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Acute myocardial infarction in renal insufficiency II: Contrast induced nephropathy, modern continuous elimination methods, importance of troponin evaluation


Authors: S. Janoušek
Authors‘ workplace: Interní kardiologická klinika ;  FN Brno, pracoviště Bohunice ;  doc. MUDr. Stanislav Janoušek, CSc.
Published in: Kardiol Rev Int Med 2007, 9(2): 90-98
Category: Editorial

Overview

The serious complication of modern interventional treatment of acute myocardial infarction (AMI) with impaired renal function is so called contrast-induced nephropathy that is connected with significantly higher morbidity and mortality. That risk is increased with stage of renal insuficiency (RI) and is also significantly higher in diabetics. Therefore its prevention is important approach to reduction mortality and rate of cardiovascular complication. The basic approach is beside risk stratification the elimination of potentially nephrotoxic drugs and the use of nonionic low- or iso-osmolality radiocontrast media with minimalization of their dosis The very important is adequate hydration and monitoring of renal function and diuresis after interventional procedure. The application of N-acetylcystein-is promising preventive pharmacotherapy. The modern continuous elimination methods are of great benefit for patients with AMI and severe renal failure, because that could be performed bedside in the intensive care department. The higher serum concentration of troponins frequently observed in patients with RI without AMI can cause some problems in diagnostics. It is very considerable that also non-coronary increase of serum troponin concentration in RI is significant negative prognostic factor

Key words:
acute myocardial infarction, renal insufficiency, contrast induced nephropathy, prevention, modern continuous elimination methods, troponin


Sources

1. National Kidney Foundation. Clinical Practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 2002; 2(Suppl 1): 1-266.

2. Berger AK, Duval S, Krumholz HM. Aspirin, beta-blocker, angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal diseases and an acute myocardial infarction. J Am Coll Cardiol 2003; 42: 201-208.

3. Rudnick MR, Berns JS, Cohen RM et al. Nephrotoxic risks of renal angiography: Contrast-media associated nephrotoxicity and atheroembolism A critical review. Am J Kidney Dis 1994; 24: 713-727.

4. Barrett BJ. Contrast nephrotoxicity. J Am Soc Nephrol 1994; 5: 125-137.

5. Yoshioka, T, Fogo, A, Beckman, JK. Reduced activity of antioxidant enzymes underlies contrast media-induced renal injury in volume depletion. Kidney Int 1992; 41: 1008-1015.

6. Agmon Y, Peleg H, Greenfield Z et al. Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat. J Clin Invest 1994; 94: 1069-1075.

7. Kramer BK, Kammerl M, Scheda F et al. A primer in radiocontrast-induced nephropathy. Nephrol Dial Transplant 1999; 14: 2830-2834.

8. Heyman SN, Rosen S. Dye-induced nephropathy. Semin Nephrol 2003; 23: 477-485.

9. Lacová K. Kontrastová nefropatie dnes (fenoldapam neuspěl ve studii CONTRAST). Interv Akut Kardiol 2005; 4: 33-37.

10. Zahálková J. Kontrastová nefropatie. Intern Med pro Praxi 2005; 7: 24-26.

11 Pannu N, Wiebe N, Tonelli M. Prophylxis Strategies for Contrast-Induced Nephropathy JAMA 2006; 295: 2765-2779.

12. Aspelin P, Aubry P, Fransson SG et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 2003; 348: 491-499.

13. Sandler CM. Contrast-agent-induced acute renal dysfunction---is iodixanol the answer? N Engl J Med 2003; 348: 551-553.

14. Rudnick MR, Goldfarb S, Wexler L et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. Kidney Int 1995; 47: 254-261.

15. Barrett BJ, Parfrey PS, Vavasour HM et al. Contrast nephropathy in patients with impaired renal function: High versus low osmolar media. Kidney Int 1992; 41: 1274-1279.

16. Harris KG, Smith TP, Cragg AH et al. Nephrotoxicity from contrast material in renal insufficiency: Ionic versus nonionic agents. Radiology 1991; 179: 849-852.

17. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 1993; 188: 171-178.

18. Chalmers N, Jackson RW. Comparison of iodixanol and iohexol in renal impairment. Br J Radiol 1999; 72: 701-703.

19. Conlon PJ, Schwab SJ. Time to abandon nonionic contrast? J Am Soc Nephrol 1994; 5: 123-124.

20. Carraro M, Malalan F, Antonione, R et al. Effects of a dimeric vs a monomeric nonionic contrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial. Eur Radiol 1998; 8: 144-147.

21. Jakobsen JA, Berg KJ, Kjaersgaard, P et al. Angiography with nonionic X-ray contrast media in severe chronic renal failure: renal function and contrast retention. Nephron 1996; 73: 549-556.

22. Cigarroa RG, Lange RA, Williams RH et al. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989; 86: 649-652.

23. Lautin EM, Freeman NJ, Schoenfeld AH et al. Radiocontrast-associated renal dysfunction: Incidence and risk factors. AJR Am J Roentgenol 1991; 157: 49-58.

24. Manske CL, Sprafka JM, Strong JH et al. Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 1990; 89: 615-620.

25 Keeley EC, Grines CL. Scraping of aortic debris by coronary guiding catheters: A prospective evaluation of 1,000; cases. J Am Coll Cardiol 1998; 32: 1861-1865.

26. McCullough PA, Sandberg KR, Borzak S et al. Benefits of aspirin and beta-blockade after myocardial infarction in patients with chronic kidney disease. Am Heart J 2002; 144: 226-232.

27. Kellum JA, Decker JM. Use of dopamine in acute renal failure? A meta-analysis. Crit Care Med 2001; 29: 1526-1531.

28. Parfrey PS, Griffiths SM, Barrett BJ et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 1989; 320: 143-149.

29. Rudnick MR, Goldfarb S, Wexler L et al. Neprotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial: a lohexol Cooperative Study. Kidney Int 1995; 47: 254-261.

30. McCarthy CS, Becker JA. Multiple myeloma and contrast media. Radiology 1992; 183: 519-521.

31. Holland MD, Galla JH, Sanders PW et al. Effect of urinary pH and diatrizoate on Bence Jones protein nephrotoxicity in the rat. Kidney Int 1985; 27: 46-50.

32. Choyke PL, Cady J, De Pollar Sl et al. Determination of serum creatinine prior to iodinat contrast media: is it necessary in all patients? Tech Urol 1998; 4: 65-69.

33. Stevens MA, Mc Cullogh PA, Tobin KJ et al. A prospective randomised trial of prevention measures in patient high risk for contrast nephropathy: Results of P.R.I.N.C.E

study. Am J Coll Cardiol 1999; 33: 403-411.

34. Vogt B, Ferrari P, Schonholzer C et al. Prophylactic hemodialysis after radiocontrast media in patient with renal insufficiency is potentially harmful. Am J Med 2001; 111: 692-698.

35. Marenzi G, Marana I, Lauri G et al. The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 2003; 349: 1333-1340.

36. Vogt B, Ferrari P, Schonholzer C et al. Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful. Am J Med 2001; 111: 692-698.

37. Marenzi G, Marana I, Lauri G et al. The prevention of radiocontrast-agent-induced nephopathy by hemofiltratioin. N Engl J Med. 2003; 349: 1333-1340.

38. Shammas KW, Kapalis MJ, Harris M. Aminophylline does not protect against radiocontrast nephropathy in patients undergoing percutaneous angiographic procedures. J Invasive Cardiol 2001; 13: 735-740.

39. Gami AS, Garovic VD. Contrast Nephropathy After Coronary Angiography. Mayo Clin Proc 2004; 79: 211-219.

40. Louis BM, Hoch BS, Hernandes C et al. Protection from the nephrotoxicity if contrast dye. Ren Fail 1996; 18: 639-646.

41. Barrett BJ, Parfrey PS. Prevention of nephrotoxicity induced by radiocontrast agents N Engl J Med 1994; 331: 1449-1450.

42. Keumaeyr HH, Junge W, Kufner A et al. Prevention of radiocontrast-media-induced nephrotoxicity by the calcium channel blocker nitrendipine. Nephrol Dial Transplant 1989; 4: 1030-1036.

43. Koch JA, Plum J, Granbensee B et al. Prostaglandin E: a new agent for the prevention of renal dysfunction in high risk patients caused by radiocontrast media. Nephrol Dial Transpl 2000; 15: 43-49.

44. Stone GW, McCullogh PA, Tumlin JA et al. Fenoldapam mesylate for the prevention of contrast-induced nephropathy: a randomised controlled trial. JAMA 2003; 290: 2284-2291.

45. Mueller C, Buerkle, G, Buettner, HJ et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: 329-336.

46. Merten GJ, Burgess WP, Gray LV et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291: 2328-2334.

47. Tepel M, van der Giet M, Schwarzfield C et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000; 343: 180-184.

48. Diaz-Sandoval LJ, Kosowsky BD, Losordo DW. Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol 2002; 89: 356-358.

49. Shyu KG, Cheng JJ, Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 2002; 40: 1383-1388.

50. Kay J, Chow WH, Chan TM et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: A randomized controlled trial. JAMA 2003; 289: 553-558.

51. Durham JD, Caputo C, Dokko J et al. A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int 2002; 62: 2202-2207.

52. Briguori C, Manganelli F, Scarpato P et al. Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol 2002; 40: 298-303.

53. Allaqaband S, Tumuluri R, Malik AM et al. Prospective randomized study of N-acetylcysteine, fenoldopam, and saline for prevention of radiocontrast-induced nephropathy. Catheter Cardiovasc Interv 2002; 57: 279-283.

54. Loutrianakis E, Stella D, Hussain A et al. Randomized comparison of fenoldopam and N-acetylcysteine to saline in the prevention of radiocontrast nephropathy. J Am Coll Cardiol 2003; 41: 327A.

55. Baker CS, Wragg A, Kumar S et al. A rapid protocol for the prevention of contrast-induced renal dysfunction (RAPPID Study). J Am Coll Cardiol 2003; 41: 39A.

56. Goldenberg I, Jonas M, Matetzki S et al. Contrast-associated nephropathy and clinical outcome of patients with chronic renal insufficiency undergoing cardiac catheterization: Lack of additive benefit of acetylcysteine to saline infusion. J Am Coll Cardiol 2003; 41: 537A.

57. Tepel M, van der Giet M, Statz M et al. The antioxidant acetylcysteine, reduces cardiovascular events in patients with endstage renal failure - a randomized controlled trial. Circulation 2003; 107: 992-995.

58. Marenzi G, Assanelli E, Marana I et al. N-acetylcysteine and contrast - induced nephropathy in primary angioplasty. N Engl J Med 2006; 354: 2773-2782.

59 Stone GW, Tumlin JA, Madyoon H et al. Design and rationale of CONTRAST-A prospective, randomized, placebo-controlled trial of fenoldopam mesylate for the prevention of radiocontrast nephropathy. Rev Cardiovasc Med 2001; 2(Suppl 1): 31-36.

60. Ishani A, Herzog CHA, Collins AJ et al. Cardiac medications and their association with cardiovascular events in incident dialysis patients: Cause or effect? Kidney Intern 2004; 65: 1017-1025.

61. Lachmanová J. Očišťovací metody krve. Praha: Grada Publishing 1999.

62. Ronco C, Bellomo R, Kellum JA. Continuous Renal Replacement Therapy: Opinions and Evidence. Adv Ren Replace Ther 2002; 9: 229-244.

63. Silvestr W. Outcome studies of continuous renal replacement therapy in the intensive care. Kidney Int 1998; 53: 138-141.

64. Ronco C, Brendolan A, Lupi A et al. Effects of different doses in continuous venovenous hemofiltration on outcomes of acute renal failure: A prospective randomised trial. Lancet 2000; 356: 26-30.

65. Novák I. Manuál CRRT. Plzeň: EU PRESS 2000 s.r.o 2003.

66. Bellomo R, Baldwin I, Ronco C et al. Atlas of Hemofiltration. Philadelpiha: Saunders 2002: 15-18.

67.Wolfe RA, Port FK, Webb RL et al. Annual data report of the United States renal data system. VI. Causes of death. Am J Kidney Dis 1998: 32 Suppl: S81-S88.

68. Joki N, Hase H, Nakamura R et al. Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease. Nephrol Dial Transplant 1997; 12: 718-723.

69. Aronow WS, Ahn C, Mercando AD et al. Prevalence of coronary artery disease, complex ventricular arrhythmias, and silent myocardial ischemia and incidence of new coronary artery events in older persons with chronic renal insufficiency and with normal renal function. Am J Cardiol 2000; 86: 1142-1143.

70. Nakamura S, Uzu T, Inenaga T et al. Prediction of coronary artery disease and cardiac events using electrocardiographic changes during hemodialysis. Am J Kid Dis 2000; 36: 592-599.

71. Zawada ET, Stinson JB, Done G. New perspectives on coronary artery disease in hemodialysis patients. South Med J 1982; 75: 694-696.

72. Antman EM, Tanasijevic MJ, Thompson B et al. Cardiac-specific troponin-I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335: 1342-1349.

73. Ohman EM, Armstrong PW, Christenson RH et al. Cardiac troponin-T levels for risk stratification in acute myocardial ischemia. N Engl J Med 1996; 335: 1333-1341.

74. Hamm CW, Heeschen C, Goldmann B et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med 1999; 340: 1623-1629.

75. The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined - A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. Eur Heart J 2000; 21: 1502-1513.

76. Galvani M, Panteghini M, Ottani F et al. The new definition of myocardial infarction: analysis of the ESC/ACC Consensus Document and reflections on its applicability to the Italian Health System. Ital Heart J 2002; 3: 543-557.

77. Babuin L. Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. Can Med Assoc J 2005; 173: 1191-1202.

78. Maeder M, Fehr T, Rickli H et al. Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest 2006; 129: 1349-1366.

79. Kato T, Sato Y, Nagao K et al. Serum cardiac troponin T in cardiac amyloidosis: serial observations in five patients. Tohoku J Exp Med 2006; 208: 163-167.

80. Khan IA. Wattanasuwan N. Role of biochemical markers in diagnosis of myocardial infarction. Int J Cardiol 2005; 104: 238-240.

81. Hamilton JS. Sharpe PC. Two cases of inflammatory muscle disease presenting with raised serum concentrations of troponin T. J Clin Pathol. 2005; 58: 1323-1324.

82. Bonnefoy E, Godon P, Kirkorian G et al. Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta. Acta Cardiol 2005; 60: 165-170.

83. Jeremias A, Gibson CM. Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med 2005; 142: 786-791.

84. McLaurin MD, Apple FS, Voss EM et al. Cardiac troponin-I, cardiac troponin-T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin-T expression in skeletal muscle. Clin Chem 1997; 43: 976-982.

85. Ricchiutti V, Apple FS. RNA expression of cardiac troponin T isoforms in diseased human skeletal muscle. Clin Chem 1999; 45: 2129-2135.

86. Bodor GS, Porterfield D, Voss EM et al. Cardiac troponin-I is not expressed in fetal and healthy or diseased adult human skeletal muscle tissue. Clin Chem 1995; 41: 1710-1715.

87. Martin GS, Becker BN, Schulman G. Cardiac troponin-I accurately predicts myocardial injury in renal failure. Nephrol Dial Transplant 1998; 13: 1709-1712.

88. Apple FS, Sharkey SW, Hoeft P et al. Prognostic value of serum cardiac troponin I and T in chronic dialysis patients: a 1-year outcomes analysis. Am J Kid Dis 1997; 29: 399-403.

89. McLaurin MD, Apple FS, Falahati A et al. Cardiac troponin I and creatine kinase-MB mass to rule out myocardial injury in hospitalized patients with renal insufficiency. Am J Cardiol 1998; 82: 973-975.

90. Bozbas H. Yildirir A. Muderrisoglu H. Cardiac enzymes, renal failure and renal transplantation. Clin Med Res 2006; 4: 79-84.

91. Hojs R. Cardiac troponin T in patients with kidney disease. Ther Apher Dial 2005; 9: 205-207.

92. Havekes B. van Manen JG. Krediet RT et al. NECOSAD Study Group. Serum troponin T concentration as a predictor of mortality in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis 2006; 47: 823-829.

93. Sharma R, Gaze DC, Pellerin D et al. Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T. Heart 2006; 92: 804-809.

94. Fernandez-Reyes MJ, Heras M, Sanchez R et al. Value of troponin T in patients with advanced chronic kidney failure. Clinical course after beginning hemodialysis. [Spanish] Nefrologia 2005; 25: 574-575.

95. Buhaescu I, Izzedine H, Covic A. Cardiac troponins in renal failure - time for an optimistic consensus? Int J Clin Pract 2005; 59: 1317-1325.

96. Conway B, McLaughlin M, Sharpe P et al. Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis. Nephrol Dial Transplant 2005; 20: 2759-2764.

97. Abbas NA, John RI, Webb MC et al. Cardiac troponins and renal function in nondialysis patients with chronic kidney disease. Clin Chem 2005; 51: 2059-2066.

98. Kontos MC, Garg R, Anderson FP et al. Outcomes in patients admitted for chest pain with renal failure and troponin I elevations. Am Heart J 2005; 150: 674-680.

99. Han JH, Lindsell CJ, Ryan RJ et al. Changes in cardiac troponin T measurements are associated with adverse cardiac events in patients with chronic kidney disease. Am J Emerg Med; 23: 468-473.

100. Hojs R, Ekart R, Hojs et al. Cardiac troponin T (cTnT) in hemodialysis patients with asymptomatic and symptomatic atherosclerosis. Arch Med Res; 2005; 36: 367-371.

101. Goicoechea M, de Vinuesa SG, Gomez-Campdera F et al. Predictive cardiovascular risk factors in patients with chronic kidney disease (CKD). Kidney Int Suppl 2005; 93(Suppl): 35-38.

102. Wayand D, Baum H, Schatzle G et al. Cardiac troponin T and I in end-stage renal failure. Clin Chem 2000; 46: 1345-1350.

103. Ooi DS, House AA. Cardiac troponin T in hemodialyzed patients. Clin Chem 1998; 44: 1410-1416.

104. Porter GA, Norton T, Bennett WM. Long term follow up of the utility of troponin T to assess cardiac risk in stable chronic hemodialysis patients. Clin Lab 2000; 46: 469-476.

105. Mockel M, Schindler R, Knorr L et al. Prognostic value of cardiac troponin T and I elevations in renal disease patients without acute coronary syndromes: a 9-month outcome analysis. Nephrol Dial Transplant 1999; 14: 1489-1495.

106. Janoušek S. Akutní infarkt myokardu u nemocných s renálním selháním I: prognóza a léčba. Kardiol Rev 2007; 1: 13-21.

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