Рrevention of contrast-induced nephropathy during interventional treatment of acute coronary syndrome.

Miakinkova L.O., Miakinkova L.O. and Yarmola T.I., Yarmola T.I. and Pustovoit G.L., Pustovoit G.L. and Kostrikova Iu.A., Kostrikova Iu.A. and Pysana B.O., Pysana B.O. and Talash V.V., Talash V.V. (2023) Рrevention of contrast-induced nephropathy during interventional treatment of acute coronary syndrome. Медичні перспективи = Medicni perspektivi (Medical perspectives) (4). pp. 49-57. ISSN 2307-0404 (print), 2786-4804 (online)

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Abstract

The aim of the work was to determine the risk factors of contrast-induced nephropathy in patients with acute coronary syndrome and to evaluate the effectiveness of methods of its prevention. There were examined 62 patients admitted to the interventional cardiology department during 9 months of routine practice with a diagnosis of acute coronary syndrome and concomitant chronic kidney disease. Among them, 56.45% have diabetic nephropathy, 21% – hypertensive nephropathy, 19.35% – chronic pyelonephritis, 3.2% – gouty nephropathy. According to the stages of chronic kidney disease: I stage – 8.1%, II stage – 46.8%, III A stage – 30.6%, III B stage – 14.5% of patients. The control group consisted of 32 patients with acute coronary syndrome without kidney pathology. All patients underwent urgent percutaneous coronary intervention with a water-soluble low-osmolarity radiocontrast medium. The risk of contrast-induced nephropathy was determined according to the Mehran scale. Contrast-induced nephropathy was diagnosed by an increase in serum creatinine by ൐25% over 24-48 hours. Prevention of contrast-induced nephropathy according to existing recommendations was carried out by prescribing early statin therapy and diuresis-controlled combined hydration in 22 patients with concomitant chronic kidney disease. Mathematical processing was performed using Statistica 8.0 software (StatSoft Inc, USA). Patients with chronic kidney disease had a high and very high risk of contrastinduced nephropathy in 19.4% and 3.2% of cases, among them in 91.6% high, and in 100% – very high-risk contrastinduced nephropathy developed. Patients in the control group had a low to moderate risk, none of them developed contrast-induced nephropathy. It has been shown that the risk of contrast-induced nephropathy depends on the stage of chronic kidney disease and is associated with a decrease in the ejection fraction of the left ventricle (≤40%), acute left ventricle failure of the III and IV classes according to Killip, a decrease in diuresis up to ≤0.6 ml/h/kg in the first 12- 24 hours after urgent percutaneous coronary intervention; taking metformin 6-12 hours before the administration of the X-ray contrast medium and the glomerular filtration rate ≤45 ml/min./1.73 m2 . In patients who underwent prevention of contrast-induced nephropathy in its entirety, its development was not registered.

Item Type:	Article
Additional Information:	DOI: 10.26641/2307-0404.2023.4.294013
Uncontrolled Keywords:	Key words: contrast-induced nephropathy, urgent percutaneous coronary intervention, acute coronary syndrome, chronic kidney disease; контраст-індукована нефропатія, ургентне черезшкірне коронарне втручання, гострий коронарний синдром, хронічна хвороба нирок
Subjects:	Nephrology Clinical medicine
Divisions:	University periodicals > Medical perspectives
Depositing User:	Ирина Медведева
Date Deposited:	24 Apr 2024 08:02
Last Modified:	24 Apr 2024 08:02
URI:	http://repo.dma.dp.ua/id/eprint/8876

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