Diagnosis and prevention of contrast-induced acute kidney injury in coronary artery disease patients undergoing endovascular intervention
https://doi.org/10.29001/2073-8552-2020-35-1-61-69
Abstract
Introduction. In recent years, there has been a continuous increase in the number of endovascular interventions performed on the coronary arteries. Contrast-induced acute kidney injury is one of the main complications in patients who undergo coronary angiography and percutaneous coronary intervention (PCI). The filtration function of kidneys is usually evaluated by the level of endogenous creatinine or using calculation formulas also based on the concentration of creatinine. Plasma biomarkers, one of which is cystatin C, are the most promising for early detection of acute kidney injury.
Purpose. (1) To evaluate the effectiveness of the prevention of contrast-induced kidney injury in patients administered with a loading dose of statins before endovascular intervention; (2) to study the prospects for early diagnosis of kidney injury using a new biomarker, cystatin C.
Material and Methods. Patients with coronary artery disease, confirmed by еру hemodynamically significant stenosis of coronary arteries and clinically manifested angina pectoris, were selected. Before the endovascular intervention, patients were administered with loading doses of statins (group 1 received atorvastatin; group 2 received rosuvastatin). All patients underwent the following studies: general clinical examination; serial biochemical blood tests for creatinine, urea, uric acid, potassium, c-reactive protein, and cystatin C; and glomerular filtration rate assessment.
Results. A decrease in renal function with a glomerular filtration rate of less than 60 mL/min/1.73 m2 on day 5 was observed in 12 patients (34.3%) of group 1 and 9 patients (27.3%) of group 2. The blood study of cystatin C level allowed establishing an early diagnosis of contrast-induced acute kidney injury 12 and 24 h after endovascular intervention.
Conclusions. A new biomarker, cystatin C, is a reliable indicator of kidney function. The anti-inflammatory effect, evaluated based on the high sensitivity c-reactive protein, was significantly more pronounced in coronary artery disease patients undergoing planned endovascular intervention and receiving loading doses of rosuvastatin compared to atorvastatin.
Purpose. (1) To evaluate the effectiveness of the prevention of contrast-induced kidney injury in patients administered with a loading dose of statins before endovascular intervention; (2) to study the prospects for early diagnosis of kidney injury using a new biomarker, cystatin C.
Material and Methods. Patients with coronary artery disease, confirmed by еру hemodynamically significant stenosis of coronary arteries and clinically manifested angina pectoris, were selected. Before the endovascular intervention, patients were administered with loading doses of statins (group 1 received atorvastatin; group 2 received rosuvastatin). All patients underwent the following studies: general clinical examination; serial biochemical blood tests for creatinine, urea, uric acid, potassium, c-reactive protein, and cystatin C; and glomerular filtration rate assessment.
Results. A decrease in renal function with a glomerular filtration rate of less than 60 mL/min/1.73 m2 on day 5 was observed in 12 patients (34.3%) of group 1 and 9 patients (27.3%) of group 2. The blood study of cystatin C level allowed establishing an early diagnosis of contrast-induced acute kidney injury 12 and 24 h after endovascular intervention.
Conclusions. A new biomarker, cystatin C, is a reliable indicator of kidney function. The anti-inflammatory effect, evaluated based on the high sensitivity c-reactive protein, was significantly more pronounced in coronary artery disease patients undergoing planned endovascular intervention and receiving loading doses of rosuvastatin compared to atorvastatin.
About the Authors
O. E. Safyanova
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Laboratory Research Assistant, Department of Ambulatory Cardiology
111a, Kievskaya str., Tomsk, 634012, Russian Federation
A. N. Repin
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Head of the Department of Ambulatory Cardiology
111a, Kievskaya str., Tomsk, 634012, Russian Federation
E. O. Vershinina
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Russian Federation
Russian Federation
Cand. Sci. (Med.), Research Scientist, Department of Ambulatory Cardiology
111a, Kievskaya str., Tomsk, 634012, Russian Federation
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Review
For citations:
Safyanova O.E., Repin A.N., Vershinina E.O. Diagnosis and prevention of contrast-induced acute kidney injury in coronary artery disease patients undergoing endovascular intervention. Siberian Journal of Clinical and Experimental Medicine. 2020;35(1):61-69. (In Russ.) https://doi.org/10.29001/2073-8552-2020-35-1-61-69
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