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Factors associated with the use of preventive care for contrast-induced acute kidney injury.

ABSTRACT: The factors that affect the implementation of preventive care for contrast-induced acute kidney injury (CIAKI) are unknown.To assess patient and provider factors associated with the use of preventive care for CIAKI.Prospective cohort study.Patients with kidney disease undergoing procedures with intravascular iodinated radiocontrast.We recorded the use of preventive care defined as the administration of: (1) pre- and post-procedure isotonic intravenous (IV) fluid, (2) N-acetylcysteine, and (3) iso-osmolal radiocontrast. We surveyed patients' providers to assess their knowledge, experience, and training on CIAKI and used multiple logistic regression to assess the independent associations of patient and provider factors with the use of these preventive interventions.We enrolled 660 patients and 87 providers. Patient factors associated with use of IV fluid and N-acetylcysteine were higher baseline serum creatinine (OR 1.5 and 5.0, p < 0.05) and inpatient status (OR 3.0 and 6.3, p < 0.05), while higher baseline serum creatinine was associated with the use of iso-osmolal contrast (OR = 13.4, p < 0.01). The primary provider characteristics associated with the use of IV fluid and N-acetylcysteine were a greater degree of prior training on CIAKI (OR 1.9 and 2.8, p < 0.05) and higher number of prior patients with CIAKI (OR 2.7 and 2.6, p < 0.05).Patient baseline kidney function and provider training and experience with CIAKI are independently associated with the use of preventive care. Efforts to increase and intensify the training providers receive on CIAKI may help decrease the incidence of this costly iatrogenic condition.

SUBMITTER: Weisbord SD

PROVIDER: S-EPMC2642579 | biostudies-other | 2009 Mar

REPOSITORIES: biostudies-other

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microRNAs profiles of contrast-induced acute kidney injury rats

Project description:Contrast-induced acute kidney injury (CI-AKI) is typically defined by an increase in serum creatinine (SCr) after intravascular administration of contrast medium. Since creatinine is an unreliable indicator for acute changes in kidney function, an early biomarkers for CI-AKI diagnosis is important for initiating therapy.We assessed the hypothesis that circulating microRNAs (miRNAs) could be served as potential biomarkers to early detect CI-AKI.The rat model of acute kidney injury was developed as we previously described. We first detect miRNA profile of plasma and kidney tissue using Agilent microarray platform. 3 miRNA species with > 1.5-fold increase in plasma samples of CI-AKI rats, including miRNA-30a, miRNA-30e and miRNA-188, were selected as candidate miRNAs of potential biomarkers. 24 rats were randomly divided into 2 groups (CI-AKI group and control group), each with 4 subgroups (n=3). Peripheral blood and kidney samples were harvest at 8h after contrast medium/normal saline administration. Total RNA sample from each rat in the same subgroup was combined together as pooled sample for further test. The Agilent microarray platform was adapted to profile the miRNA spectra.

2016-05-14 | E-GEOD-81400 | biostudies-arrayexpress

microRNAs profiles of contrast-induced acute kidney injury rats

2016-05-14 | GSE81400 | GEO

The conundrum of contrast-induced acute kidney injury.

Project description:More than sixty years have elapsed since contrast induced nephropathy (CIN) was first described in the medical literature. This term has since been extensively explored, with a variety of studies conducted to investigate its incidence and various mechanisms examined to explain its pathophysiology. However, the topic of CIN remains one of controversy with a widely variable and often questionable incidence derived from various studies. The past two decades have seen a surge in reports questioning the existing of CIN altogether and if more harm is actually being caused to patients out of fear of this potential complication. We have attempted to review relevant studies regarding CIN and highlight the key points of its surmised understanding. The review has a higher focus on more recent literature and updates, in order to determine if an accurate estimate can be made on the incidence of CIN. While there was certainly no lack of material available, practically all the studies reviewed were limited by one or more significant drawbacks that limited the reliability of their conclusions regarding CIN. Based on the information reviewed, the strengths and the flaws encountered in other studies can be used to design a randomized control trial that may help in concluding the longstanding debate on this topic. However due to time, financial, and perhaps even ethical constraints such a trial will be difficult to arrange, and so a definitive answer on CI-AKI, and whether it really exist, may continue to elude clinicians.

| S-EPMC7212164 | biostudies-literature

Urinary proteomics investigations into contrast-induced acute kidney injury.

Project description:Some patients have a decline in renal function after contrast medium injection, and this phenomenon is called contrast-induced acute kidney injury (CI-AKI); a small number of people even suffer severe renal failure. To date, the mechanism of CI-AKI remains unclear. We aimed to identify novel potential biomarkers in the urine of patients with CI-AKI through LC-MS/MS and bioinformatics analysis. We enrolled patients who underwent coronary angiography (contrast agent: iohexol). The CI-AKI group included 4 cases, and the non-CI-AKI group included 20 cases. We mixed the 4 CI-AKI samples and 20 non-CI-AKI samples. Then, a 0.6 ml urine sample was used for proteome analysis with LC-MS/MS approach. Metascape, ExPASy, and the Human Protein Atlas were utilized for bioinformatics analysis. We obtained 724 and 830 urine proteins from the CI-AKI and non-CI-AKI groups, respectively. The distribution of the pI values and molecular weights (MWs) of postoperative urine proteins showed no significant difference between the CI-AKI group and the non-CI-AKI group. A total of 99differentially expressed proteins (DEPs) were detected, among which 18 proteins were detected only in tubule cells, and 19 proteins were detected in both tubule cells and glomeruli. With GO analysis, the GEPs were mainly associated with immune response and inflammation. Although biomarkers cannot be asserted from this single pilot study, our results may help advance the understanding of the mechanisms of CI-AKI and identify potential novel biomarkers for further investigation.

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Genome-wide analysis of long noncoding RNAs and mRNAs associated with contrast-induced acute kidney injury

Project description:Purpose:little is known about the roles of lncRNA in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). Here, we compared the expression profiles of lncRNAs and mRNAs in kidney tissue between CI-AKI rats and controls. Methods:Based on a reliable CI-AKI rat model, we sought to investigate the roles of lncRNA in the kidney injury following intra-arterial contrast exposure by RNA sequencing. Results: We identified 88 differentially expressed known and novel lncRNAs at 12 hours following intra-arterial iodinated contrast medium injection. Functional enrichment analysis implied that these lncRNAs were potentially associated with oxidative stress and DNA damage response. Conclusions:These prefound findings provide the first evidence of lncRNA in the development of CI-AKI.

2021-05-18 | GSE134824 | GEO

Urinary proteomics investigations into contrast-induced acute kidney injury

Project description:The incidence of CI-AKI varies from 5% to 20% among hospitalized patients. However, research on the pathophysiological mechanism and biomarkers of CI-AKI has not been deep so far, especially research with LC-MS/MS methods. MS has brought proteomics research into the modern era and continues to be the best choice for accurate medicine. Thus, we identified the urine proteins of CI-AKI patients with LC-MS/MS methods and compared the differences in urine protein expression between CI-AKI patients and non-CI-AKI patients with bioinformatics analysis. Several DEPs were identified in CI-AKI patients, some of which are related to kidney diseases, including annexin A2 (ANXA2), growth differentiation factor 15 (GDF15) and retinol-binding protein 4 (RBP4). We think that they are likely to be biomarkers of CI-AKI. Among the DEPs, we found that the number and degree of proteins expressed in tubules were more significant than those in glomeruli, which indicated that tubule injury may play a more important role in CI-AKI. Through bioinformatics analysis, we found that the immune response and inflammation were involved in CI-AKI, which indicated that the immune system and inflammatory response may participate in CI-AKI progression. Our study revealed some proteins that are likely to be biomarkers and provided a further understanding of CI-AKI.

2021-02-21 | PXD024271 |

Incidence, Risk Factors and Prognosis of Contrast-Induced Acute Kidney Injury in Acute Heart Failure Patients Undergoing Coronary Angiography.

Project description:Background and objectivesHeart failure (HF) is a well-known risk factor for contrast-induced acute kidney injury (CI-AKI). We sought to evaluate the risk factors and prognostic impact of CI-AKI in patients with AHF who undergo coronary angiography (CAG).MethodsA total 594 patients with AHF underwent CAG from May 1, 2011 to December 31, 2013. CI-AKI was defined as an increase ≥25% or ≥0.5 mg/dL in serum creatinine at 48 hours after CAG or the initiation of dialysis after CAG. The deviation of body weight on CAG day from the dry weight (ΔBWTCAG, %) was calculated for each patient.ResultsOverall, CI-AKI was observed in 24.7% of patients. Patients with CI-AKI had higher in-hospital death (16.3% vs. 5.1%, p<0.001; relative risk [RR], 2.50; 95% confidence interval [CI], 1.45-4.31) and 1-year post-discharge death (38.1% vs. 17.4%, p<0.001; hazard ratio, 2.16; 95% CI, 1.40-3.34) than those without CI-AKI. Patients with CI-AKI had greater ΔBWTCAG than those without CI-AKI (5.5±5.7% vs. 3.7±4.0%, p<0.001). A J-shaped association between the risk of CI-AKI and ΔBWTCAG was noted. In patients with weight excess (n=179), an increase of ΔBWT by 1% was associated with 9% (RR, 1.09; 95% CI, 1.03-1.16), while in patients with weight deficiency (n=86), a decrease of ΔBWT by 1% was associated with 11% increased risk for CI-AKI (RR, 1.11; 95% CI, 1.05-1.17).ConclusionsIn AHF patients undergoing CAG CI-AKI is common and associated with worse clinical outcomes. Achieving optimum body weight before CAG may reduce the risk of CI-AKI.Trial registrationClinicalTrials.gov Identifier: NCT01389843.

| S-EPMC9536667 | biostudies-literature

Melatonin Alleviates Contrast-Induced Acute Kidney Injury by Activation of Sirt3.

Project description:Oxidative stress and apoptosis play a vital role in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). The purpose of our study was to investigate the protective effects and mechanisms of melatonin against CI-AKI in a CI-AKI mouse model and NRK-52E cells. We established the CI-AKI model in mice, and the animals were pretreated with melatonin (20 mg/kg). Our results demonstrated that melatonin treatment exerted a renoprotective effect by decreasing the level of serum creatinine (SCr) and blood urea nitrogen (BUN), lessening the histological changes of renal tubular injuries, and reducing the expression of neutrophil gelatinase-associated lipid (NGAL), a marker of kidney injury. We also found that pretreatment with melatonin remarkably increased the expression of Sirt3 and decreased the ac-SOD2 K68 level. Consequently, melatonin treatment significantly decreased the oxidative stress by reducing the Nox4, ROS, and malondialdehyde (MDA) content and by increasing the superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity levels. The antiapoptotic effect of melatonin on CI-AKI was revealed by decreasing the ratio of Bax/Bcl2 and the cleaved caspase3 level and by reducing the number of apoptosis-positive tubular cells. In addition, melatonin treatment remarkably reduced the inflammatory cytokines of interleukin-1β (IL-1β), tumor necrosis factor α (TNFα), and transforming growth factor β (TGFβ) in vivo and in vitro. Sirt3 deletion and specific Sirt3 siRNA abolished the above renoprotective effects of melatonin in mice with iohexol-induced acute kidney injury and in NRK-52E cells. Thus, our results demonstrated that melatonin exhibited the renoprotective effects of antioxidative stress, antiapoptosis, and anti-inflammation by the activation of Sirt3 in the CI-AKI model in vivo and in vitro. Melatonin may be a potential drug to ameliorate CI-AKI in clinical practice.

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Risk factors for contrast-induced acute kidney injury (CI-AKI): protocol for systematic review and meta-analysis.

Project description:IntroductionIdentifying the patients who are at risk for contrast-induced acute kidney injury (CI-AKI), which is defined as an increase in serum creatinine after exposure to contrast media, is a critical step in targeted prevention strategies. The absolute and relative importance of individual risk factors have not been systematically evaluated, let alone the new, controversial and modifiable risk factors of CI-AKI.Methods and analysisOn 1 July 2019, a search was performed on MEDLINE, Embase and the Cochrane Database of Systematic Reviews. We will perform a systematic review and meta-analysis to assess the important risk factors for developing CI-AKI, including those new, modifiable factors, which are considered controversial. The secondary endpoint will be all-cause mortality. Two authors will then independently screen studies that meet the criteria for inclusion, consulting with a third author to resolve any dispute. The quality of the included studies will be assessed according to the Newcastle-Ottawa scale.Ethics and disseminationEthics approval in this systematic review and meta-analysis protocol is not needed. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Prospero registration numberCRD42019121534.

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Non-coding RNA-Associated ceRNA Networks in a New Contrast-Induced Acute Kidney Injury Rat Model.

Project description:Contrast-induced acute kidney injury (CI-AKI) is a severe complication of intravascular applied radial contrast media, and recent progress in interventional therapy and angiography has revived interest in explaining detailed mechanisms and developing effective treatment. Recent studies have indicated a potential link between CI-AKI and microRNA (miRNA). However, the potential non-coding RNA-associated-competing endogenous RNA (ceRNA) pairs involved in CI-AKI still remain unclear. In this study, we systematically explored the circRNA or lncRNA-associated-ceRNA mechanism in a new rat model of CI-AKI through deep RNA sequencing. The results revealed that the expression of 38 circRNAs, 12 lncRNAs, 13 miRNAs and 127 mRNAs were significantly dysregulated. We performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses for mRNAs with significantly different expression and then constructed comprehensive circRNA or lncRNA-associated ceRNA networks in kidney of CI-AKI rats. Thereafter, two constructed ceRNA regulatory pathways in this CI-AKI rat model-novel_circ_0004153/rno-miR-144-3p/Gpnmb or Naglu and LNC_000343/rno-miR-1956-5p/KCP-were validated by real-time qPCR. This study is the first one to provide a systematic dissection of non-coding RNA-associated ceRNA profiling in kidney of CI-AKI rats. The selected non-coding RNA-associated ceRNA networks provide new insight for the underlying mechanism and may profoundly affect the diagnosis and therapy of CI-AKI.

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