PCI complications: renal failure: Difference between revisions

	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

← Older edit Newer edit →

VisualWikitext

Revision as of 20:28, 5 November 2012

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

ref1 PMID 16489569
ref2 PMID 15957128
ref3 PMID 12943868
ref4 PMID 15864241
ref5 PMID 12010907
ref6 PMID 15619387
ref7 PMID 12875753

Template:WikiDoc Sources

@@ Line 17: / Line 17: @@
 ** 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).
-===2011 ACCF/AHA Guidelines for Contrast-Induced Acute Kidney Injury<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref> (DO  NOT EDIT)===
-{|class="wikitable"
-|-
-| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
-|-
-| bgcolor="LightGreen"|
-<nowiki>"</nowiki>'''1.'''  Patients should be assessed for risk of [[Contrast induced nephropathy|contrast-induced acute kidney injury]] before PCI.<ref name="pmid15464318">{{cite journal |author=Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G |title=A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=7 |pages=1393–9 |year=2004 |month=October |pmid=15464318|doi=10.1016/j.jacc.2004.06.068|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01445-7|accessdate=2011-12-06}}</ref><ref name="pmid16461821">{{cite journal |author=Moscucci M, Rogers EK, Montoye C, Smith DE, Share D, O'Donnell M, Maxwell-Eward A, Meengs WL, De Franco AC, Patel K, McNamara R, McGinnity JG, Jani SM, Khanal S, Eagle KA |title=Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions |journal=[[Circulation]] |volume=113 |issue=6 |pages=814–22 |year=2006 |month=February|pmid=16461821 |doi=10.1161/CIRCULATIONAHA.105.541995|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16461821|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
-|-
-| bgcolor="LightGreen"|
-<nowiki>"</nowiki>'''2.''' Patients undergoing cardiac catheterization with [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should receive adequate preparatory [[Contrast induced nephropathy#Hydration with or without bicarbonate|hydration]].<ref name="pmid15267006">{{cite journal |author=Bader BD, Berger ED, Heede MB, Silberbaur I, Duda S, Risler T, Erley CM |title=What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? |journal=[[Clinical Nephrology]] |volume=62 |issue=1 |pages=1–7 |year=2004 |month=July |pmid=15267006 |doi= |url=|accessdate=2011-12-06}}</ref><ref name="pmid11822926">{{cite journal |author=Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H |title=Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty |journal=[[Archives of Internal Medicine]] |volume=162|issue=3 |pages=329–36 |year=2002 |month=February |pmid=11822926 |doi=|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11822926|accessdate=2011-12-06}}</ref><ref name="pmid7969280">{{cite journal |author=Solomon R, Werner C, Mann D, D'Elia J, Silva P |title=Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents |journal=[[The New England Journal of Medicine]] |volume=331 |issue=21 |pages=1416–20 |year=1994 |month=November |pmid=7969280|doi=10.1056/NEJM199411243312104 |url=http://dx.doi.org/10.1056/NEJM199411243312104|accessdate=2011-12-06}}</ref><ref name="pmid12411756">{{cite journal |author=Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J |title=A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity |journal=[[Nephron. Clinical Practice]] |volume=93 |issue=1 |pages=C29–34 |year=2003 |month=January |pmid=12411756 |doi= |url=|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
-|-
-| bgcolor="LightGreen"|
-<nowiki>"</nowiki>'''3.''' In patients with [[Chronic kidney disease|chronic kidney disease (CKD)]] ([[creatinine clearance]] ≤60 mL/min), the volume of [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should be minimized.<ref name="pmid19189906">{{cite journal |author=Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL |title=Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality |journal=[[Annals of Internal Medicine]] |volume=150 |issue=3 |pages=170–7 |year=2009 |month=February |pmid=19189906 |doi= |url=|accessdate=2011-12-06}}</ref><ref name="pmid9375704">{{cite journal |author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW |title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality |journal=[[The American Journal of Medicine]]|volume=103 |issue=5 |pages=368–75 |year=1997 |month=November |pmid=9375704 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(97)00150-2|accessdate=2011-12-06}}</ref><ref name="pmid8589322">{{cite journal |author=Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L |title=Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure |journal=[[Journal of the American Society of Nephrology : JASN]] |volume=6 |issue=5 |pages=1451–8 |year=1995 |month=November|pmid=8589322 |doi= |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=8589322|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
-|}
 ==Risk Factors==
 *Prior [[renal insufficiency]]