•  
  •  
 

Abstract

Introduction. Contrast Induced Nephropathy (CIN) after percutaneous coronary intervention (PCI) is common in stage 3 chronic kidney disease (CKD) patients. While there is no cure for CIN and some cases are fatal for the kidney or even life, it is preventable. Eventhough controversial, hydration and N-Acetyl Cysteine (NAC) are modalities to prevent CIN. Not having a certain guideline to prevent CIN in Integrated Cardiac Services (ICS) Cipto Mangunkusumo Hospital for PCI patients generates interest to study it. Methods. A prospective cohort is conducted to evaluate plasma creatinine before and 48 hours after PCI, meanwhile recording whom is given combined hydration and NAC and which not. Results. 43,4% of stage 3 CKD patients are given hydration and NAC, and incidence of CIN occurred in 5.26% patients all belonging to the non hydration and NAC group. Attributable risk is 100% means CIN can be prevented with hydration and NAC. Conclusions. Hydation and NAC is indicated to be protective against CIN in stage 3 CKD patients undergoing PCI.

References

1. Rudnick MR, Tumlin JA. Pathogenesis, clinical features, and diagnosis of contrast-induced nephropathy. UpToDate,Inc [internet]. 2012 [cited Sept 2012]. Available from: http://www. UptoDate.com. 2. Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105(19):2259-64. 3. Schilp J, de Blok C, Langelaan M, Spreeuwenberg P, Wagner C. Guideline adherence for identification and hydration of high risk hospital patients for contrast-induced nephropathy. BMC Nephrol. 2014;15:2. 4. Owen RJ, Hiremath S, Myers A, Fraser-Hill M, Barrett BJ. Consensus guidelines for the prevention of contrast induced nephropathy. Can Assoc Radiol J. 2014;65(2):96-105. 5. Duru OK, Vargas RB, Kermah D, Nissenson AR, Norris KC. High prevalence of stage 3 chronic kidney disease in older adults despite normal serum creatinine. J Gen Intern Med. 2009;24(1):86-92. 6. Chen SL, Zhang J, Yei F, Zhu Z, Liu Z, Lin S, et al. Clinical outcomes of contrast-induced nephropathy in paients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol. 2008;126(3):407-13. 7. Kellum JA, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, Herzog CA, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter. 2012;2(Suppl 2):76–86. 8. Iakovou I, Dangas G, Lansky AJ, Mintz G, Ashby D, Losquadro M, et al. Incidence, predictors, and economic impact of contrast induced nephropathy: results in 8,628 patients treated with percutaneous coronary interventions. J Am Coll Cardiol. 2002;39(Suppl 1):2A. 9. Gruberg L, Mintz GS, Mehran R, Dangas G, Lansky AJ, Kent KM, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol. 2000;36(5):1542-8. 10. Newhouse JH, Kho D, Rao QA, Starren J. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 2008;191(2):376-82. 11. Yuniadi Y, Ningrum NR. Risk factors and incidence of contrast induced nephropathy following coronary intervention. Med J Indones. 2008;17(2):131-7. 12. Parfrey PS, Griffiths SM, Barrett BJ, Paul MD, Genge M, Withers J, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med. 1989;320(3):143-9. 13. Aspelin PR, Aubry P, Fransson SG, Fransson SV, Strasser R, Willenbrock R, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348(6):491-9. 14. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology.1993;188(1):171-8. 15. Barrett BJ, Parfrey PS, McDonald JR, Hefferton DM, Reddy ER, McManamon PJ. Nonionic low-osmolality versus ionic highosmolality contrast material for intravenous use in patients perceived to be at high risk: Randomized Trial. Radiology. 1992;183(1):105-10. 16. Tepel M, Aspelin P, Lamiere N. Contrast-induced nephropathy: a clinical and evidence-based approach. Circulation. 2006;113(14):1799-806. 17. Sweiger MJ, Chambers CE, Davidson CJ, Zhang S, Blankenship J, Bhalla NP, et al. Prevention of contrast induced nephropathy: recomendations for the high risk patients undergoing cardiovascular procedures. Catheter Cardiovasc Interv. 2007;69(1):135-40. 18. Gleeson T, Bulugahapitiya S. Contrast-induced nephropathy. Am J Radiol. 2004; 183(6):1673-89. 19. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;100:S11-5. 20. Marenzi G, Ferrari C, Marana I, Assanelli E, De Metrio M, Teruzzi G, et al. Prevention of contrast induced nephropathy by furosemide with matched hydration the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv. 2012;5(1):90–7. 21. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Metaanalysis: effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med. 2008;148(4):284-94. 22. Balemans CEA, Reichert LJM, Schelven BIH, van den Brand JAJG, Wetzels JFM. Epidemiology of Contrast Material-induced Nephropathy in the era of hydration. Radiology. 2012;263(3):706- 13. 23. Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, et al. randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxiciy. Nephron Clin Pract.2003;93(1):c29-34. 24. Nikolsky E, Mehran R, Turcot D, Aymong ED, Mintz GS, Lasic Z et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol. 2004;94(3):300-5.

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.