Skip to main content
Top
Published in: Cardiology and Therapy 1/2018

Open Access 01-06-2018 | Study Protocol

The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale

Authors: Alhasan Mujtaba, Mohammed A. Taher, Mazin A. Hazza, Hassan M. Al-Rubaye, Asaad H. Kata, Hamid AbdulWahab, AbdulAmeer AbdulBari, Hayder K. AlRubay

Published in: Cardiology and Therapy | Issue 1/2018

Login to get access

Abstract

Introduction

Patients undergoing coronary catheterization are at high risk of developing contrast-induced nephropathy (CIN) acute kidney injury (AKI). Several approaches have been supposed to limit such an effect but with mixed results or non-practical methods. Spironolactone is supposed to be effective as a nephroprotective agent in animal studies. This study will try to measure the effect of spironolactone on the incidence of CIN-AKI in patients undergoing coronary catheterization (angiography angioplasty).

Methods

This study is a single-center, investigator-driven, double-blinded randomized controlled study in Iraq-Basra. More than 400 patients admitted for coronary angio unit in our center will be allocated in a 1:1 ratio to receive either spironolactone 200 mg single dose or placebo in addition to their usual premedication.

Planned Outcomes

Primary end point will be CIN defined as more than 25% or 0.3 mg/dl elevation in serum creatinine (S.Cr.) from baseline during the first 2–3 days after the procedure. We hope to identify or answer an important question regarding CIN in such high-risk patients.

Trial Registration

ClinicalTrials.gov Identifier, NCT03329443.
Literature
1.
go back to reference Tehrani S, et al. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest. 2013;43:483–90.CrossRefPubMed Tehrani S, et al. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest. 2013;43:483–90.CrossRefPubMed
2.
go back to reference Tziakas D, et al. Validation of a new risk score to predict contrast-induced nephropathy after percutaneous coronary intervention. Am J Cardiol. 2014;113:1487–93.CrossRefPubMed Tziakas D, et al. Validation of a new risk score to predict contrast-induced nephropathy after percutaneous coronary intervention. Am J Cardiol. 2014;113:1487–93.CrossRefPubMed
3.
go back to reference Sadeghi HM, Stone GW, Grines CL, et al. Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation. 2003;108:2769–75.CrossRefPubMed Sadeghi HM, Stone GW, Grines CL, et al. Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation. 2003;108:2769–75.CrossRefPubMed
4.
go back to reference Liu M, et al. Aggressive hydraTion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention to prevent contrast-induced nephropathy (ATTEMPT): study design and protocol for the randomized, controlled trial, the ATTEMPT, RESCIND 1 (First study for REduction of contraSt-induCed nephropathy following carDiac catheterization) trial. Am Heart J. 2016;172:88–95.CrossRefPubMed Liu M, et al. Aggressive hydraTion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention to prevent contrast-induced nephropathy (ATTEMPT): study design and protocol for the randomized, controlled trial, the ATTEMPT, RESCIND 1 (First study for REduction of contraSt-induCed nephropathy following carDiac catheterization) trial. Am Heart J. 2016;172:88–95.CrossRefPubMed
5.
go back to reference Droppa M, Desch S, Blase P, et al. Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty. Clin Res Cardiol. 2011;100:1037–43.CrossRefPubMed Droppa M, Desch S, Blase P, et al. Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty. Clin Res Cardiol. 2011;100:1037–43.CrossRefPubMed
6.
go back to reference Thayssen P, Lassen JF, Jensen SE, et al. Prevention of contrast-induced nephropathy with N-acetylcysteine or sodium bicarbonate in patients with ST-segment-myocardial infarction: a prospective, randomized, open-labeled trial. Circ Cardiovasc Interv. 2014;7:216–24.CrossRefPubMed Thayssen P, Lassen JF, Jensen SE, et al. Prevention of contrast-induced nephropathy with N-acetylcysteine or sodium bicarbonate in patients with ST-segment-myocardial infarction: a prospective, randomized, open-labeled trial. Circ Cardiovasc Interv. 2014;7:216–24.CrossRefPubMed
8.
go back to reference Mejia-Vilet JM, et al. Renal ischemia-reperfusion injury is prevented by the mineralocorticoid receptor blocker spironolactone. Am J Physiol Renal Physiol. 2007;293:F78–86.CrossRefPubMed Mejia-Vilet JM, et al. Renal ischemia-reperfusion injury is prevented by the mineralocorticoid receptor blocker spironolactone. Am J Physiol Renal Physiol. 2007;293:F78–86.CrossRefPubMed
9.
go back to reference Sanchez-Pozos K, et al. Recovery from ischemic acute kidney injury by spironolactone administration. Nephrol Dial Transplant. 2012;27:3160–9.CrossRefPubMed Sanchez-Pozos K, et al. Recovery from ischemic acute kidney injury by spironolactone administration. Nephrol Dial Transplant. 2012;27:3160–9.CrossRefPubMed
10.
go back to reference Pretorius M, et al. Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery. Crit Care Med. 2012;40(10):2805–12.CrossRefPubMedPubMedCentral Pretorius M, et al. Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery. Crit Care Med. 2012;40(10):2805–12.CrossRefPubMedPubMedCentral
11.
go back to reference Briguori C, et al. Cystatin C and contrast-induced acute kidney injury. Circulation. 2010;121:2117–22.CrossRefPubMed Briguori C, et al. Cystatin C and contrast-induced acute kidney injury. Circulation. 2010;121:2117–22.CrossRefPubMed
12.
go back to reference Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, Herzog CA, Joannidis M, Kribben A, Levey AS, MacLeod AM, Mehta RL, Murray PT, Naicker S, Opal SM, Schaefer F, Schetz M, Uchino S. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1–138.CrossRef Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, Herzog CA, Joannidis M, Kribben A, Levey AS, MacLeod AM, Mehta RL, Murray PT, Naicker S, Opal SM, Schaefer F, Schetz M, Uchino S. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1–138.CrossRef
13.
go back to reference Tong J, et al. Neutrophil gelatinase-associated lipocalin in the prediction of contrast-induced nephropathy: a systematic review and meta-analysis. J Cardiovasc Pharmacol. 2015;66:239–45.CrossRefPubMed Tong J, et al. Neutrophil gelatinase-associated lipocalin in the prediction of contrast-induced nephropathy: a systematic review and meta-analysis. J Cardiovasc Pharmacol. 2015;66:239–45.CrossRefPubMed
14.
go back to reference Sarwar CM, Papadimitriou L, Pitt B, et al. Hyperkalemia in heart failure. J Am Coll Cardiol. 2016;68(14):1575–89.CrossRefPubMed Sarwar CM, Papadimitriou L, Pitt B, et al. Hyperkalemia in heart failure. J Am Coll Cardiol. 2016;68(14):1575–89.CrossRefPubMed
17.
go back to reference Nassir FS. Contrast-induced nephropathy in diabetic and non-diabetic patients after coronary intervention. J Babylon Univ/Pure Appl Sci. 2014;22(9):2530–46. Nassir FS. Contrast-induced nephropathy in diabetic and non-diabetic patients after coronary intervention. J Babylon Univ/Pure Appl Sci. 2014;22(9):2530–46.
18.
go back to reference Taher, et al. Predicting contrast-induced nephropathy post coronary intervention: a prospective cohort study. Egypt Heart J. 2015;67:337–43.CrossRef Taher, et al. Predicting contrast-induced nephropathy post coronary intervention: a prospective cohort study. Egypt Heart J. 2015;67:337–43.CrossRef
20.
go back to reference Dong Y, et al. How strong is the evidence for sodium bicarbonate to prevent contrast-induced acute kidney injury after coronary angiography and percutaneous coronary intervention? Medicine. 2016;95(7):e2715.CrossRefPubMedPubMedCentral Dong Y, et al. How strong is the evidence for sodium bicarbonate to prevent contrast-induced acute kidney injury after coronary angiography and percutaneous coronary intervention? Medicine. 2016;95(7):e2715.CrossRefPubMedPubMedCentral
21.
go back to reference Brar SS, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014;383(9931):1814–23.CrossRefPubMed Brar SS, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014;383(9931):1814–23.CrossRefPubMed
22.
go back to reference Butler J, et al. Rationale and design of the aldosterone targeted neurohormonal combined with natriuresis therapy in heart failure (ATHENA-HF) trial. JACC Heart Fail. 2016;4(9):726–35.CrossRefPubMedPubMedCentral Butler J, et al. Rationale and design of the aldosterone targeted neurohormonal combined with natriuresis therapy in heart failure (ATHENA-HF) trial. JACC Heart Fail. 2016;4(9):726–35.CrossRefPubMedPubMedCentral
23.
go back to reference Ferreira JP, Santos M, Almeida S, Marques I, Bettencourt P, Carvalho H. Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure. Eur J Intern Med. 2014;25:67–72.CrossRefPubMed Ferreira JP, Santos M, Almeida S, Marques I, Bettencourt P, Carvalho H. Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure. Eur J Intern Med. 2014;25:67–72.CrossRefPubMed
24.
go back to reference McInnes CT, et al. Spironolactone dose–response relationships in healthy subjects. Br J Clin Pharm. 1982;13:513–8.CrossRef McInnes CT, et al. Spironolactone dose–response relationships in healthy subjects. Br J Clin Pharm. 1982;13:513–8.CrossRef
Metadata
Title
The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale
Authors
Alhasan Mujtaba
Mohammed A. Taher
Mazin A. Hazza
Hassan M. Al-Rubaye
Asaad H. Kata
Hamid AbdulWahab
AbdulAmeer AbdulBari
Hayder K. AlRubay
Publication date
01-06-2018
Publisher
Springer Healthcare
Published in
Cardiology and Therapy / Issue 1/2018
Print ISSN: 2193-8261
Electronic ISSN: 2193-6544
DOI
https://doi.org/10.1007/s40119-018-0112-3

Other articles of this Issue 1/2018

Cardiology and Therapy 1/2018 Go to the issue
Obesity Clinical Trial Summary

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.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.