PCI complications: renal failure

WikiDoc Resources for PCI complications: renal failure
Articles
Most recent articles on PCI complications: renal failure Most cited articles on PCI complications: renal failure Review articles on PCI complications: renal failure Articles on PCI complications: renal failure in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on PCI complications: renal failure Images of PCI complications: renal failure Photos of PCI complications: renal failure Podcasts & MP3s on PCI complications: renal failure Videos on PCI complications: renal failure
Evidence Based Medicine
Cochrane Collaboration on PCI complications: renal failure Bandolier on PCI complications: renal failure TRIP on PCI complications: renal failure
Clinical Trials
Ongoing Trials on PCI complications: renal failure at Clinical Trials.gov Trial results on PCI complications: renal failure Clinical Trials on PCI complications: renal failure at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on PCI complications: renal failure NICE Guidance on PCI complications: renal failure NHS PRODIGY Guidance FDA on PCI complications: renal failure CDC on PCI complications: renal failure
Books
Books on PCI complications: renal failure
News
PCI complications: renal failure in the news Be alerted to news on PCI complications: renal failure News trends on PCI complications: renal failure
Commentary
Blogs on PCI complications: renal failure
Definitions
Definitions of PCI complications: renal failure
Patient Resources / Community
Patient resources on PCI complications: renal failure Discussion groups on PCI complications: renal failure Patient Handouts on PCI complications: renal failure Directions to Hospitals Treating PCI complications: renal failure Risk calculators and risk factors for PCI complications: renal failure
Healthcare Provider Resources
Symptoms of PCI complications: renal failure Causes & Risk Factors for PCI complications: renal failure Diagnostic studies for PCI complications: renal failure Treatment of PCI complications: renal failure
Continuing Medical Education (CME)
CME Programs on PCI complications: renal failure
International
PCI complications: renal failure en Espanol PCI complications: renal failure en Francais
Business
PCI complications: renal failure in the Marketplace Patents on PCI complications: renal failure
Experimental / Informatics
List of terms related to PCI complications: renal failure

Editors-In-Chief: Alexandra Almonacid M.D. and Jeffrey J.Popma M.D.

Incidence

• The morbidity and mortality associated with PCI relates directly to the extent of baseline renal disease.
• Patients with evidence of mild renal dysfunction have a 20 percent higher risk of death a one year following PCI than patients with preserved renal function (1-4).
• Mild renal dysfunction following PCI may increase the risk of death up to four fold at one year following PCI compared with patients with preserved renal function (1, 2, 4, 5).
• Worsening of renal function may occur after contrast agent administration in 13 to 20% of patients
• 5% patient will have a 1 mg/dl increase of creatinine following angiography
• <1% chronic dialysis

Etiology

Renal dysfunction following contrast administration during angiography may relate to either contrast induced nephropathy (CIN), cholesterol embolization syndrome, or both.

• Contrast Induced Nephropathy
  • The risk of CIN is dependent on the dose of the contrast agents used, hydration status at the time of the procedure, pre-existing renal function of the patient, age, hemodynamic stability, anemia, and diabetes (1, 6), and the risk for cholesterol embolization syndrome relates to catheter manipulation in an ascending or descending atherosclerotic aorta that releases cholesterol crystals (7).
  • While the risk of hemodialysis is less than 3 percent in cases of uncomplicated CIN, the in-hospital mortality in the setting of hemodialysis exceeds 30 percent (5).

Risk Factors

• Prior renal insufficiency
• [Diabetes Mellitus]
• Dehydration before the procedure
• [Congestive Heart Failure]
• Larger volumes of contrast material
• Nephrotoxic drugs
• Recent (<48 hour) contrast exposure.

Toxicities Associated with Radiocontrast Agents

• Allergic (anaphylactoid) reactions
  • Grade I: Single episode of emesis, nausea, sneezing, or vertigo
  • Grade II: Hives, multiple episodes of emesis, fevers, or chills
  • Grade III: Clinical shock, bronchospasm, laryngospasm or edema, loss of consciousness, hypotension, hypertension, cardiac arrhythmia, angioedema, or pulmonary edema
• Cardiovascular toxicity
  • Electrophysiologic
    • Bradycardia (asystole, heart block)
    • Tachycardia (sinus, ventricular)
    • Ventricular fibrillation
  • Hemodynamic
    • Hypotension (cardiac depression, vasodilation)
    • Heart failure (cardiac depression, increased intravascular volume)
• Nephrotoxicity
• Discomfort
  • Nausea
  • Vomiting
  • Heat and flushing
• Hyperthyroidism

References

1. ref1 PMID 16489569
2. ref2 PMID 15957128
3. ref3 PMID 12943868
4. ref4 PMID 15864241
5. ref5 PMID 12010907
6. ref6 PMID 15619387
7. ref7 PMID 12875753