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Sodium bicarbonate for the prevention of contrast-induced nephropathy: the efficacy of high concentration solution.
Tamai, N, Ito, S, Nakasuka, K, Morimoto, K, Miyata, K, Inomata, M, Yoshida, T, Suzuki, S, Murakami, Y, Sato, K
The Journal of invasive cardiology. 2012;(9):439-42
Abstract
BACKGROUND The appropriate dose of sodium bicarbonate to prevent contrast-induced nephropathy (CIN) has not been established. METHODS AND RESULTS To determine the efficacy of high-concentration sodium bicarbonate, 123 consecutive patients with renal dysfunction undergoing coronary angiography with/without intervention were administrated either high-concentration (group H: 833 mEq/L, n = 87) or low-concentration (group L: 160 mEq/L, n = 36) sodium bicarbonate at the rate of 3 mL/kg/h for 1 hour before the contrast exposure, and followed by 1 mL/kg/h for 7 hours. A total of 77 patients (group H, n = 54; group L, n = 23) without prophylactic continuous hemodiafiltration were analyzed in this study. Urine pH (n = 10 for each group and n = 5 for control) was increased by concentration and time-dependent manner in each group. Urine pH at 3 hours after administration of sodium bicarbonate was significantly higher in group H than group L and control (8.50 ± 0.94 vs 6.95 ± 1.17 vs 5.70 ± 0.97, respectively; P<.001). Incidence of CIN (0% vs 17.3%; P=.005) was lower in group H than group L. Percent change in creatinine within 48 hours was significantly lower in group H than group L (-2.65 ± 9.83% vs 9.14 ± 14.0%; P=.001). Percent change in estimated glomerular filtration rate within 48 hours was significantly higher in group H than group L (3.97 ± 11.8 vs -7.43 ± 13.3; P<.001). CONCLUSION Administration of a higher concentration of sodium bicarbonate was more effective for urine alkalization and prevention of CIN.
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[Efficacy of high dose atorvastatin on preventing contrast induced nephropathy in patients underwent coronary angiography].
Zhou, X, Jin, YZ, Wang, Q, Min, R, Zhang, XY
Zhonghua xin xue guan bing za zhi. 2009;(5):394-6
Abstract
OBJECTIVE To compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention. METHODS All patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n = 100) and high dose group received additional atorvastatin 80 mg at 12 to 24 hours before procedure (n = 50). Scr, Ccr, blood beta(2)-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups. RESULTS Baseline demographic characteristics and nephropathy risk factors were similar between groups. Ccr was significantly reduced while blood beta(2)-M and uric NAG/Cr were significantly increased in low dose group (all P < 0.05). Blood beta(2)-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35 +/- 0.52) mg/L vs. (2.67 +/- 0.64) mg/L, P = 0.008], day 3 [(2.49 +/- 0.55) mg/L vs. (2.80 +/- 0.64) mg/L, P = 0.011] and day 5 [(2.29 +/- 0.53) mg/L vs. (2.56 +/- 0.66) mg/L, P = 0.026] post-procedure respectively;urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19 +/- 0.30) U/mmol vs. (1.46 +/- 0.34) U/mmol, P < 0.001], day 3 [(1.30 +/- 0.30) U/mmol vs. (1.59 +/- 0.33) U/mmol, P < 0.001], and day 5 [(1.10 +/- 0.30) U/mmol vs. (1.34 +/- 0.35) U/mmol, P = 0.001] post-procedure respectively;Ccr in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69 +/- 20.99) ml/min vs. (65.19 +/- 18.72) ml/min, P = 0.035], day 3 [(64.04 +/- 15.82) ml/min vs. (56.79 +/- 14.50) ml/min, P = 0.019]post-procedure respectively. CONCLUSION High dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.
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Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease.
Geluk, CA, Dikkers, R, Perik, PJ, Tio, RA, Götte, MJ, Hillege, HL, Vliegenthart, R, Houwers, JB, Willems, TP, Oudkerk, M, et al
European radiology. 2008;(2):244-52
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Abstract
We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS>or=400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12+/-4 months, CCS>or=400, 10-399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85-0.93) for CCS was superior to 0.69 (95% CI: 0.61-0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.
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Variability of repeated coronary artery calcium measurements by 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT.
Horiguchi, J, Matsuura, N, Yamamoto, H, Hirai, N, Kiguchi, M, Fujioka, C, Kitagawa, T, Kohno, N, Ito, K
European radiology. 2008;(2):209-16
Abstract
High reproducibility on coronary artery calcium scoring is a key requirement in monitoring the progression of coronary atherosclerosis. The purpose of this prospective study is to assess the reproducibility of 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT with respect to 2.5-mm-thickness images on spiral overlapping reconstruction. One hundred patients suspected of coronary artery disease were scanned twice repeatedly, both on prospective electrocardiograph-triggered step-and-shoot and retrospective electrocardiograph-gated spiral scans. Using 1.25-mm-thickness collimation, 1.25-mm- and 2.5-mm-thickness image sets on prospective scans and 2.5-mm-thickness image sets with 1.25-mm increment (overlapping) on retrospective scans were obtained. Coronary artery calcium scores, interscan variability and interobserver variability were evaluated. The mean interscan variability in coronary artery calcium measurement on 1.25-mm prospective/2.5-mm prospective/2.5-mm overlapping retrospective scans were Agatston: 10%/18%/12%, volume: 10%/12%/10% and mass: 8%/13%/11% for observer 1 and Agatston: 8%/14%/10%, volume: 7%/9%/10% and mass: 7%/10%/9% for observer 2, respectively. The mean interobserver variability was 5% to 14%. In conclusion, prospective electrocardiograph-triggered 64-slice CT using the 1.25-mm prospective scan shows the lowest variability. The 2.5-mm prospective scan on volume or mass scoring shows variability of around 10%, comparable to 2.5-mm-thickness spiral overlapping reconstruction images.
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Managing the high-risk patient: experience with fenoldopam, a selective dopamine receptor agonist, in prevention of radiocontrast nephropathy during percutaneous coronary intervention.
Kini, AA, Sharma, SK
Reviews in cardiovascular medicine. 2001;:S19-25
Abstract
Acute worsening of renal function due to contrast agents occurs in 15% to 40% of patients with baseline renal insufficiency undergoing percutaneous coronary intervention. Radiocontrast nephropathy is associated with increased morbidity, prolonged hospitalization, and higher in-hospital mortality. Our nonrandomized data suggest that in adequately hydrated patients, the dopamine-1 receptor agonist fenoldopam is a useful adjunct during PCI for prevention of RCN, reducing its incidence to less than 5%. This renoprotective effect of fenoldopam was more pronounced in diabetics, with moderate renal failure, in whom no agent has been shown so far to be beneficial.