Контраст-индуцированное острое повреждение почек у больных со стабильной ишемической болезнью сердца: важнейшие факторы риска и распространенность
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Mironova O.Iu., Staroverov I.I., Sivakova O.A., Fomin V.V. Contrast-induced acute kidney injury in patients with stable coronary artery disease: the most important risk factors and prevalence. Therapeutic Archive. 2020; 92 (9): 44–48.
DOI: 10.26442/00403660.2020.09.000751
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Материалы и методы. В открытое проспективное наблюдательное когортное исследование включены 1023 больных. КИ-ОПП определялось как повышение уровня сывороточного креатинина на 25% от исходного. Средний возраст пациентов составил 61,7±10,1 года; 72,4% – мужчины, 84,4% страдали артериальной гипертензией. На основании полученных данных имелась построенная модель множественной логистической регрессии.
Результаты. КИ-ОПП развилось у 132 (12,9%) больных. Логистическая регрессионная модель включала пол, индекс массы тела, массу тела, возраст, наличие сердечной недостаточности, сахарного диабета, артериальной гипертензии, анемии, гиперурикемии, протеинурии и исходный уровень сывороточного креатинина. Площадь под кривой составила 0,749 (95% доверительный интервал 0,703–0,795; p<0,0001). При попытках ввести в качестве переменных исходный уровень скорости клубочковой фильтрации и объема контраста модель теряла статистическую значимость, а площадь под кривой снижалась.
Заключение. КИ-ОПП остается довольно частым видом острого повреждения почек у больных со стабильной ишемической болезнью сердца, которым проводятся чрескожные вмешательства. Перед любым вмешательством с внутриартериальным введением контрастного вещества коморбидным пациентам необходимо тщательно оценить все имеющиеся факторы риска.
Ключевые слова: контраст-индуцированная нефропатия, контраст-индуцированное острое повреждение почек, контраст-ассоциированное острое повреждение почек, ишемическая болезнь сердца, чрескожное коронарное вмешательство, контрастное вещество, прогноз.
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Aim. The aim of our study was to assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) receiving optimal medical treatment with indications to coronary angiography and intraarterial administration of contrast agents.
Materials and methods. 1023 patients with stable CAD were included in the open prospective observational cohort study. The CI-AKI was defined as a rise in serum creatinine ≥25% from baseline. The mean age of the study group was 61.7±10.1 years; 72.4% were males and 84.4% had arterial hypertension. A multiple logistic regression model of prediction of CI-AKI was created.
Results. CI-AKI developed in 132 (12.9%) of the patients. The multiple logistic regression model included gender, BMI, weight, age, heart failure, diabetes mellitus, arterial hypertension, anemia, hyperuricemia, proteinuria and baseline serum creatinine. Area under the curve for the model was 0.749 (95% confidence interval 0.703–0,795; p<0.0001). When trying to build a prognostic model, including baseline GFR and contrast volume, the model lost significance and the AUC diminished.
Conclusion. The CI-AKI remains quite a common kidney injury developing in patients with stable CAD undergoing percutaneous interventions. Several risk factors need to be assessed very carefully before any intervention requiring intraarterial contrast media administration especially in patients with comorbidities.
Keywords: contrast-induced nephropathy, contrast-induced acute kidney injury, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, contrast, prognosis.
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6. Zeng J-feng, Chen S-qun, Ye J-feng, et al. A simple risk score model for predicting contrast-induced nephropathy after coronary angiography in patients with diabetes. Clin Exp Nephrol. 2019;23(7):969-81. doi: 10.1007/s10157-019-01739-0
7. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol. 2004;44(7):1393-9. doi: 10.1016/j.jacc.2004.06.068
8. Huang C, Li S, Mahajan S, et al. Development and Validation of a Model for Predicting the Risk of Acute Kidney Injury Associated With Contrast Volume Levels During Percutaneous Coronary Intervention. 2019;L(11):1-13. doi: 10.1001/jamanetworkopen.2019.16021
9. Вершинина Е.О., Репин А.Н. Контраст-индуцированная нефропатия при плановых эндоваскулярных вмешательствах на коронарных артериях. Сибирский журн. клинической и экспериментальной медицины. 2016;31(3):61-7 [Vershinina EO, Repin АN. Contrast-induced nephropathy after elective percutaneous coronary interventions. Siberian Journal of Clinical and Experimental Medicine (In Russ.)]. doi: 10.29001/2073-8552-2016-31-3-61-67
10. Zhao F, Lei R, Yang SK, et al. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: A systematic review and meta-analysis. Cancer Imaging. 2019;19(1):1-8. doi: 10.1186/s40644-019-0224-6
11. Maioli M, Toso A, Leoncini M, et al. Persistent renal damage after contrast-induced acute kidney injury: Incidence, evolution, risk factors, and prognosis. Circulation. 2012;125(25):3099-107. doi: 10.1161/CIRCULATIONAHA.111.085290
12. Lakhal K, Robert-Edan V, Ehrmann S. In the Name of Contrast-Induced Acute Kidney Injury… Chest. 2020;157(4):751-2. doi: 10.1016/j.chest.2019.12.009
13. Caspi O, Habib M, Cohen Y, et al. Acute Kidney Injury After Primary Angioplasty: Is Contrast-Induced Nephropathy the Culprit? J Am Heart Assoc. 2017;6(6):1-10. doi: 10.1161/JAHA.117.005715
14. Yarkova NA, Borovkov NN. Algorithm for early diagnosis of contrast-induced nephropathy using biomarkers of renal damage. Sovrem Tehnol Med. 2017;9(4):156-61. doi: 10.17691/stm2017.9.4.19
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1. McCullough PA, Adam A, Becker CR, et al. Risk Prediction of Contrast-Induced Nephropathy. Am J Cardiol. 2006;98(6 Suppl. 1):27-36. doi: 10.1016/j.amjcard.2006.01.022
2. KDIGO Working Group. Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):124-38. http://www.kdigo.org/
clinical_practice_guidelines/pdf/KDIGO AKI Guideline.pdf
3. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med. 2019;380(22):2146-55. doi: 10.1056/NEJMra1805256
4. Kellum JA, Zarbock A, Nadim MK. What endpoints should be used for clinical studies in acute kidney injury? Intensive Care Med. 2017;43(6):901-3. doi: 10.1007/s00134-017-4732-1
5. Maioli M, Toso A, Gallopin M, et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med. 2010;11(6):444-9. doi: 10.2459/JCM.0b013e328335227c
6. Zeng J-feng, Chen S-qun, Ye J-feng, et al. A simple risk score model for predicting contrast-induced nephropathy after coronary angiography in patients with diabetes. Clin Exp Nephrol. 2019;23(7):969-81. doi: 10.1007/s10157-019-01739-0
7. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol. 2004;44(7):1393-9. doi: 10.1016/j.jacc.2004.06.068
8. Huang C, Li S, Mahajan S, et al. Development and Validation of a Model for Predicting the Risk of Acute Kidney Injury Associated With Contrast Volume Levels During Percutaneous Coronary Intervention. 2019;L(11):1-13. doi: 10.1001/jamanetworkopen.2019.16021
9. Vershinina EO, Repin АN. Contrast-induced nephropathy after elective percutaneous coronary interventions. Siberian Journal of Clinical and Experimental Medicine (In Russ.) doi: 10.29001/2073-8552-2016-31-3-61-67
10. Zhao F, Lei R, Yang SK, et al. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: A systematic review and meta-analysis. Cancer Imaging. 2019;19(1):1-8. doi: 10.1186/s40644-019-0224-6
11. Maioli M, Toso A, Leoncini M, et al. Persistent renal damage after contrast-induced acute kidney injury: Incidence, evolution, risk factors, and prognosis. Circulation. 2012;125(25):3099-107. doi: 10.1161/CIRCULATIONAHA.111.085290
12. Lakhal K, Robert-Edan V, Ehrmann S. In the Name of Contrast-Induced Acute Kidney Injury… Chest. 2020;157(4):751-2. doi: 10.1016/j.chest.2019.12.009
13. Caspi O, Habib M, Cohen Y, et al. Acute Kidney Injury After Primary Angioplasty: Is Contrast-Induced Nephropathy the Culprit? J Am Heart Assoc. 2017;6(6):1-10. doi: 10.1161/JAHA.117.005715
14. Yarkova NA, Borovkov NN. Algorithm for early diagnosis of contrast-induced nephropathy using biomarkers of renal damage. Sovrem Tehnol Med. 2017;9(4):156-61. doi: 10.17691/stm2017.9.4.19
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
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O.Iu. Mironova1, I.I. Staroverov2, O.A. Sivakova2, V.V. Fomin1
1 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 National Medical Research Center for Cardiology, Moscow, Russia