Post on 12-Feb-2017
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Prevention of contrast-induced nephropathy
Nicolas Boudou, MD,Cardiology department
Rangueil university hospitalToulouse, France
Pôle Cardiovasculaire et Métabolique
Pôle Cardiovasculaire et Métabolique
Potential conflicts of interest
Speaker's name: Dr Nicolas Boudou
I do not have any potential conflict of interest
Contrast-induced nephropathy (CIN)
Iatrogenic disease
• Impairment of renal function
• 25% serum creatinine (SCr) from baseline or 44 μmol/L in
absolute value
• 48-72 hrs after contrast administration
• SCr levels peak between 2- 5 days
• Usually return normal in 14 days
Epidemiology: Frequence decline over the past decade ≈ 15% to ≈ 7%
Consequences: mortality, MACE and length of hospitalization
P McCullough et al. Am J Cardiol 2006; 98
M T James et al. Circ Cardiovasc Interv. 2013;6:37-43
Risk ratio for mortality associated with contrast-induced acute kidney injury (CI-AKI)
N: 139 603 pts; 34 studies
Pooled ajusted RR= 2.39
(95% CI, 1.98-2.90; p<0.001)
Risk ratio for MACE with contrast-induced acute kidney injury (CI-AKI)
N: 70 031 pts; 14 studies
Pooled ajusted RR= 2.42
(95% CI, 1.62-3.64; p<0.001)
M T James et al. Circ Cardiovasc Interv. 2013;6:37-43
Especially if Glomerular filtration rate (GFR) <40 mL/min/1.73 m2
• Preventive hydratation 12hrs before, continuated for at least 24hrs
• Hydratation with isotonic saline
• Short term high dose statin therapy
• Volume constrat media should be minimized
< 350 mL or < 4 mL/kg or total volume contrast/GFR ratio <3.4
W Laskey et al. J Am Coll Cardiol 2007;50:584-90
Independant predictor of an
abnormal increase in SCr
V/ CrCl > 3.7
Marenzi et al. J Am Coll Cardiol Intv 2012;5:90-7
Michael et al. Catheter Cardiovasc Interv 2014 [Epub ahead of print]
Patel et al. J Am Coll Cardiol Intv 2013;6:128-36
Contrast nephropathy: 3.8%
Lin et al. Eurointervention 2014;9:1173-80
516 ptsIncidence of CIN 5.4% (28/516)
Mehran et al. J ACC 2004;44;1393-1399
Lin et al. Eurointervention 2014;9:1173-80
Conclusion
How to prevent CIN
– Hydratation with isotonic saline
– Minimize volume contrast media
• V/ CrCl < 4 or 6
• or <4 mL/kg
• or <350 mL,
– Furosemide with matched hydratation can be an option ( CrCl< 60mL)
Conclusion
How to minimize volume contrast media
– Coronary angiogram to assess CTO and collaterals
– No CTO-PCI ad hoc
– Define your strategy (according to anatomy, renal function…)
– Selective injection in a collateral than in main artery
– IVUS
– Stop the procedure before V/ CrCl >8 ?