Editorial comment
Contrast-induced nephropathy: Can we better predict and prevent it?
Nefropatia induzida por contraste: poderemos prever e preveni-la melhor?
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OSI: oxidative stress index; TAS: total antioxidant status; TOS: total oxidant status.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fatih Aksoy, Hasan Aydın Baş, Ali Bağcı, Hasan Basri Savaş" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Fatih" "apellidos" => "Aksoy" ] 1 => array:2 [ "nombre" => "Hasan" "apellidos" => "Aydın Baş" ] 2 => array:2 [ "nombre" => "Ali" "apellidos" => "Bağcı" ] 3 => array:2 [ "nombre" => "Hasan" "apellidos" => "Basri Savaş" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255120304947" "doi" => "10.1016/j.repc.2020.08.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120304947?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921001872?idApp=UINPBA00004E" "url" => "/21742049/0000004000000007/v1_202107150708/S2174204921001872/v1_202107150708/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Contrast-induced nephropathy: Can we better predict and prevent it?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "499" "paginaFinal" => "500" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro Pinto Cardoso" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Pedro Pinto" "apellidos" => "Cardoso" "email" => array:1 [ 0 => "pedropintocardoso@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Nefropatia induzida por contraste: poderemos prever e preveni-la melhor?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Contrast-induced nephropathy (CIN) is a major concern in daily practice for everyone working in interventional cardiology.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The use of contrast agents has been growing due to the increasing number of procedures that use them, such as: structural heart therapies and primary angioplasty for ST-segment elevation myocardial infarction (STEMI). Contrast-induced nephropathy has a major impact on prognosis after primary percutaneous coronary intervention (PCI).<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,2</span></a> In this particular setting, it is problematic due to the clinical instability of the patient and the impossibility of prevention in an emerging situation.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Contrast-induced nephropathy is a well-known cause of acute renal failure but the underlying mechanisms are yet to be fully understood.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The evidence is in favor of a combination of direct toxic effects on tubular epithelial cells and renal ischemia as the pathogenetic role. The generation of reactive oxygen species, which in turn scavenge nitric oxide, further increases hypoxia.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Identified risk factors for CIN are the baseline renal function itself, diabetes, acute myocardial infarction, shock and the volume of contrast medium administered during the procedure.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Among patients with STEMI, the role of contrast agents has been questioned in acute kidney injury (AKI).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> In this study, Caspi et al. concluded that the risk for AKI was similar among STEMI patients regardless of exposure to contrast material. Independent predictors of AKI in patients who underwent primary PCI included age ≥70 years, insulin-treated diabetes, diuretic therapy, previous infarction, baseline estimated glomerular filtration rate, and variables related to the presence of pump failure (higher Killip class, intra-aortic balloon pump use) and reduced left ventricular ejection fraction but not contrast agent dose.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this issue Fatih Aksoy et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> assessed the association between total oxidant status (TOS), total antioxidant capacity (TAC) and CIN in patients with STEMI. They assessed a cohort of 341 patients. In a multivariate regression analysis, they concluded that high-sensitivity C-reactive protein, uric acid and oxidative status index predicted the development of CIN. They also suggest that incorporating these variables into existing risk scores like the Mehran risk score<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> could improve its accuracy. Nevertheless, only 16.7% of these patients developed CIN, which the authors acknowledged could have influenced their results.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The results suggest, nonetheless, that TOC, TAC and oxidative stress index are associated with the development of CIN, reinforcing the possibility that oxidative stress may be partially responsible for the development of CIN, as already suggested by others.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Preventive measures for CIN, such as fluid administration, pharmacological strategies, use of different contrast agents and renal replacement therapies, have been extensively assessed in many trials.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There seems to be some consensus on fluid administration as a means of protecting from CIN, but the results from trials are conflicting.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11,12</span></a> The addition of sodium bicarbonate may provide additional kidney protection by alkalinizing renal tubular fluid and thereby minimizing tubular damage.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Fluid administration possibly associated with furosemide forced diuresis seems to be a good strategy, although there is the risk of hypovolemia. The fear of giving too much volume, mainly in patients with low ejection fraction can, on the other hand, lead to suboptimal protection. Renal Guard, a device enabling volume administration to be balanced with urine output, showed that a high urine output was achievable, while avoiding hypovolemia, thus protecting from CIN.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Randomized trials with N-acetylcysteine had conflicting results but this drug can have a protective effect.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The authors tried to identify further markers of increased risk of AKI. Still, measuring TOC and TAC in daily practice does not seem feasible. The result of this study may however contribute to further investigation on the mechanisms of CIN and possibly lead to novel therapeutic options to prevent CIN.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Currently, hydration and possibly sodium bicarbonate/N-acetylcysteine seem to be the best and only way to prevent CIN.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 45 | 39 | 84 |
| 2024 September | 43 | 32 | 75 |
| 2024 August | 35 | 37 | 72 |
| 2024 July | 26 | 30 | 56 |
| 2024 June | 22 | 24 | 46 |
| 2024 May | 38 | 23 | 61 |
| 2024 April | 49 | 34 | 83 |
| 2024 March | 26 | 25 | 51 |
| 2024 February | 27 | 18 | 45 |
| 2024 January | 41 | 31 | 72 |
| 2023 December | 44 | 37 | 81 |
| 2023 November | 58 | 48 | 106 |
| 2023 October | 20 | 22 | 42 |
| 2023 September | 24 | 27 | 51 |
| 2023 August | 26 | 21 | 47 |
| 2023 July | 22 | 8 | 30 |
| 2023 June | 25 | 10 | 35 |
| 2023 May | 36 | 33 | 69 |
| 2023 April | 24 | 12 | 36 |
| 2023 March | 46 | 25 | 71 |
| 2023 February | 38 | 20 | 58 |
| 2023 January | 19 | 26 | 45 |
| 2022 December | 43 | 41 | 84 |
| 2022 November | 36 | 41 | 77 |
| 2022 October | 41 | 31 | 72 |
| 2022 September | 22 | 26 | 48 |
| 2022 August | 22 | 28 | 50 |
| 2022 July | 29 | 46 | 75 |
| 2022 June | 30 | 27 | 57 |
| 2022 May | 30 | 30 | 60 |
| 2022 April | 32 | 35 | 67 |
| 2022 March | 35 | 56 | 91 |
| 2022 February | 31 | 44 | 75 |
| 2022 January | 27 | 34 | 61 |
| 2021 December | 27 | 38 | 65 |
| 2021 November | 45 | 35 | 80 |
| 2021 October | 108 | 70 | 178 |
| 2021 September | 52 | 30 | 82 |
| 2021 August | 79 | 48 | 127 |
| 2021 July | 42 | 52 | 94 |
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