Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 8/2015

01-08-2015 | Cardiac

Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

Authors: Yuan-hui Liu, Yong Liu, Ning Tan, Ji-yan Chen, Ying-ling Zhou, Jian-fang Luo, Dan-qing Yu, Li-wen Li, Hua-long Li, Piao Ye, Peng Ran

Published in: European Radiology | Issue 8/2015

Login to get access

Abstract

Objectives

Contrast-induced nephropathy (CIN) has not been systematically studied in high-risk patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods

We prospectively observed 515 consecutive patients with CKD undergoing PCI. Patients were divided into three groups: patients who underwent attempted PCI for CTO (group A, n = 85), patients who did not receive PCI for CTO (group B, n = 45) and patients without CTO (group C, n = 385).

Results

CIN developed in 55 patients (10.68 %). Group A patients received a larger CM dose than group B or group C (p = 0.024). The intravenous hydration volume, age and CIN Mehran score were not significantly different between the three groups. The incidence of CIN was 9.4 % for group A, 6.7 % for group B and 11.4 % for group C (p = 0.344). In-hospital mortality and required renal replacement therapy (p = 0.325) were not significantly different between the groups. Multivariate analysis showed that after adjusting for potential confounding factors, the odds ratio for CIN was 1.03 (p = 0.944) for group A and 0.64 for group B (p = 0.489) compared to group C.

Conclusions

Attempts to achieve recanalization of CTO in patients with CKD might not increase the risk of CIN if appropriate preventative measures are taken.

Key Points

• Contrast-induced nephropathy can increase morbidity and mortality
• Chronic kidney disease patients are at the greatest risk of CIN
• Patients with CKD undergoing CTO-PCI are common
• Incidence of CIN has not been reported in CKD patients
• CTO-PCI in CKD patients might not increase the risk of CIN
Literature
1.
Mehran R, Aymong ED, Nikolsky E et al (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399PubMed
2.
Wi J, Ko YG, Kim JS et al (2011) Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart 97:1753–1757PubMedCrossRef
3.
Christofferson RD, Lehmann KG, Martin GV et al (2005) Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol 95:1088–1091PubMedCrossRef
4.
Joyal D, Afilalo J, Rinfret S (2010) Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis. Am Heart J 160:179–187PubMedCrossRef
5.
Jones DA, Weerackody R, Rathod K et al (2012) Successful recanalization of chronic total occlusions is associated with improved long-term survival. JACC Cardiovasc Interv 5:380–388PubMedCrossRef
6.
Tajstra M, Gasior M, Gierlotka M et al (2012) Comparison of five-year outcomes of patients with and without chronic total occlusion of noninfarct coronary artery after primary coronary intervention for ST-segment elevation acute myocardial infarction. Am J Cardiol 109:208–213PubMedCrossRef
7.
Weisbord SD, Palevsky PM (2010) Strategies for the prevention of contrast-induced acute kidney injury. Curr Opin Nephrol Hypertens 19:539–549PubMedCrossRef
8.
Bailie GR, Uhlig K, Levey AS (2005) Clinical practice guidelines in nephrology: evaluation, classification, and stratification of chronic kidney disease. Pharmacotherapy 25:491–502PubMedCrossRef
9.
Di Mario C, Hildick-Smith D, Gershlick A et al (2013) Highlights from The Experts “Live”, 4th annual congress of the Euro CTO Club, London 2012. EuroIntervention 8:1359–1361PubMedCrossRef
10.
Di Mario C, Werner GS, Sianos G et al (2007) European perspective in the recanalisation of chronic total occlusions (CTO): consensus document from the EuroCTO Club. EuroIntervention 3:30–43PubMedCrossRef
11.
Sianos G, Werner GS, Galassi AR et al (2012) Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 8:139–145PubMedCrossRef
12.
Patel MR, Bailey SR, Bonow RO et al (2012) ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/ SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 144:39–71PubMedCrossRef
13.
Stacul F, van der Molen AJ, Reimer P et al (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21:2527–2541PubMedCrossRef
14.
Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944PubMedCrossRef
15.
McCullough PA, Wolyn R, Rocher LL et al (1997) Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 103:368–375PubMedCrossRef
16.
17.
Harkonen S, Kjellstrand CM (1977) Exacerbation of diabetic renal failure following intravenous pyelography. Am J Med 63:939–946PubMedCrossRef
18.
Manske CL, Sprafka JM, Strony JT et al (1990) Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 89:615–620PubMedCrossRef
19.
Dangas G, Iakovou I, Nikolsky E et al (2005) Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 95:13–19PubMedCrossRef
20.
Tsai TT, Patel UD, Chang TI et al (2014) Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI Registry. JACC Cardiovasc Interv 7:1–9PubMedCentralPubMedCrossRef
21.
Aguiar-Souto P, Ferrante G, Del FF et al (2010) Frequency and predictors of contrast-induced nephropathy after angioplasty for chronic total occlusions. Int J Cardiol 139:68–74PubMedCrossRef
22.
Patel VG, Brayton KM, Tamayo A et al (2013) Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv 6:128–136PubMedCrossRef
23.
Kini AS, Mitre CA, Kim M et al (2002) A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention: effect of selective dopamine receptor agonist fenoldopam. Catheter Cardiovasc Interv 55:169–173PubMedCrossRef
24.
Diaz-Sandoval LJ, Kosowsky BD, Losordo DW (2002) Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol 89:356–358PubMedCrossRef
25.
Nikolsky E, Mehran R, Turcot D et al (2004) Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 94:300–305PubMedCrossRef
26.
Kane GC, Doyle BJ, Lerman A et al (2008) Ultra-low contrast volumes reduce rates of contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography. J Am Coll Cardiol 51:89–90PubMedCrossRef
27.
Mercuri M, Xie C, Levy M et al (2009) Predictors of increased radiation dose during percutaneous coronary intervention. Am J Cardiol 104:1241–1244PubMedCrossRef
28.
Morino Y, Kimura T, Hayashi Y et al (2010) In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv 3:143–151PubMedCrossRef
29.
Tan N, Liu Y, Chen JY et al (2013) Use of the contrast volume or grams of iodine-to-creatinine clearance ratio to predict mortality after percutaneous coronary intervention. Am Heart J 165:600–608PubMedCrossRef
30.
Borgia F, Viceconte N, Ali O et al (2012) Improved cardiac survival, freedom from mace and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions. Int J Cardiol 161:31–38PubMedCrossRef
31.
Mehran R, Claessen BE, Godino C et al (2011) Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv 4:952–961PubMedCrossRef
32.
Weisbord SD, Palevsky PM (2008) Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol 3:273–280PubMedCrossRef
33.
Wright RS, Anderson JL, Adams CD et al (2011) 2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 57:1920–1959PubMedCrossRef
34.
Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31:2501–2555PubMedCrossRef
Metadata
Title
Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease
Authors
Yuan-hui Liu
Yong Liu
Ning Tan
Ji-yan Chen
Ying-ling Zhou
Jian-fang Luo
Dan-qing Yu
Li-wen Li
Hua-long Li
Piao Ye
Peng Ran
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3360-1

Other articles of this Issue 8/2015

European Radiology 8/2015 Go to the issue

Molecular Imaging

Photoacoustic breast tomography prototypes with reported human applications

Computed Tomography

Wavelet-based calculation of cerebral angiographic data from time-resolved CT perfusion acquisitions

Cardiac

Dual-source cardiac computed tomography angiography (CCTA) in the follow-up of cardiac transplant: comparison of image quality and radiation dose using three different imaging protocols

Gastrointestinal

Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy

Chest

Low-dose CT screening in an Asian population with diverse risk for lung cancer: A retrospective cohort study

Chest

CT findings of minimally invasive adenocarcinoma (MIA) of the lung and comparison of solid portion measurement methods at CT in 52 patients