Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지

Evaluation of Factors Affecting Glomerular Filtration Rate by Contrast Media in Patients with Coronary Angiography

심혈관 조영술 시행 환자의 조영제 사용 시 사구체여과율 변화에 영향을 미치는 인자들 평가

  • Kim, Eun-Young (Clinical Pharmacy, College of Pharmacy, Chungbuk National University) ;
  • Lee, Ok-Sang (Clinical Pharmacy, College of Pharmacy, Chungbuk National University) ;
  • Lim, Sung-Cil (Clinical Pharmacy, College of Pharmacy, Chungbuk National University)
  • 김은영 (충북대학교 약학대학 임상약학실) ;
  • 이옥상 (충북대학교 약학대학 임상약학실) ;
  • 임성실 (충북대학교 약학대학 임상약학실)
  • Received : 2012.04.02
  • Accepted : 2012.06.16
  • Published : 2012.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Performance of coronary angiography for exact diagnosis and treatments of cardiovascular disease have been increased recently and it also brings increase of the contrast-induced nephropathy (CIN) referred from increasing use of radiological contrast agents. The variation of estimated glomerular filtration rate (eGFR) is an indicator of CIN, which is known to increase when renal function is decreased. Therefore, this study was to evaluate the affecting factors including concomitant drug on variation of eGFR of patients who underwent coronary angiography according to the conditions of renal function. Medical records of 66 patients were evaluated retrospectively and the patients underwent coronary angiography or angioplasty with nonionic and isotonic contrast media (iodixanol) at Chungnam national university hospital from 1 Jan 2008 to 30 Jul 2010. Patients group was divided into 2 groups; the patients in stages 3-4 chronic kidney disease (CKD) and the patients in stage 2 CKD. Each group was researched about the effect of concomitant drug and clinical characteristics on eGFR variation. The change of eGFR was compared among baseline and 2 or 3 day after coronary angiography. In results, the eGFR variation in group over age 75 was significantly decreased after radiological contrast agents exposure (p $$\leq_-$$ 0.05). The eGFR variation in anemia was significantly decreased after radiological contrast agents exposure in stage 2 CKD (p > 0.05). The eGFR variation in group under $HbA_{1c}$ 6.5% was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). The eGFR variation by taking statins, angiotensin converting enzyme inhibitors, calcium channel blockers and nitroglycerin was increased after radiological contrast agents exposure in stage 2 CKD (p $$\leq_-$$ 0.05). The eGFR variation by using of diuretics was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). The eGFR variation by taking statins, nitroglylcerin was increased after radiological contrast agents exposure in stages 3-4 CKD(p > 0.05). The eGFR variation in group over contrast dosage 150 ml was significantly decreased after radiological contrast agents exposure in stages 3-4 CKD (p $$\leq_-$$ 0.05). Therefore, when undergoing coronary angiography, contrast dosage should be minimized less than 150 ml, and diuretics should be restricted as possible in stages 3-4 CKD. Patients over age 75 require special attention to prevent CIN, and if patients undergo coronary angiography in stages 3-4 CKD, $HbA_{1c}$ is also requried to maintain below 6.5% to prevent CIN.

Keywords

References

  1. Aderson RA, Linda SL, Beanos AS, Enrich SL, Miller PR, Gallow PA, Scarier AW : Nonoliguric acute renal failure. The New England Journal of Medicine 1997; 296: 1134-8.
  2. Schusterman N, Strom BL, Murray TG, Morrison G, West SL, Maislin G : Risk factors and outcome of hospitalacquired acute renal failure. Clinical epidemiologic study. The American Journal of Cardiology 1987; 83: 65-71.
  3. Solomon R : Contrast-medium-induced acute renal failure. Kidney International 1998; 53: 230-42. https://doi.org/10.1038/sj.ki.4495510
  4. Nash K, Hafeez A, Hou S : Hospital-acquired renal insufficiency. American Journal of Kidney Diseases 2002; 39: 930-6. https://doi.org/10.1053/ajkd.2002.32766
  5. Rudnick MR, Berns JS, Cohen RM, Goldfarb S: Contrast media-associated nephrotoxicity. Semin Nephrol 1997; 17: 15-26.
  6. Weisberg LS, Kurnik PB, Kurnik BR : Risk of radiocontrast nephropathy in patients with and without diabetes mellitus. Kidney International 1994; 45: 259-265. https://doi.org/10.1038/ki.1994.32
  7. Lautin EM, Freeman NJ, Schoenfeld AH : Radiocontrast associated renal dysfunction: incidence and risk factors. American Journal of Roentgenology 1991; 157: 49-58. https://doi.org/10.2214/ajr.157.1.2048539
  8. Cohan RH, Dunnick NR: Intravascular contrast media: Adverse reactions. American Journal of Roentgenology 1987; 149: 665-70. https://doi.org/10.2214/ajr.149.4.665
  9. Weisberg LS, Kurnik PB, Kurnik BR : Risk of radiocontrast nephropathy in patients with and without diabetes mellitus. Kidney International 1994; 45: 259-65.
  10. Barrett BJ : Contrast nephrotoxicity. Journal of the Amerian Society of Nephrology 1994; 5: 125-37.
  11. McCullough PA, Soman SS: Contrast-induced nephropathy. Critical Care Clinics 2005; 21: 261-80. https://doi.org/10.1016/j.ccc.2004.12.003
  12. Agmon Y, Peleg H, Greenfeld Z, Rosen S, Brezis M : Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat. J Clin Invest 1994; 94: 1069-75. https://doi.org/10.1172/JCI117421
  13. Murakami R, Machida M, Tajima H : Plasma endothelin, nitric oxide and atrial natriuretic peptide levels in humans after abdominal angiography. Acta Radiol 2002; 43: 340-3. https://doi.org/10.1034/j.1600-0455.2002.430319.x
  14. Sheridan AM, Bonventre JV : Pathophysiology of ischemic acute renal failure. Contributions to Nephrology 2001; 132: 7-21.
  15. Bakris GL, Gaber AO, Jones JD : Oxygen free radical involvement in urinary Tamm-Horsfall protein excretion after intrarenal injection of contrast medium. Radiology 1990; 175: 57-60. https://doi.org/10.1148/radiology.175.1.2315505
  16. Hizoh I, Haller C : Radiocontrast-induced renal tubular cell apoptosis: hypertonic versus oxidative stress. Investigational Radiology 2002; 37: 428-34. https://doi.org/10.1097/00004424-200208000-00003
  17. Safirstein R, Andrade L, Vieira JM: Acetylcysteine and nephrotoxic effects of radiographic contrast agents: a new use for an old drug. The New England Journal of Medicine 2000; 343: 210-212. https://doi.org/10.1056/NEJM200007203430311
  18. DiMari J, Megyesi J, Udvarhelyi : N-acetylcysteine ameliorates ischemic renal failure. American Journal of Physiology 1997; 27: F292-8.
  19. Briguori C, Colombo A, Airoldi F : N-acetylcysteine versus fenoldopam mesylate to prevent contrast agentassociated nephrotoxicity. Journal of the American College of Cardiology 2004; 44: 762-5. https://doi.org/10.1016/j.jacc.2004.04.052
  20. Koch JA, Plum J, Grabensee B, Modder U : Prostaglandin E1: a new agent for the prevention of renal dysfunction in high risk patients caused by radiocontrast media? Nephrology Dialysis Transplantation 2000; 15: 43-9.
  21. Gurkowski L, MacDougall M, Wiegmann T : Effects of misoprostol on contrast-induced renal dysfunction. American Journal of Therapeutics 1995; 2: 837-42. https://doi.org/10.1097/00045391-199511000-00003
  22. Erley CM, Duda SH, Schlepckow S : Adenosine antagonist theophylline prevents the reduction of glomerular filtration rate after contrast media application. Kidney International 1994; 45: 1425-31. https://doi.org/10.1038/ki.1994.186
  23. Tada H, Kagaya Y, Takeda M : Endogenous erythropoietin system in non-hematopoietic lineage cells plays a protective role in myocardial ischemia/reperfusion. Cardiovascular Research 2006; 71; 466-77. https://doi.org/10.1016/j.cardiores.2006.05.010
  24. Grimm C, Wenzel A, Acar N l: Hypoxic preconditioning and erythropoietin protect retinal neurons from degeneration. Advances in Experimental Medicine and Biology 2006; 588: 119-31.
  25. Solomon R, Werner C, Mann D : Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. The New England Journal of Medicine 1994; 331: 1416-20. https://doi.org/10.1056/NEJM199411243312104
  26. Briguori C, Colombo A, Violante A : Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. European heart Journal 2004; 25: 206-11. https://doi.org/10.1016/j.ehj.2003.11.016
  27. Gruberg L, Mintz GS, Mehran R : The prognostic implications of further renal function deterioration within 48 hours of interventional coronary procedures in patients with preexistent chronic renal insufficiency. Journal of the American College of Cardiology 2000; 36: 1542-8. https://doi.org/10.1016/S0735-1097(00)00917-7
  28. Cheon IS, Choi JH, Kim KL : Decreased number and impaired angiogenic function of endothelial progenitor cells in patients with chronic renal failure. Korean Circulation Journal 2004; 34: 1033-42. https://doi.org/10.4070/kcj.2004.34.11.1033
  29. Lee YS, Kim KS, Hyun DW : The change of arterial stiffness according to dialysis in patients with end-stage renal disease. Korean Circulation Journal 2004; 34: 865-73. https://doi.org/10.4070/kcj.2004.34.9.865
  30. Mueller C, Buerkle G, Buettner HJ : Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Archives of Internal Medicine 2002; 162: 329-36. https://doi.org/10.1001/archinte.162.3.329
  31. Barrett BJ, Carlisle EJ : Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 1993; 188: 171-8. https://doi.org/10.1148/radiology.188.1.8511292
  32. Aspelin P, Aubry P, Fransson SG : Nephrotoxicity in highrisk patients study of iso-osmolar and low-osmolar non-ionic contrast media study investigators : Nephrotoxic effects in high-risk patients undergoing angiography. The New England Journal of Medicine 2003; 348: 491-9. https://doi.org/10.1056/NEJMoa021833
  33. Arstall MA, Yang J, Stafford I : N-acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction: safety and biochemical effects. Circulation 1995; 92: 2855-62. https://doi.org/10.1161/01.CIR.92.10.2855
  34. Chung SR, Kim ES, Jung JY, Kim : The protective effect of recombinant human erythropoietin and N-acetylcysteine in radiocontrast-induced nephrotoxicity. The Korean Journal of nephrology 2007; 26: 699-704.
  35. Khanal S, Attallah N, Smith DE : Statin therapy reduces contrast-induced nephropathy: an analysis of contemporary percutaneous interventions. The American journal of Medicine 2005; 118: 843-9. https://doi.org/10.1016/j.amjmed.2005.03.031
  36. Gupta RK, Kapoor A, Tavani S : Captopril for the prevention of contrast media-induced nephropathy in diabetic patients: a randomized study. Indian Heart Journal 1999; 51: 521-6.
  37. Thomas: Diuretics, ACE inhibitors and NSAIDS the triple whammy. The Medical Journal of Australia 2000; 172 (4): 184-5.
  38. Peter C. Austin and Muhammad M. Mamdani : Impact of the pravastatin or atorvastatin evaluation and infection therapythrombolysis In myocardial infarction 22/reversal of atherosclerosis with aggressive lipid lowering trials on trends in intensive versus moderate statin therapy in ontario Canada. Circulation 2005; 112: 1296-1300. https://doi.org/10.1161/CIRCULATIONAHA.104.531582
  39. Smilde TJ, Wissen SV, Wollersheim H : Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial. The Lancet 2001; 357: 577-81. https://doi.org/10.1016/S0140-6736(00)04053-8
  40. Ridker PM, Danielson E, Fonseca FAH et al: Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. The New England Journal of Medicine 2008; 359: 2195-2207. https://doi.org/10.1056/NEJMoa0807646
  41. Horowitz JD, Antman EM, Lorell BH, Barry WH, Smith TW : Potentiation of the cardiovascular effects of nitroglycerin by Nacetylcysteine. Circulation 1983; 68: 1247. https://doi.org/10.1161/01.CIR.68.6.1247
  42. Neumayer HH, Junge W, Kufner A, Wenning A: Prevention of radiocontrast-media-induced nephrotoxicity by the calcium channel blocker nitrendipine: a prospective randomized clinical trial. Nephrology Dialysis Transplantation 1989; 4: 1030-6.
  43. Winniford MD, Kennedy PL, Wells PJ, Hillis LD : Potentiation of nitroglycerin-induced coronary dilatation by N-acetylcysteine. Circulation 1986; 73: 138. https://doi.org/10.1161/01.CIR.73.1.138
  44. Loscalzo J : N-acetylcysteine potentiates inhibition of platelet aggregation by nitroglycerin. Journal of Clinical Investigation 1985; 76: 703. https://doi.org/10.1172/JCI112024
  45. Berns AS: Nephrotoxicity of contrast media. Kidney international 1989; 36: 730-40. https://doi.org/10.1038/ki.1989.254
  46. Isenbarger DW, Kent SM, O'Malley PG : Meta-analysis of randomized clinical trials on the usefulness of acetylcysteine for prevention of contrast nephropathy. The American Journal of Cardiology 2003; 92: 1454-8. https://doi.org/10.1016/j.amjcard.2003.08.059
  47. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W : Prevention of radiographic contrast-agent-induced reductions in renal function by acetylcysteine. The New England Journal of Medicine 2000; 343: 180-4. https://doi.org/10.1056/NEJM200007203430304
  48. Parfrey PS, Griffiths SM, Barrett BJ : Contrast material - induced renal failure in patients with diabetes mellitus, renal insufficiency, or both: a prospective controlled study. The New England Journal of Medicine 1989; 320: 143-9. https://doi.org/10.1056/NEJM198901193200303