospital stay (G1) while 161 (3%) showed a decrease in GFR of ≥50% (G11). The rest of the patients could be attributed to G2- G10 (table). There was a pronounced correlation between extent of GFR-reduction and peak creatine kinase (indicating size of STEMI, r2=0.785; G1: 1521±1684 U/l vs. G11: 2885±2943 U/l, p<0.01) as well as left-ventricular ejection fraction (LVEF) (r2=0.79; G1: 50.9±9% vs. G11: 41.4±10%, p<0.01). However, no such correlation could be detected between GFR-reduction and amount of contrast media (CM) applied (r2=0.05, G1: 141±60 ml vs. G11: 139±61 ml, p=0.5). Analysis of outcome-data (1-year-mortality and major adverse cardiovascular and cerebrovascular events (MACCE: death, stroke, re-infarction)) revealed, that beneath a threshold of 25% deterioration of renal function did not significantly impact prognosis, while higher degrees of deterioration led to a 7-fold increase in mortality and a 5-fold increase in MACCE-rates (table). Impact of GFR-reduction on outcome Group G1 G2 G3 G4 G5 G6 G7 G8 G9 G10 G11 GFR-reduction (in %) 0–4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 ≥50 Patients, n (%) 3518 (53) 881 (13) 717 (11) 492 (7) 327 (5) 196 (3) 119 (2) 88 (1) 48 (1) 36 (1) 161 (3) 1 year mortality (%) 7 4 5 8 7 15 20 22 39 43 50 1-year-MACCE (%) 12 8 8 12 10 19 27 27 49 49 52 Conclusions These data from a large STEMI-registry show that small changes (less than 25%) in GFR did not significantly impact long-term outcome, while the impact was pronounced for all patients beyond that threshold. The degree of renal deterioration furthermore correlated with size of STEMI as well as reduction of LV-function after STEMI while no correlation to amount of contrast media could be found.

scholarly journals Association of Kidney-Related Safety Events with Incident Chronic Kidney Disease in Veterans

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Helman SR ◽  
◽  
Stewart PM ◽  
Siddiqui T ◽  
Fink JC ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Heart Catheterization ◽  
Stepwise Logistic Regression ◽  
Retrospective Case ◽  
Left Heart Catheterization ◽  
Incident Chronic Kidney Disease ◽  
Contrast Exposure ◽  
The Impact

Objective: The impact of Nonsteroidal Anti-Inflammatory Drugs (NSAID) and iodine-based contrast exposures on developing Chronic Kidney Disease (CKD) is controversial. We examined the association of these exposures with the development of CKD in a Veteran population. Methods: A retrospective case-control study of 154,448 veterans from the Veterans Affairs (VA) Corporate Data Warehouse (CDW) database between 2005 and 2014 was conducted to assess the association between incident stage 3 CKD with Acute Kidney Injury (AKI), NSAID use, iodine-based contrast exposures, and comorbid conditions. Stepwise logistic regression was used to determine multivariable adjusted Odds Ratios (OR). Results: The mean age was 59 (SD±13), and the median eGFR was 84 (IQR: 73, 96). AKI was associated with increased odds of CKD (inpatient: OR=3.76, 95% CI: 3.44, 4.11; outpatient: OR=4.73, 95% CI: 4.09, 5.46) and demonstrated escalated odds with >1 episode (inpatient: OR=5.72, 95% CI: 4.71, 6.95; outpatient: OR=8.36, 95% CI: 6.32, 11.06). Months of NSAID prescriptions was associated with CKD, with ORs at >0-6 months, >6-12 months, and >12 months of 1.27 (95% CI: 1.23, 1.32), 1.54 (95% CI: 1.46, 1.63), and 1.69 (95% CI: 1.62, 1.77) respectively. Iodine-based contrast exposure was associated with increased odds of CKD, with ORs for 1-2 Computed Tomography (CT) scans, ≥3CT scans, and left heart catheterization of 1.29 (95% CI: 1.24, 1.35), 1.29 (95% CI: 1.20, 1.28), and 1.38 (95% CI: 1.17, 1.63) respectively. Conclusion: AKI events, NSAID use, and iodine-based contrast exposures are associated with increased odds for developing stage 3 CKD in veterans.

scholarly journals The Impact of Transplant Recipient and Donor Organ Type 2 Diabetes Polygenic Risk Scores on the Development of Early Post-Transplant Diabetes

2021 ◽  
Author(s):  
Abraham Shaked ◽  
Bao-Li Loza ◽  
Elisabet Loon ◽  
Kim Olthoff ◽  
Weihua Guan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Risk Scores ◽  
Polygenic Risk ◽  
Post Transplant ◽  
Kidney Recipients ◽  
Liver And Kidney ◽  
Transplant Candidates ◽  
The Impact

Abstract Post-transplant diabetes mellitus (PTDM) is a complication which reduces allograft and recipient life-span. Polygenic risk scores (PRS) robustly show association with greater type 2 diabetes (T2D) development risk. We examined T2D-PRS in transplant recipients and donors using genome-wide genotyping in 1581 liver recipients, and 1555 donors and 2062 kidney recipients and 533 donors from four centers. Liver and kidney recipient T2D-PRS was associated with pre-transplant T2D and PTDM development. Liver donor, but not kidney donor, T2D-PRS was an independent risk factor for PTDM development. Inclusion of a combined liver recipient and donor T2D-PRS significantly improved PTDM prediction vs clinical characteristics-only models: AUC (95%CI): 67.6% (64.1% − 71.1%) vs. 62.3% (58.8% − 65.8%), p = 0.0001. Liver recipients in the highest quintile of recipient-donor combined T2D-PRS had the greatest PTDM risk: OR (95%CI) = 3.22 (2.07–5.00), p = 1.92E-07, compared to the lowest quintile. T2D-PRS allows identification of transplant candidates with high PTDM risk, for whom early preemptive diabetes management is warranted. Pre-transplant knowledge of donor T2D-PRS in the setting of living liver donation should optimized selection of donors to reduce PTDM.

Evaluating the Proposed Mechanism by Which Atorvastatin Can Protect Renal Tissue against Contrast Media: An Animal study

2019 ◽  
pp. 75-84
Keyword(s):  
Contrast Media ◽  
Kidney Injury ◽  
Saline Group ◽  
Pleiotropic Effect ◽  
Renal Tissue ◽  
Male Rats ◽  
Dependent Manner ◽  
Group 2 ◽  
Dose Dependent ◽  
Media Group

Contrast- induced nephropathy (CIN) is an elevation of serum creatinine of ≥ 0.5 mg/dL from baseline after two to three days of exposure to contrast substance if there is no other cause for acute kidney injury. Atorvastatin may protect normal kidney physiology from contrast- induced kidney injury by effects unrelated to hypolipidemia termed pleiotropic effect by decline of endothelin production, angiotensin system down regulation, and under expression of endothelial adhesion molecules. This study was conducted to assess the strategy by which atorvastatin can achieve protective effect for kidneys after exposure to contrast media in an animal model. A 40 male rats were distributed randomly into 4 groups; ten rats for each: group (1): given normal saline; group (2): CIN group given iopromide as contrast media; group (3): given atorvastatin (20mg/kg) and iopromide; and group (4): given atorvastatin (40mg/kg) and iopromide. Blood collected by cardiac puncture for detection of serum glutathione, malondialdehyde, matrix metalloproteinase-9, and interleukin-18. The results have shown a significant increase in inflammatory and oxidative stress markers in contrast media group, and significant reduction in these markers in atorvastatin treated groups, in a dose-dependent manner. As conclusion, atorvastatin mechanism for protection against CIN in a dose-dependent manner can mediate by anti-inflammatory and antioxidant effects.

Assessment of Acute Kidney Injury in Patients Undergoing Elective Coronary Angiography and Percutaneous Coronary Intervention

2012 ◽  
Vol 5 (1) ◽  
pp. 37-43
Author(s):  
ABMM Alam ◽  
M Moniruzzaman ◽  
MB Alam ◽  
N Islam ◽  
F Khatoon ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Contrast Media ◽  
Creatinine Level ◽  
Ace Inhibitor ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Group I ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Group Ii

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction.Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development.Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12227 Cardiovasc. j. 2012; 5(1): 37-43

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