scholarly journals Atrial Fibrillation and Chronic Kidney Disease—A Risky Combination for Post-Contrast Acute Kidney Injury

2021 ◽  
Vol 10 (18) ◽  
pp. 4140
Author(s):  
Łukasz Kuźma ◽  
Anna Tomaszuk-Kazberuk ◽  
Anna Kurasz ◽  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Kidney Injury ◽  
Post Contrast ◽  
Acute Kidney Disease ◽  
Patients At Risk ◽  
Kidney Impairment

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.

scholarly journals Dickkopf-3 in the prediction of contrast media induced acute kidney injury

2020 ◽  
Author(s):  
Felix S. Seibert ◽  
Anja Heringhaus ◽  
Nikolaos Pagonas ◽  
Benjamin Rohn ◽  
Frederic Bauer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Creatinine Ratio ◽  
Creatinine Concentration

Abstract Background Dickkopf-3 (DKK3) has recently been discovered as a urinary biomarker for the prediction of acute kidney injury (AKI) after cardiac surgery. This finding needs to be confirmed for AKI in other clinical settings. The present study investigates whether DKK3 can predict contrast-induced AKI (CI-AKI). Methods We performed a prospective study in 490 patients undergoing coronary angiography. Primary endpoint was an increase in serum creatinine concentration ≥ 0.3 mg/dl within 72 h after the procedure. DKK3 was assessed < 24 h before coronary angiography. Predictive accuracy was assessed by receiver operating characteristic (ROC) curves. Results CI-AKI was observed in 30 (6.1%) patients, of whom 27 corresponded to stage I and 3 to stage II according to the Acute Kidney Injury Network (AKIN) criteria. Subjects who developed CI-AKI had a 3.8-fold higher urinary DKK3/creatinine ratio than those without CI-AKI (7.5 pg/mg [interquartile range [IQR] 1.2–1392.0] vs. 2.0 pg/mg [IQR 0.9–174.0]; p = 0.047). ROC analysis revealed an area under the curve (AUC) of 0.61. Among subjects without clinically overt chronic kidney disease (estimated glomerular filtration rate [eGFR] > 60 ml/min, urinary albumin creatinine ratio < 30 mg/g), the DKK3/creatinine ratio was 5.4-fold higher in those with subsequent CI-AKI (7.5 pg/mg [IQR 0.9–590.1] vs. 1.38 pg/mg [IQR 0.8–51.0]; p = 0.007; AUC 0.62). Coronary angiography was associated with a 43 times increase in the urinary DKK3/creatinine ratio. Conclusions Urinary DKK3 is an independent predictor of CI-AKI even in the absence of overt chronic kidney disease (CKD). The study thereby expands the findings on DKK3 in the prediction of postoperative loss of kidney function to other entities of AKI. Graphic abstract

scholarly journals P0603INFLUENCE OF FERRITIN VALUES IN THE PORGNOSIS OF ACUTE KIDNEY INJURY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Pablo Díez ◽  
Andres Fernández Ramos ◽  
Patricia Muñoz Ramos ◽  
Marta Sanz Sainz ◽  
Begoña Santos Sánchez-Rey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Iron Metabolism ◽  
Cox Regression ◽  
Transferrin Saturation ◽  
Kidney Injury ◽  
Iron Storage ◽  
Reason For Admission

Abstract Background and Aims Acute Kidney Injury (AKI) is one of the most frequent causes of hospitalization and many factors have been associated to its prognosis and recovery. The role of iron in AKI physiopathology and its influence is not well known. Recent studies have shown that elevated levels of catalytic iron are associated with higher mortality in patients with AKI, however, catalytic iron is not available in usual clinical practice. Ferritin, especially abundant in the liver, is the primary intracellular iron storage protein. A small amount is secreted to the circulation and is an indirect marker of total body iron deposits. In this study we analyze the influence of iron, with ferritin values, in the prognosis of AKI. Method We developed a retrospective, single-center study that enrolled patients with AKI, hospitalized in our center between 2013 and 2014 with iron metabolism values in the first 72 hours after admission. At baseline, we collected demographic information, comorbidities, reason for admission and iron metabolism values (ferritin, transferrin, transferrin saturation index and serum iron). We analyzed variables associated with low and high ferritin values and its impact in AKI long-term prognosis using univariate and multivariable Cox regression. Results Of the 1731 analyzed patients, 833 (48.1%) had ferritin records. The mean age was 78±14 years and 48% of the patients were women. The most frequent comorbidity was hypertension (76%), followed by chronic kidney disease (46%), dyslipidemia (44%), heart failure (31%), diabetes mellitus (29%) and atrial fibrillation (27%). The most frequent reason for admission was infection (35%) followed by AKI (19%). Ferritin values differed significantly according age (p&lt;0.0001), sex (p=0.024), diabetes (0.012), hypertension (p=0.002), neoplasia (p=0.016), reason for admission (p=0.018), baseline CKD-EPI (0.012) and lactate at admission (p&lt;0.0001). During the hospitalization, 165 (20%) patients died. Factor associated to mortality were ferritin&gt;500 ng/ml (p=0.013), lactate at admission (p&lt;0.001), age (p=0.045), hypertension (p=0.014), dyslipidemia (p&lt;0.001), ischemic heart disease (p=0.006), chronic kidney disease (p=0.001), baseline CKD-EPI (p=0.01), atrial fibrillation (p=0.005), neoplasia (p=0.023), Barthel index (p&lt;0.001) and hemoglobin (p=0.006) and bicarbonate (p=0.012) at admission. Multivariate logistic regression demonstrated that ferritin levels over 500 ng/mL was an independent predictor of mortality (1.6 [1,1-2,3] HR [CI 95%]) (p=0.013). Conclusion Ferritin values higher than 500 ng/mL independently predicts mortality in patients admitted with AKI.

scholarly journals Oral Hydration as a Safe Prophylactic Measure To Prevent Post-Contrast Acute Kidney Injury in Oncologic Patients with Chronic Kidney Disease (IIIb) Referred for Contrast-Enhanced Computed Tomography: Subanalysis of The Oncological Group of The NICIR Study.

2021 ◽  
Author(s):  
Carmen Sebastia ◽  
Alfredo Páez-Carpio ◽  
Elena Guillen ◽  
Blanca Paño ◽  
JoanAlbert Arnaiz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Oral Hydration ◽  
Post Contrast ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract Background The objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). Material and Methods We performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water two hours before and 2000 mL during the 24 hours after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L)3 mL/kg/h starting one hour before and 1 mL/kg/h during the first hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the first 48 to 72 hours after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis in each group. Results Of 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no significant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. Conclusion In oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not significantly differ from that of patients receiving i.v. hydration.

scholarly journals Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Toxins ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 395
Author(s):  
Inga Chomicka ◽  
Marlena Kwiatkowska ◽  
Alicja Lesniak ◽  
Jolanta Malyszko
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Creatinine Concentration ◽  
Post Contrast ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Enhanced Ct

Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14–28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.

scholarly journals Modern concept — renal continuum (acute kidney injury, acute kidney disease, chronic kidney disease)

2021 ◽  
Vol 11 (2) ◽  
pp. 94-97
Author(s):  
A. M. Shutov ◽  
E. V. Efremova ◽  
M. V. Menzorov ◽  
V. A. Serov ◽  
A. A. Samoshilova
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Early Diagnosis ◽  
Prognostic Significance ◽  
Kidney Injury ◽  
Current Understanding ◽  
Modern Concept ◽  
Acute Kidney Disease ◽  
The Relationship

The lectures present the current understanding of the renal continuum, reflecting the relationship between acute kidney injury (AKI), acute kidney disease (AKD) and chronic kidney disease (CKD). The issue of early diagnosis of AKI remains unresolved, despite numerous studies on biomarkers of acute kidney injury. The epidemiology, clinical and prognostic significance of AKD have not been sufficiently studied. Awareness of both doctors and patients about the «renal continuum» and the possibilities of timely diagnosis and prevention of renal complications is required.

scholarly journals Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e037256
Author(s):  
Li Lei ◽  
Yan Xue ◽  
Zhaodong Guo ◽  
Bowen Liu ◽  
Yibo He ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Southern China ◽  
Bootstrap Method ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Discriminative Power

ObjectivesTo establish a nomogram for contrast-induced acute kidney injury (CI-AKI) risk assessment among patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).DesignProspective observational cohort study.SettingSouthern China.InterventionsNone.Participants643 consecutive patients with CKD (defined as estimated glomerular filtration rate calculated by Modification of Diet in Renal Disease formula <60 mL/min/1.73 mm2) were enrolled.Outcome measuresThe end point was CI-AKI defined as serum creatinine elevation ≥0.5 mg/dL or 25% from baseline within the first 48–72 hours following contrast exposure.Predictors of CI-AKI were selected by multivariable logistic regression and stepwise approach. A nomogram based on these predictors was constructed and compared with the classic Mehran Score. For validation, a bootstrap method (1000 times) was performed.ResultsThe nomogram including age, weight, heart rate, hypotension, PCI and β-blocker demonstrated a better predictive value than the classic Mehran Score (area under the curve: 0.78 vs 0.71, p=0.024), as well as a well-fitted calibration curve (χ2=12.146, p=0.145). Validation through the bootstrap method (1000 times) also indicated a good discriminative power (adjusted C-statistic: 0.76).ConclusionsWith fewer predictors and higher discriminative power, the present nomogram may be a simple and reliable tool to identify patients with CKD at risk of CI-AKI, whereas further external validations are needed.

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