Рrevention of contrast-induced nephropathy during interventional treatment of acute coronary syndrome

L.O.  Miakinkova; T.I.  Yarmola; G.L.  Pustovoit; Iu.A.  Kostrikova; B.O.  Pysana; V.V.  Talash

doi:10.26641/2307-0404.2023.4.294013

Authors

L.O. Miakinkova Poltava State Medical University, Ukraine http://orcid.org/0000-0002-3889-3735
T.I. Yarmola Poltava State Medical University, Shevchenko str. 23, Poltava, 36000, Ukraine http://orcid.org/0000-0002-7428-0223
G.L. Pustovoit Poltava State Medical University, Shevchenko str. 23, Poltava, 36000, Ukraine http://orcid.org/0000-0001-6879-8088
Iu.A. Kostrikova Poltava State Medical University, Shevchenko str. 23, Poltava, 36000, Ukraine http://orcid.org/0000-0002-8675-8896
B.O. Pysana Poltava State Medical University, Shevchenko str. 23, Poltava, 36000, Ukraine https://orcid.org/0000-0002-7021-6697
V.V. Talash Poltava state medical university, Shevchenko str., 23, Poltava, 36011, Ukraine

DOI:

https://doi.org/10.26641/2307-0404.2023.4.294013

Keywords:

contrast-induced nephropathy, urgent percutaneous coronary intervention, acute coronary syndrome, chronic kidney disease

Abstract

The aim of the work was to determine the risk factors of contrast-induced nephropathy in patients with acute coronary syndrome and to evaluate the effectiveness of methods of its prevention. There were examined 62 patients admitted to the interventional cardiology department during 9 months of routine practice with a diagnosis of acute coronary syndrome and concomitant chronic kidney disease. Among them, 56.45% have diabetic nephropathy, 21% – hypertensive nephropathy, 19.35% – chronic pyelonephritis, 3.2% – gouty nephropathy. According to the stages of chronic kidney disease: I stage – 8.1%, II stage – 46.8%, III A stage – 30.6%, III B stage – 14.5% of patients. The control group consisted of 32 patients with acute coronary syndrome without kidney pathology. All patients underwent urgent percutaneous coronary intervention with a water-soluble low-osmolarity radiocontrast medium. The risk of contrast-induced nephropathy was determined according to the Mehran scale. Contrast-induced nephropathy was diagnosed by an increase in serum creatinine by >25% over 24-48 hours. Prevention of contrast-induced nephropathy according to existing recommendations was carried out by prescribing early statin therapy and diuresis-controlled combined hydration in 22 patients with concomitant chronic kidney disease. Mathematical processing was performed using Statistica 8.0 software (StatSoft Inc, USA). Patients with chronic kidney disease had a high and very high risk of contrast-induced nephropathy in 19.4% and 3.2% of cases, among them in 91.6% high, and in 100% – very high-risk contrast-induced nephropathy developed. Patients in the control group had a low to moderate risk, none of them developed contrast-induced nephropathy. It has been shown that the risk of contrast-induced nephropathy depends on the stage of chronic kidney disease and is associated with a decrease in the ejection fraction of the left ventricle (≤40%), acute left ventricle failure of the III and IV classes according to Killip, a decrease in diuresis up to ≤0.6 ml/h/kg in the first 12-24 hours after urgent percutaneous coronary intervention; taking metformin 6-12 hours before the administration of the X-ray contrast medium and the glomerular filtration rate ≤45 ml/min./1.73 m². In patients who underwent prevention of contrast-induced nephropathy in its entirety, its development was not registered.

References

Chekalina NI. Resveratrol has a positive effect on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease. Wiad Lek. 2017;70(2,2):286-91.

Chekalina NI, Kazakov YM, Mamontova TV, Vesnina LE, Kaidashev IP. Resveratrol more effectively than quercetin reduces endothelium degeneration and level of necrosis factor α in patients with coronary artery disease. Wiad Lek. 2016;69(3,2):475-9.

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfon-so F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroInter-vention. 2019;14(14):1435-534. doi: https://doi.org/10.4244/EIJY19M01_01

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et. al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: https://doi.org/10.1093/eurheartj/ehx393

Shams E, Mayrovitz HN. Contrast-Induced Ne-phropathy: A Review of Mechanisms and Risks. Cureus. 2021;13(5):e14842. doi: https://doi.org/10.7759/cureus.14842

Yang Y, George KC, Luo R, Cheng Y, Shang W, Ge S, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol. 2018;19(1):374. doi: https://doi.org/10.1186/s12882-018-1161-5

Ivanov D. [Contrast-induced nephropathy: searching for new solutions to prevent its development]. POCHKI. 2021;8(3):136-8. Ukrainian. doi: https://doi.org/10.22141/2307-1257.8.3.2019.176450

Aksu U, Gulcu O, Aksakal E, Kalkan K, Topcu S. Long-Term Mortality and Contrast-Induced Nephropathy. Angiology. 2019;70(8):783. doi: https://doi.org/10.1177/0003319718823628

Maioli M, Toso A, Gallopin M, Leoncini M, Tedeschi D, Micheletti C, et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med (Hagerstown). 2010;11(6):444-9. doi: https://doi.org/10.2459/JCM.0b013e328335227c

Macdonald DB, Hurrell C, Costa AF, McInnes MDF, O'Malley ME, Barrett B, et al. Canadian Association of Radiologists Guidance on Contrast Associated Acute Kidney Injury. Can Assoc Radiol J. 2022;73(3):499-514. doi: https://doi.org/10.1177/08465371221083970

Pustovoyt AL, Yarmola TI, Talash VV, Tkachenko LA, Kostrikova UA. [Studying the Main Issues of Contrast-Induced Nephropathy (Review of Literature)]. JMBS. 2018;3(2,11):208-16. Ukrainian. doi: https://doi.org/10.26693/jmbs03.02.208

Van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, et al. Post-contrast acute kidney injury. P. 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2018;28(7):2856-69. doi: https://doi.org/10.1007/s00330-017-5247-4

Steffens L, Hayes L, Wiebe AZ. Pharmacology of Contrast-In- duced Nephropathy. AACN Advanced Cri-tical Care. 2019;30(2):97-104. doi: https://doi.org/10.4037/aacnacc2019550

Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, et al. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet. 2021;398(10315):1974-83. doi: https://doi.org/10.1016/S0140-6736(21)02326-6

Antomonov MYu. [Mathematical processing and analysis of biomedical data]. Kyiv: Firma maloho druku; 2006. 558 p. Ukrainian.