scholarly journals Recombinant Brain Natriuretic Peptide for the Prevention of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease Undergoing Nonemergent Percutaneous Coronary Intervention or Coronary Angiography: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jinming Liu ◽  
Yanan Xie ◽  
Fang He ◽  
Zihan Gao ◽  
Yuming Hao ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Percutaneous Coronary Intervention ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Brain Natriuretic Peptide ◽  
Cystatin C ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary

The role of brain natriuretic peptide (BNP) in the prevention of contrast-induced nephropathy (CIN) is unknown. This study aimed to investigate BNP’s effect on CIN in chronic kidney disease (CKD) patients undergoing elective percutaneous coronary intervention (PCI) or coronary angiography (CAG). The patients were randomized to BNP (0.005 μg/kg/min before contrast media (CM) exposure and saline hydration,n=106) or saline hydration alone (n=103). Cystatin C, serum creatinine (SCr) levels, and estimated glomerular filtration rates (eGFR) were assessed at several time points. The primary endpoint was CIN incidence; secondary endpoint included changes in cystatin C, SCr, and eGFR. CIN incidence was significantly lower in the BNP group compared to controls (6.6% versus 16.5%,P=0.025). In addition, a more significant deterioration of eGFR, cystatin C, and SCr from 48 h to 1 week (P<0.05) was observed in controls compared to the BNP group. Although eGFR gradually deteriorated in both groups, a faster recovery was achieved in the BNP group. Multivariate logistic regression revealed that using >100 mL of CM (odds ratio: 4.36,P=0.004) and BNP administration (odds ratio: 0.21,P=0.006) were independently associated with CIN. Combined with hydration, exogenous BNP administration before CM effectively decreases CIN incidence in CKD patients.

scholarly journals Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein

2018 ◽  
Vol 8 (2) ◽  
pp. 151-159 ◽  
Author(s):  
Kazuhiro Dan ◽  
Toru Miyoshi ◽  
Makoto Nakahama ◽  
Tomofumi Mizuno ◽  
Kenzo Kagawa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Confidence Interval ◽  
Coronary Intervention ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Percutaneous Coronary

Background: Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. Objective: This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). Methods: We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 before coronary angiography. The primary outcome was the occurrence of major adverse renal and cardiovascular events (MARCE) including cardiac death, revascularization, heart failure, cerebral infarction, worsening renal function > 25% from baseline, and renal replacement therapy at 1 year. Results: Patients were divided into the a MARCE (n = 126) and a non-MARCE (n = 378) group. The incidence of CKD was 51% in all subjects (including those on hemodialysis) and was significantly higher in the MARCE group than in the non-MARCE group (p = 0.00001). Multivariate logistic regression analysis identified that CKD was independently associated with MARCE (adjusted odds ratio 2.03, 95% confidence interval 1.21–3.39, p = 0.007). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiography. Cox proportional hazards analysis revealed that patients with CKD and high CRP (≥0.3 mg/dL) had the worst prognosis (hazard ratio 4.371, 95% confidence interval 2.634–7.252, p = 0.00001) compared to patients without CKD and with low CRP. Conclusion: CKD combined with CRP predicted more clinical events in patients undergoing PCI with EES.

Abstract 19702: Excessive Hydration Volume Tends to be Associated With a Higher Risk of Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yong Liu ◽  
Hualong Li ◽  
Jiyan Chen ◽  
Ning Tan ◽  
Yingling Zhou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Percutaneous Coronary Intervention ◽  
Kidney Disease ◽  
Acute Heart Failure ◽  
Normal Saline ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary

Introduction: Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). However, no well-defined protocols regarding the optimal rate and duration of normal saline administration currently exist. Hypothesis: Higher intravascular hydration volume of normal saline adjusted by weight (hydration volume/weight [HV/W], mL/kg) can reduce the risk of CIN in patients with CKD undergoing percutaneous coronary intervention (PCI). Methods: Patients with CKD (creatinine clearance [CrCl] <90 mL/min/1.73 m2) undergoing PCI with hydration at the speed recommended by the current guidelines (1 mL/kg/h [0.5 mL/kg/h for left ventricular ejection fraction <40% or severe congestive heart failure]) were included in the study (n=1406). Results: Individuals with higher HV/W ratios were more likely to develop CIN (Q1, Q2, Q3, and Q4: 4.3%, 6.6%, 10.9%, and 15.0%, respectively; P<0.001) and acute heart failure (0.29%, 2.28%, 2.73%, and 5.01%, respectively; P=0.001), and were associated with higher in-hospital costs (8,314, 8,634, 9,274, 10,073 dollars, respectively; P25 mL/kg), the adjusted OR was 1.93 (95% CI: 1.09~3.42; P=0.025). Additionally, higher hydration was significantly associated with an increased risk of death (Q2 vs. Q1: adjusted hazard ratio [HR]: 3.59, 95% CI: 1.19~10.84; Q3 vs. Q1: adjusted HR: 3.51, Q4 vs. Q1: adjusted HR: 4.29, P<0.05). Conclusions: Excessive intravascular hydration volume at routine speed was associated with higher risks of CIN, acute heart failure, and death, as well as increased health care costs.

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