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1.
Effectiveness of oral hydration in preventing contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention: a pairwise and network meta-analysis.
Zhang, W, Zhang, J, Yang, B, Wu, K, Lin, H, Wang, Y, Zhou, L, Wang, H, Zeng, C, Chen, X, et al
Coronary artery disease. 2018;(4):286-293
Abstract
BACKGROUND The effectiveness of oral hydration in preventing contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography or intervention has not been well established. This study aims to evaluate the efficacy of oral hydration compared with intravenous hydration and other frequently used hydration strategies. METHODS PubMed, Embase, Web of Science, and the Cochrane central register of controlled trials were searched from inception to 8 October 2017. To be eligible for analysis, studies had to evaluate the relative efficacy of different prophylactic hydration strategies. We selected and assessed the studies that fulfilled the inclusion criteria and carried out a pairwise and network meta-analysis using RevMan5.2 and Aggregate Data Drug Information System 1.16.8 software. RESULTS A total of four studies (538 participants) were included in our pairwise meta-analysis and 1754 participants from eight studies with four frequently used hydration strategies were included in a network meta-analysis. Pairwise meta-analysis indicated that oral hydration was as effective as intravenous hydration for the prevention of CI-AKI (5.88 vs. 8.43%; odds ratio: 0.73; 95% confidence interval: 0.36-1.47; P>0.05), with no significant heterogeneity between studies. Network meta-analysis showed that there was no significant difference in the prevention of CI-AKI. However, the rank probability plot suggested that oral plus intravenous hydration had a higher probability (51%) of being the best strategy, followed by diuretic plus intravenous hydration (39%) and oral hydration alone (10%). Intravenous hydration alone was the strategy with the highest probability (70%) of being the worst hydration strategy. CONCLUSION Our study shows that oral hydration is not inferior to intravenous hydration for the prevention of CI-AKI in patients with normal or mild-to-moderate renal dysfunction undergoing coronary angiography or intervention.
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Meta-analysis of rosuvastatin efficacy in prevention of contrast-induced acute kidney injury.
Zhang, J, Guo, Y, Jin, Q, Bian, L, Lin, P
Drug design, development and therapy. 2018;:3685-3690
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a complication after the intravascular administration of a contrast medium injection. Previous studies have investigated statins as therapy for CIN due to its positive results in the prevention of contrast-induced acute kidney injury (CI-AKI). Nevertheless, the beneficial effects of rosuvastatin pretreatment in preventing CIN in patients with acute coronary syndromes still remain controversial. In this study, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the beneficial impact of rosuvastatin in the prevention of CI-AKI in acute coronary syndrome patients. METHODS PubMed, Embase, and Cochrane library were searched, for RCTs, updated on January 2018. The method was to evaluate rosuvastatin prior to angiography for the prevention of CI-AKI in patients undergoing coronary angiography, of which the main outcome was the incidence of CIN. RESULTS A total of five RCTs were included in this analysis. Patients treated with rosuvastatin prior to invasive angiography had a significantly lower incidence of CI-AKI than controls (odds ratio [OR]: 0.53, 95% CI: 0.40-0.71, P<0.0001). Moreover, the subgroup analysis also showed that the benefit of rosuvastatin for patients with chronic kidney disease (OR: 0.49, 95% CI: 0.26-0.92, P=0.03) and diabetes mellitus (OR: 0.56, 95% CI: 0.38-0.83, P=0.004) which was consistent in compared with the respective control groups. CONCLUSION The findings of this meta-analysis suggest that the preoperative rosuvastatin treatment significantly reduces the risk of renal insufficiency of CIN in at-risk patients with chronic kidney disease or diabetes mellitus. Additional studies are needed to identify at-risk patients, provide optimum dose peri-procedural treatment, and reduce the incidence of CIN.
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The efficacy of probucol combined with hydration in preventing contrast-induced nephropathy in patients with coronary heart disease undergoing percutaneous coronary intervention: a multicenter, prospective, randomized controlled study.
Fu, N, Yang, S, Zhang, J, Zhang, P, Liang, M, Cong, H, Lin, W, Tian, F, Lu, C
International urology and nephrology. 2018;(1):105-112
Abstract
PURPOSE To investigate the preventive effect of probucol combined with hydration on contrast-induced nephropathy (CIN) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). METHODS A total of 641 patients undergoing PCI were randomly assigned to either a probucol group (probucol 500 mg twice daily and hydration; n = 321) or a control group (hydration only; n = 320). The primary endpoint was the incidence of CIN, defined as an increase in serum creatinine (Scr) by ≥ 44.2 μmol/L or ≥ 25% within 72 h after the administration of contrast agent. Secondary endpoints were changes in Scr, cystatin-C (Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP), superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major adverse events during hospitalization or the 14-day follow-up period. RESULTS The incidence of CIN was 4.0% (13/321) in the probucol group and 10.9% (35/320) in the control group. The probucol group had lower Cys-C and higher Ccr at 48 and 72 h after PCI compared with the control group. At 48 and 72 h following the operation, Cys-C and CRP were lower in the probucol group compared with the control group, but Ccr, SOD, and GSH were higher. There were no differences in the incidence of major adverse events during hospitalization or the 14-day follow-up between the groups. Multivariate logistic regression analysis showed that probucol was an independent protective factor for CIN. CONCLUSIONS Probucol combined with hydration more effectively decreased the incidence of CIN in patients with coronary heart disease undergoing PCI compared with hydration alone.
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Short-term rosuvastatin treatment for the prevention of contrast-induced acute kidney injury in patients receiving moderate or high volumes of contrast media: a sub-analysis of the TRACK-D study.
Zhang, J, Li, Y, Tao, GZ, Chen, YD, Hu, TH, Cao, XB, Jing, QM, Wang, XZ, Ma, YY, Wang, G, et al
Chinese medical journal. 2015;(6):784-9
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Abstract
BACKGROUND Current randomized trials have demonstrated the effects of short-term rosuvastatin therapy in preventing contrast-induced acute kidney injury (CIAKI). However, the consistency of these effects on patients administered different volumes of contrast media is unknown. METHODS In the TRACK-D trial, 2998 patients with type 2 diabetes and concomitant chronic kidney disease (CKD) who underwent coronary/peripheral arterial angiography with or without percutaneous intervention were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard-of-care. This prespecified analysis compared the effects of rosuvastatin versus standard therapy in patients exposed to (moderate contrast volume [MCV], 200-300 ml, n = 712) or (high contrast volume [HCV], ≥ 300 ml, n = 220). The primary outcome was the incidence of CIAKI. The secondary outcome was a composite of death, dialysis/hemofiltration or worsened heart failure at 30 days. RESULTS Rosuvastatin treatment was associated with a significant reduction in CIAKI compared with the controls (2.1% vs. 4.4%, P = 0.050) in the overall cohort and in patients with MCV (1.7% vs. 4.5%, P = 0.029), whereas no benefit was observed in patients with HCV (3.4% vs. 3.9%, P = 0.834). The incidence of secondary outcomes was significantly lower in the rosuvastatin group compared with control group (2.7% vs. 5.3%, P = 0.049) in the overall cohort, but it was similar between the patients with MCV (2.0% vs. 4.2%, P = 0.081) or HCV (5.1% vs. 8.8%, P = 0.273). CONCLUSIONS Periprocedural short-term rosuvastatin treatment is effective in reducing CIAKI and adverse clinical events for patients with diabetes and CKD after their exposure to a moderate volume of contrast medium.
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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.
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B-type natriuretic peptide for prevention of contrast-induced nephropathy in patients with heart failure undergoing primary percutaneous coronary intervention.
Zhang, J, Fu, X, Jia, X, Fan, X, Gu, X, Li, S, Wu, W, Fan, W, Su, J, Hao, G, et al
Acta radiologica (Stockholm, Sweden : 1987). 2010;(6):641-8
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is one of the leading causes of hospital-acquired renal failure and increase in the mortality and length of hospital stay after percutaneous coronary intervention (PCI). PURPOSE To evaluate the protective effect of B-type natriuretic peptide (BNP) on CIN in patients with heart failure undergoing PCI. MATERIAL AND METHODS In the prospective, placebo-controlled, randomized trial, 149 consecutive acute myocardial infarction (AMI) patients with heart failure undergoing primary PCI received recombinant human BNP (rhBNP) or placebo from the time of admission to 24 h after PCI. Serum creatinine (SCr) levels were measured to evaluate the protective effect of rhBNP on renal function. Estimated glomerular filtration rate (eGFR) was calculated by the simplified modification of diet in renal disease study equation. CIN was defined as a postprocedure peak increase in SCr of >0.5 mg/dl or >25% from baseline. RESULTS The baseline characteristics were similar in the two groups. The SCr significantly increased after PCI, with the peak value at 48 h, and then began to decrease. At day 7 after PCI, the SCr had lowered to the baseline level in the BNP group, but it failed to do so in the control group. At 24, 48, and 72 h and 7 days after PCI, the SCr was lower in the BNP group than that in the control group. The eGFR decreased significantly after PCI, with the lowest value at 48 h, and then it began to increase. The eGFR after PCI was higher in the rhBNP group than that in the control group. The occurrence of CIN was significantly lower in the rhBNP group than in the control group. CONCLUSION Periprocedural use of BNP could further promote the recovery of renal function and decrease the occurrence of CIN compared with routine treatment alone in patients with heart failure undergoing primary PCI.
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Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine.
Chen, SL, Zhang, J, Yei, F, Zhu, Z, Liu, Z, Lin, S, Chu, J, Yan, J, Zhang, R, Kwan, TW
International journal of cardiology. 2008;(3):407-13
Abstract
BACKGROUND The potential role of hydration in prevention of contrast-induced nephropathy (CIN) still remains to be unclear. METHODS Nine-hundred and thirty-six patients scheduled for percutaneous coronary intervention (PCI) were enrolled into the present study, and divided into normal (serum creatinine<1.5 mg/dl) and abnormal (serum creatine> or =1.5 mg/dl) groups according to their baseline serum concentration of creatinine. Each group was further randomly divided into two subgroups: hydration and nonhydration. All patients in abnormal group took twice orally loading dose of 1200 mg acetylcysteine (ATLS) at 12 h before scheduled time for coronary angiogram and immediately after procedure. Creatinine concentration was remeasured at the time of admission (just before catheterization), every day for the following three days. The primary end point during 6-month follow-up included clinical driven revascularization (either PCI or CABG), death from all causes, and requiring emergency renal-replacement therapy. RESULTS The incidence of CIN was more commonly in abnormal group that in normal group (6.52% vs. 37.68%, p<0.001). Hydration had potentials in prevention of CIN only in patients with elevated baseline concentration of creatinine. Multivariate analysis demonstrated that the following variables remained to be significant factors correlating with CIN: age> or =70 years (odds ration [OR] 5.27, 95% confidence interval [CI] 1.94 to 13.07, p=0.0007), contrast volume> or =320 ml (OR 3.26, 95% CL 2.14 to 7.58, p=0.01), diabetes mellitus (OR 9.86, 95% CL 5.38 to 31.67, p<0.0001), and peripheral arterial disease (OR 11.25, 95% CL 5.12 to 43.19, p<0.0001). Patients with CIN in abnormal group had worse clinical outcomes, compared to patients with CIN in normal group. CONCLUSION Patients with CIN and preexisting renal insufficiency had worse clinical outcomes. Hydration with 0.45% sodium chloride alone had no potential effect on the occurrence of CIN in patients with normal renal function. Combination of hydration with ATLS could reduce the incidence of CIN in patients at high risk.