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Hydration Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-Analysis.
Cai, Q, Jing, R, Zhang, W, Tang, Y, Li, X, Liu, T
Journal of interventional cardiology. 2020;:7292675
Abstract
AIMS: Many previous studies have examined the effect of different hydration strategies on prevention of contrast-induced acute kidney injury (CI-AKI), but the optimal strategy is unknown. We performed a network meta-analysis (NWM) of these previous studies to identify the optimal strategy. METHODS AND RESULTS Web of Science, PubMed, OVID Medline, and Cochrane Library were searched from their inception dates to September 30, 2018. Randomized controlled trials (RCTs) were selected based on strict inclusion criteria, and a Bayesian NWM was performed using WinBUGS V.1.4.3. We finally analyzed 60 eligible RCTs, which examined 21,293 patients and 2232 CI-AKI events. Compared to intravenous 0.9% sodium chloride (reference), intravenous sodium bicarbonate (OR [95% CI]: 0.74 [0.57, 0.93]), hemodynamic guided hydration (0.41 [0.18, 0.93]), and RenalGuard guided hydration (0.32 [0.14, 0.70]) significantly reduced the occurrence of CI-AKI. Oral hydration and intravenous 0.9% sodium chloride were each noninferior to no hydration in preventing CI-AKI. Intravenous 0.9% sodium chloride, sodium bicarbonate, and hemodynamic guided hydration were each noninferior to oral hydration in preventing CI-AKI. Based on surface under the cumulative ranking curve values, the RenalGuard system was best (0.974) and hemodynamic guided hydration was second best (0.849). CONCLUSION There was substantial evidence to support the use of RenalGuard or hemodynamic guided hydration for preventing CI-AKI in high-risk patients, especially those with chronic kidney disease or cardiac dysfunction.
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Nicorandil for the prevention of contrast-induced nephropathy: A meta-analysis of randomized controlled trials.
Ma, X, Li, X, Jiao, Z, Zhang, Y
Cardiovascular therapeutics. 2018;(2)
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Abstract
INTRODUCTION Nicorandil has been suggested as a preventative strategy against the incidence of contrast-induced nephropathy (CIN). However, results of relevant randomized controlled trials (RCTs) were inconsistent. AIMS We performed a meta-analysis of RCTs to evaluate the preventive efficacy of periprocedural treatment of nicorandil against the incidence of CIN. METHODS Relevant RCTs were identified via search of PubMed, Embase, and Cochrane's Library databases. Results were pooled using a random-effect model. Subgroup analyses were performed to evaluate the potential influence of administering routes on the efficacy of nicorandil against CIN incidence. RESULTS Four RCTs with 709 patients were included. Treatment of nicorandil significantly reduced the incidence of CIN as compared with controls (risk ration [RR]: 0.38, 95% confidence interval [CI]: 0.19 ~ 0.74, P = .005) with moderate heterogeneity (I2 = 33%). Results of subsequent subgroup analysis showed that nicorandil significantly reduced the risk of CIN if orally administered (RR: 0.32, P < .001), but did not if intravenously administered (RR: 0.47, I2 = 68%). Moreover, treatment with nicorandil was associated with significantly less increment of SCr (weight mean difference [WMD]: -3.98%, P < .001) and a tendency of less increment of cystatin C (WMD: -3.86%, P = .08) after 48-hour contrast exposure as compared with controls. CONCLUSIONS Periprocedural treatment with nicorandil may be preventative against the incidence of CIN in patients undergoing contrast exposure. The influence of periprocedural nicorandil on clinical outcome in these patients deserves further investigation.
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The effect of preparative solid food status on the occurrence of nausea, vomiting and aspiration symptoms in enhanced CT examination: prospective observational study.
Li, X, Liu, H, Zhao, L, Liu, J, Cai, L, Zhang, L, Liu, L, Zhang, W
The British journal of radiology. 2018;(1090):20180198
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Abstract
OBJECTIVE To evaluate the correlation between preparative solid food status and the incidence of nausea, vomiting and aspiration symptoms in contrast-enhanced CT examination, and to provide direction for standardizing the preparative dietary policies. METHODS Patients who underwent routine enhanced CT examination at our hospital between June 2015 and June 2017 (110,836 cases) were enrolled and allocated into solid food fasting group (51,807 cases) and solid food non-fasting group (59,029 cases). Fluids ingestion was not restricted for any case. The differences in the incidence of nausea, vomiting and aspiration symptoms between the two groups of patients with various basic data were compared. The risk factors for the occurrence of nausea, vomiting and aspiration symptoms were analyzed. RESULTS The total incidence of nausea and vomiting was extremely low (0.071%), and no aspiration developed. There was no significant difference in the incidence of nausea and vomiting between the two groups in all respects (p > 0.05). The incidence of nausea and vomiting in patients with an iodine adverse drug reaction (ADR) history was higher than those with other ADR history (p = 0.008) and those without ADR history (p = 0.001). CONCLUSION The occurrence of nausea and vomiting has no correlation with the preparative solid food status. Unless compulsory in clinical needs and constraints and gastrointestinal examination, solid food fasting is not a must in other examinations. Particular attention should be paid to the patients with an iodine ADR history in an effort to prevent possible ADRs. ADVANCES IN KNOWLEDGE The correlation between preparative solid food status and the incidence of nausea, vomiting and aspiration symptoms in contrast-enhanced CT examination were comprehensively analyzed in a large-scale population.
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Recent progress in therapeutic and diagnostic applications of lanthanides.
Zhang, J, Li, Y, Hao, X, Zhang, Q, Yang, K, Li, L, Ma, L, Wang, S, Li, X
Mini reviews in medicinal chemistry. 2011;(8):678-94
Abstract
The biological properties of the lanthanides, primarily based on their similarity to calcium, have been the basis for research into potential therapeutic applications of lanthanides since the early part of the twentieth century. Up to date, cerium nitrate has been used as a topical cream with silver sulfadiazene for the treatment of burn wounds. A lanthanide texaphyrin complex (motexafin gadolinium) has been evaluated through Phase III clinical trials for the treatment of brain metastases in non-small cell lung cancer. Lanthanum carbonate (Fosrenol) as a phosphate binder has been approved for the treatment of hyperphosphatemia in renal dialysis patients in both the USA and Europe. This review will highlight therapeutic applications of the lanthanides for burn wounds, cancer, hyperphosphatemia, immune function, magnetic resonance imaging (MRI) contrast agents and osteoporosis, and discuss their future potential in the medical fields.