Efficacy of Atorvastatin in Prevention of Contrast induced Nephropathy in Patients Undergoing Coronary Angiography

Background The use of radiocontrast media has increased greatly from the past decades for diagnostic radiography and interventional procedures and it is estimated that approximately 60 million people in the world are used radiocontrast media each year. Objective The aim of this study was to evaluate the efficacy of atorvastatin (ATN) 80 mg in the prevention of CIN in patients undergoing angiography. Patients and Methods This study was a prospective, two‑arm, parallel group, controlled, clinical trial. This study has been performed on 100 Egyptian patients. Patients of either sex and aged between 21 and 65 years admitted for coronary angiography from January 2019 to June 2019, the patients had serum cretinine between 1 and 1.5 mg/dl or estimated glomerular filtration rate (eGFR > 60 ml/min/1.73m2) and suffering from controlled DM or HTN. Results As regard to prevalence of contrast nephropathy, in our study we found that the total prevalence was 13%. We have concluded a great effect of diabetes on development of contrast nephropathy. We have concluded a great effect of hypertension on development of contrast nephropathy. There was a great effect of number of vessels affected on development of contrast nephropathy. As regard FBS there was no significant difference between the two groups. Also, there was a highly significant positive correlation between and study markers of acute kidney injury (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR) and FBS. As regard Contrast media dose there was no significant difference between the two groups. Also, there was a highly significant positive correlation between and study markers of acute kidney injury (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR) and contrast media dose. In our study there was a highly significant difference between the two groups as regard study markers of evidence of contrast nephropathy (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR).Also, there was a great effect of on development of contrast nephropathy. In our study there was a highly significant difference between the two groups as regard study markers of evidence of contrast nephropathy (72 h- Serum creat Delta Serum creat, 72 h- GFR and Delta GFR).Also, there was a great effect of on development of contrast nephropathy. Conclusion There was a beneficial significant effect of statin on prevention of contrast nephropathy, also we concluded that age, hypertension, DM, dyslipidaemia, FBS, hemoglobin level, serum uric acid and dose of contrast media are major risk factors for developing contrast nephropathy.

Prevalence of contrast nephropathy following the administration of N-acetyl cysteine; a systematic review and meta-analysis

Introduction: Nephropathy is a serious complication in patients receiving contrast during imaging. N-acetyl cysteine (NAC) can reduce the contrast nephropathy. This review evaluates the prevalence of contrast-induced nephropathy (CIN) following the administration of NAC. Methods: A systematic literature search and meta-analysis was conducted in Scopus, Web of Science and PubMed for articles published by December 30, 2019 including the keywords of "N-acetyl cysteine ", "Acute kidney injury", "Nephrotoxicity", "Contrast media", "Contrast-induced AKI" and "Contrast nephropathy". Results: A total of 29 articles of 537 studies examining 5,980 individuals were incorporated in this systematic review and meta-analysis. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 9% (0.09), i.e. nine out of every 100 patients undergoing contrast media resulted in CIN but a prevalence of 14% (0.14) was observed in the placebo group. In addition, 41 out of every 100 patients with hypertension undergoing contrast media resulted in CIN (prevalence: 41%) and 64 out of every 100 patients with diabetes undergoing contrast media resulted in CIN (prevalence: 64%). Conclusion: The prevalence of CIN in the group receiving NAC is lower than those who did not receive this drug. Additionally, in patients suffering from diabetes and hypertension, CIN is more prevalent compared to healthy people.

Contrast-induced nephropathy associated factors in patients with significant coronary obstruction

Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the “Hermanos Ameijeiras” hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication.

Complications

Cardiac catheterization is an invasive study that involves real risks to the patient. The risks increase with patient age and co-morbidity. Though vascular complications (particularly haematoma formation) and vasovagal reactions are more common, the risk of serious complications from diagnostic cardiac catheterization and coronary angiography remains low. This chapter covers complications that may arise, including death, myocardial infarction, pulmonary oedema, stroke, hypotension, cardiac tamponade, contrast reactions, vasovagal reactions, arrhythmias, vascular complications, limb ischaemia, coronary dissection (including left main stem dissection and iatrogenic type A aortic dissection), air embolism, coronary perforation, renal failure, contrast nephropathy, and cholesterol embolization.