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Specificity was highest for the Athens CIN Score (Lazaros, ###), and this was accompanied with a positive predictive value of ##% and a negative predictive value of ##% Highest reported specificity of the <PERSOON> score was ##% (Aykan, ###) Specificity of the simple risk score of <PERSOON> (###) was found to be ##% based on an <PERSOON> utility of patient questionnaires that can predict impaired kidney function and guide which patients need eGFR evaluation will be discussed briefly in chapter # on eGFR evaluation However, in NL it has been common practice to determine eGFR in all patients receiving intravascular iodine-containing CM and therefore their use is A summary of risk factors for PC-AKI was made from observational studies with, unfortunately, very low to low <PERSOON> level of evidence has been graded as low due to the observational nature of the included studies For the patients receiving iodine-containing contrast for CT-scan the level of evidence has been graded low, due to downgrading by # points # for imprecision and # for heterogeneity of included studies For the patients receiving iodine-containing contrast media for CAG and/or PCI the level of evidence has been graded low, due to downgrading by # points for imprecision (wide confidence interval, surpassing borders of Grading of evidence by using the GRADE method was not possible, since this was a diagnostic question Thus the EBRO methodology was applied (<PERSOON>, ###) <PERSOON> included studies were graded as EBRO B We Which risk factors have the best value in identification of patients with increased risk of PC-AKI? Which clinical tools or questionnaires have the best diagnostic value in identification of patients with increased P (patient category) adult (â¥## years) patients receiving intravascular iodine-containing contrast medium; I (intervention) questionnaires or other clinical tools to estimate risk of PC-AKI; C (comparison) other questionnaires or other clinical tools to estimate risk of <PERSOON> working group considered sensitivity, specificity, AUC, validity, reliability critical outcome measures for the decision making process <PERSOON> working group defined PC-AKI as described in the chapter Terminology A separate search strategy was developed for the first four research sub questions (PICO # â #) and the fifth For the sub questions # â #, the databases Medline (OVID), Embase and the Cochrane Library were searched from #st of January ### up to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) This search was updated on April ##th ### A total of ### studies were found <PERSOON> initial literature search procured ### hits and the update adult patients who underwent radiological examination using intravascular iodine-containing contrast potential risk factors related either to patient characteristics and/or treatment characteristics and/or iodine-containing contrast medium characteristics were studied in how they influenced the risk of PC-AKI; risk factors were corrected for confounders in multivariable models; For sub question #, the working group selected the studies in which the risk of PC-AKI was compared for.
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have the best value in identification of patients with increased risk of PC-AKI? Which clinical tools or questionnaires have the best diagnostic value in identification of patients with increased P (patient category) adult (â¥## years) patients receiving intravascular iodine-containing contrast medium; I (intervention) questionnaires or other clinical tools to estimate risk of PC-AKI; C (comparison) other questionnaires or other clinical tools to estimate risk of <PERSOON> working group considered sensitivity, specificity, AUC, validity, reliability critical outcome measures for the decision making process <PERSOON> working group defined PC-AKI as described in the chapter Terminology A separate search strategy was developed for the first four research sub questions (PICO # â #) and the fifth For the sub questions # â #, the databases Medline (OVID), Embase and the Cochrane Library were searched from #st of January ### up to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) This search was updated on April ##th ### A total of ### studies were found <PERSOON> initial literature search procured ### hits and the update adult patients who underwent radiological examination using intravascular iodine-containing contrast potential risk factors related either to patient characteristics and/or treatment characteristics and/or iodine-containing contrast medium characteristics were studied in how they influenced the risk of PC-AKI; risk factors were corrected for confounders in multivariable models; For sub question #, the working group selected the studies in which the risk of PC-AKI was compared for For the fifth sub question, the databases Medline (OVID), Embase and the Cochrane Library were searched from #st of January ### up to ##th of September ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) This search was updated on April ##th , ### A total of ### studies were found <PERSOON> initial literature search procured ### hits and the update retrieved a measurement instrument that has been validated and estimates the risk of PC-AKI; if patients had to fill in the measurement instrument, we applied an additional criterion that the instrument Based on title and abstract a total of ### studies were initially selected (### in the initial search and ## in the updated search) After examination of full text a total of ### studies were excluded and ## studies definitely Based on title and abstract a total of ### studies were selected After examination of full text a total of ### studies were excluded and ## studies definitely included in the literature summary A total of two studies were added after the update of the search one was regarding patients with a history of kidney transplantation and Based on title and abstract a total of ## studies were selected (## in the initial search and ## in the updated search) One more study was added through cross-referencing After examination of full text a total of ## studies were excluded and ## studies definitely included in the literature summary.
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fifth sub question, the databases Medline (OVID), Embase and the Cochrane Library were searched from #st of January ### up to ##th of September ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) This search was updated on April ##th , ### A total of ### studies were found <PERSOON> initial literature search procured ### hits and the update retrieved a measurement instrument that has been validated and estimates the risk of PC-AKI; if patients had to fill in the measurement instrument, we applied an additional criterion that the instrument Based on title and abstract a total of ### studies were initially selected (### in the initial search and ## in the updated search) After examination of full text a total of ### studies were excluded and ## studies definitely Based on title and abstract a total of ### studies were selected After examination of full text a total of ### studies were excluded and ## studies definitely included in the literature summary A total of two studies were added after the update of the search one was regarding patients with a history of kidney transplantation and Based on title and abstract a total of ## studies were selected (## in the initial search and ## in the updated search) One more study was added through cross-referencing After examination of full text a total of ## studies were excluded and ## studies definitely included in the literature summary included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are included ## studies were included in the literature analysis, the most important study characteristics and results were ## studies were included in the literature analysis, the most important study characteristics and results were <PERSOON> R, et al Contrast-induced acute kidney injury in renal transplant recipients after cardiac <PERSOON> F, et al Frequency and predictors of contrast-induced nephropathy after angioplasty Araujo GN, Wainstein MV, McCabe JM, et al Comparison of two risk models in predicting the incidence of contrastinduced nephropathy after percutaneous coronary intervention <PERSOON> T, et al Is coronary artery disease complexity valuable in the prediction of contrast induced nephropathy besides <PERSOON> risk score, in patients with ST elevation myocardial infarction treated with primary <PERSOON> BI, et al Epidemiology of contrast material-induced nephropathy in the era of <PERSOON> A, et al Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention Diabetes Res Clin Pract ### Dec;###(#) ###-## Bartholomew BA, Harjai KJ, Dukkipati S, et al Impact of nephropathy after percutaneous coronary intervention and a <PERSOON> K, et al Background fluctuation of kidney function versus contrast-induced nephrotoxicity AJR <PERSOON> J, Yei F, et al.
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included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are included ## studies were included in the literature analysis, the most important study characteristics and results were ## studies were included in the literature analysis, the most important study characteristics and results were <PERSOON> R, et al Contrast-induced acute kidney injury in renal transplant recipients after cardiac <PERSOON> F, et al Frequency and predictors of contrast-induced nephropathy after angioplasty Araujo GN, Wainstein MV, McCabe JM, et al Comparison of two risk models in predicting the incidence of contrastinduced nephropathy after percutaneous coronary intervention <PERSOON> T, et al Is coronary artery disease complexity valuable in the prediction of contrast induced nephropathy besides <PERSOON> risk score, in patients with ST elevation myocardial infarction treated with primary <PERSOON> BI, et al Epidemiology of contrast material-induced nephropathy in the era of <PERSOON> A, et al Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention Diabetes Res Clin Pract ### Dec;###(#) ###-## Bartholomew BA, Harjai KJ, Dukkipati S, et al Impact of nephropathy after percutaneous coronary intervention and a <PERSOON> K, et al Background fluctuation of kidney function versus contrast-induced nephrotoxicity AJR <PERSOON> J, Yei F, et al coronary intervention a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine <PERSOON-##> YL, Fu NK, <PERSOON-##> J, et al A simple preprocedural score for risk of contrast-induced acute kidney injury after <PERSOON-##> E, Poh KK, Lu Q, et al Comparison of combination therapy of high-dose oral N-acetylcysteine and intravenous sodium bicarbonate hydration with individual therapies in the reduction of Contrast-induced Nephropathy during <PERSOON-##> E, Poh KK, Shen L, et al Diabetic patients with normal baseline renal function are at increased risk of developing contrast-induced nephropathy post-percutaneous coronary intervention <PERSOON-##> E, Poh KK, Liang S, et al Risk factors and clinical outcomes for contrast-induced nephropathy after percutaneous coronary intervention in patients with normal serum creatinine <PERSOON-##> Med Singapore ### <PERSOON-##>;##(#) ###-## <PERSOON-##> E, Poh KK, Liang S, et al Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions <PERSOON-##>, PH, Hsu, CY, et al CHADS # score predicts risk of contrast-induced nephropathy in stable coronary artery disease patients undergoing percutaneous coronary interventions <PERSOON-##> SK, et al <PERSOON> ratio of contrast volume to glomerular filtration rate predicts in-hospital and sixmonth mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction Cardiol J ###;##(#) ###.
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intervention a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine <PERSOON> YL, Fu NK, <PERSOON> J, et al A simple preprocedural score for risk of contrast-induced acute kidney injury after <PERSOON> E, Poh KK, Lu Q, et al Comparison of combination therapy of high-dose oral N-acetylcysteine and intravenous sodium bicarbonate hydration with individual therapies in the reduction of Contrast-induced Nephropathy during <PERSOON> E, Poh KK, Shen L, et al Diabetic patients with normal baseline renal function are at increased risk of developing contrast-induced nephropathy post-percutaneous coronary intervention <PERSOON> E, Poh KK, Liang S, et al Risk factors and clinical outcomes for contrast-induced nephropathy after percutaneous coronary intervention in patients with normal serum creatinine <PERSOON> Med Singapore ### <PERSOON>;##(#) ###-## <PERSOON> E, Poh KK, Liang S, et al Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions <PERSOON>, PH, Hsu, CY, et al CHADS # score predicts risk of contrast-induced nephropathy in stable coronary artery disease patients undergoing percutaneous coronary interventions <PERSOON> SK, et al <PERSOON-##> ratio of contrast volume to glomerular filtration rate predicts in-hospital and sixmonth mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction <PERSOON-##>-converting enzyme inhibitors as a risk factor for contrast-induced <PERSOON-##> E, et al Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables <PERSOON-##> RH, et al Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material risk stratification by using estimated glomerular filtration rate <PERSOON-##> JR, et al Contrast material-induced nephrotoxicity and intravenous low-osmolality Ding <PERSOON-##> TQ, et al Impact of elevated serum glycated albumin levels on contrast-induced acute kidney injury in diabetic patients with moderate to severe renal insufficiency undergoing coronary angiography <PERSOON-##> ### <PERSOON-##> M, et al Is there an association between non-steroidal anti-inflammatory drugs and contrast <PERSOON-##> LP, Bahlis LF, Carvalhal GF Computerized tomography contrast induced nephropathy (CIN) among adult inpatients <PERSOON-##> Y, et al A new preprocedure risk score for predicting contrast-induced acute kidney injury <PERSOON-##> N, et al Impact of minimum contrast media volumes during elective percutaneous coronary intervention for prevention of contrast-induced nephropathy in patients with stable coronary artery disease Cardiovasc Eng J, <PERSOON-##> RF, Subramaniam RM, et al Comparative Effect of Contrast Media Type on the Incidence of <PERSOON-##> C, <PERSOON-##> MT, et al.
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as a risk factor for contrast-induced <PERSOON> E, et al Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables <PERSOON> RH, et al Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material risk stratification by using estimated glomerular filtration rate <PERSOON> JR, et al Contrast material-induced nephrotoxicity and intravenous low-osmolality Ding <PERSOON> TQ, et al Impact of elevated serum glycated albumin levels on contrast-induced acute kidney injury in diabetic patients with moderate to severe renal insufficiency undergoing coronary angiography <PERSOON> ### <PERSOON> M, et al Is there an association between non-steroidal anti-inflammatory drugs and contrast <PERSOON> LP, Bahlis LF, Carvalhal GF Computerized tomography contrast induced nephropathy (CIN) among adult inpatients <PERSOON> Y, et al A new preprocedure risk score for predicting contrast-induced acute kidney injury <PERSOON> N, et al Impact of minimum contrast media volumes during elective percutaneous coronary intervention for prevention of contrast-induced nephropathy in patients with stable coronary artery disease Cardiovasc Eng J, <PERSOON-##> RF, Subramaniam RM, et al Comparative Effect of Contrast Media Type on the Incidence of <PERSOON-##> C, <PERSOON-##> MT, et al Fu N, <PERSOON-##> X, <PERSOON-##> S, et al Risk score for the prediction of contrast-induced nephropathy in elderly patients undergoing <PERSOON-##> I, et al Contrast induced acute kidney injury in acute coronary syndrome patients A single Gao YM, <PERSOON-##> D, <PERSOON-##> H, et al Derivation and validation of a risk score for contrast-induced nephropathy after cardiac Ghani <INSTELLING>, Tohamy KY Risk score for contrast induced nephropathy following percutaneous coronary intervention <PERSOON-##> Y, <PERSOON-##> JY, et al Hyperuricemia Is an Independent Predictor of Contrast-Induced Acute Kidney Injury and Gurm HS, <PERSOON-##> J, et al A novel tool for reliable and accurate prediction of renal complications in patients <PERSOON-##> KK, et al Incidence of contrast-induced nephropathy in kidney transplant recipients <PERSOON-##> YF, Hsieh KL, Kung FL, et al Nephrotoxic polypharmacy and risk of contrast medium-induced nephropathy in <PERSOON-##> C-S, How C-K, et al Contrast medium exposure during computed tomography and risk of development of end-stage renal disease in patients with chronic kidney disease A national population based propensity score-matched, <PERSOON-##> S, <PERSOON-##> T, et al Development and validation of a pre-percutaneous coronary intervention risk model of <PERSOON-##> MA, Halimi JM, et al Predictive factors of contrast-induced nephropathy in patients undergoing primary <PERSOON-##> L, <PERSOON-##> X, Qin W, et al Novel risk score of contrast-induced nephropathy after percutaneous coronary intervention <PERSOON-##> JR, et al.
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et al Risk score for the prediction of contrast-induced nephropathy in elderly patients undergoing <PERSOON> I, et al Contrast induced acute kidney injury in acute coronary syndrome patients A single Gao YM, <PERSOON> D, <PERSOON> H, et al Derivation and validation of a risk score for contrast-induced nephropathy after cardiac Ghani <INSTELLING>, Tohamy KY Risk score for contrast induced nephropathy following percutaneous coronary intervention <PERSOON> Y, <PERSOON> JY, et al Hyperuricemia Is an Independent Predictor of Contrast-Induced Acute Kidney Injury and Gurm HS, <PERSOON> J, et al A novel tool for reliable and accurate prediction of renal complications in patients <PERSOON> KK, et al Incidence of contrast-induced nephropathy in kidney transplant recipients <PERSOON> YF, Hsieh KL, Kung FL, et al Nephrotoxic polypharmacy and risk of contrast medium-induced nephropathy in <PERSOON> C-S, How C-K, et al Contrast medium exposure during computed tomography and risk of development of end-stage renal disease in patients with chronic kidney disease A national population based propensity score-matched, <PERSOON> S, <PERSOON-##> T, et al Development and validation of a pre-percutaneous coronary intervention risk model of <PERSOON-##> MA, Halimi JM, et al Predictive factors of contrast-induced nephropathy in patients undergoing primary <PERSOON> L, <PERSOON-##> X, Qin W, et al Novel risk score of contrast-induced nephropathy after percutaneous coronary intervention <PERSOON-##> JR, et al <PERSOON-##> G, et al Impact of female gender on frequency of contrast medium-induced nephropathy post hoc analysis of dialysis versus diuresis trial <PERSOON-##>) ### <PERSOON-##> M, et al Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction <PERSOON-##> JP, et al A randomized comparison of #-h sodium bicarbonate hydration versus standard peri-procedural saline hydration in patients with chronic kidney disease undergoing intravenous contrast-enhanced <PERSOON-##> YW, van Buren M, et al Randomised trial of no hydration vs sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography <PERSOON-##> OT, et al <PERSOON-##> risk score predicts contrast-induced acute kidney injury in STEMI patients <PERSOON-##> role of inflammation in contrast-induced nephropathy <PERSOON-##> E, et al Usefulness of <PERSOON-##> as a Predictor of Contrast-Induced Nephropathy After Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction and Presentation of a Lenhard DC, Frisk AL, Lengsfeld P, et al <PERSOON-##> effect of iodinated contrast agent properties on kinetics and oxygenation <PERSOON-##> MA, et al.
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<PERSOON> G, et al Impact of female gender on frequency of contrast medium-induced nephropathy post hoc analysis of dialysis versus diuresis trial <PERSOON>) ### <PERSOON> M, et al Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction <PERSOON> JP, et al A randomized comparison of #-h sodium bicarbonate hydration versus standard peri-procedural saline hydration in patients with chronic kidney disease undergoing intravenous contrast-enhanced <PERSOON> YW, van Buren M, et al Randomised trial of no hydration vs sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography <PERSOON> OT, et al <PERSOON> risk score predicts contrast-induced acute kidney injury in STEMI patients <PERSOON> role of inflammation in contrast-induced nephropathy <PERSOON> E, et al Usefulness of <PERSOON-##> as a Predictor of Contrast-Induced Nephropathy After Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction and Presentation of a Lenhard DC, Frisk AL, Lengsfeld P, et al <PERSOON-##> effect of iodinated contrast agent properties on kinetics and oxygenation <PERSOON-##> MA, et al <PERSOON-##> YH, et al Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing <PERSOON-##> YS, Fang HY, <PERSOON-##> H, et al Predictors of contrast-induced nephropathy in chronic total occlusion percutaneous <PERSOON-##> WP, Bei WJ, et al A novel risk score model for prediction of contrast-induced nephropathy after emergent <PERSOON-##> PB, Hansell P, et al Renal failure in ##,### patients undergoing coronary procedures using iso-osmolar or <PERSOON-##> Y, <PERSOON-##> YL, et al <PERSOON-##> contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy after primary percutaneous coronary intervention <PERSOON-##> Y, <PERSOON-##> N, <PERSOON-##> J, et al <PERSOON-##> relationship between hyperuricemia and the risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with relatively normal serum creatinine Clinics (Sao <PERSOON-##>) ### <PERSOON-##> D, et al Female gender and contrast-induced nephropathy in primary Luo Y, <PERSOON-##> Z, et al Remedial hydration reduces the incidence of contrast-induced nephropathy and short-term adverse events in patients with ST-segment elevation myocardial infarction a single-center, randomized trial <PERSOON-##>, H , <PERSOON-##>, E I , et al <PERSOON-##> ratio of contrast volume to glomerular filtration rate predicts outcomes after percutaneous coronary intervention for ST-segment elevation acute myocardial infarction <PERSOON-##> M, et al.
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Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing <PERSOON> YS, Fang HY, <PERSOON> H, et al Predictors of contrast-induced nephropathy in chronic total occlusion percutaneous <PERSOON> WP, Bei WJ, et al A novel risk score model for prediction of contrast-induced nephropathy after emergent <PERSOON> PB, Hansell P, et al Renal failure in ##,### patients undergoing coronary procedures using iso-osmolar or <PERSOON> Y, <PERSOON> YL, et al <PERSOON> contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy after primary percutaneous coronary intervention <PERSOON> Y, <PERSOON> N, <PERSOON> J, et al <PERSOON> relationship between hyperuricemia and the risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with relatively normal serum creatinine Clinics (Sao <PERSOON-##>) ### <PERSOON-##> D, et al Female gender and contrast-induced nephropathy in primary Luo Y, <PERSOON-##> Z, et al Remedial hydration reduces the incidence of contrast-induced nephropathy and short-term adverse events in patients with ST-segment elevation myocardial infarction a single-center, randomized trial <PERSOON-##>, H , <PERSOON-##>, E I , et al <PERSOON> ratio of contrast volume to glomerular filtration rate predicts outcomes after percutaneous coronary intervention for ST-segment elevation acute myocardial infarction <PERSOON-##> M, et al <PERSOON-##> M, et al Effects of hydration in contrast-induced acute kidney injury after primary angioplasty a <PERSOON-##> AL Hemofiltration in the prevention of radiocontrast agent induced nephropathy <PERSOON-##> EW, et al Posttraumatic contrast-induced acute kidney injury minimal consequences or McDonald JS, Katzberg RW, McDonald RJ, et al Is the presence of a solitary kidney an independent risk factor for for McDonald JS, McDonald RJ, Carter RE, et al Risk of intravenous contrast material-mediated acute kidney injury <PERSOON-##> JS, McDonald RJ, <PERSOON-##> JC, et al Risk of acute kidney injury, dialysis, and mortality in patients with chronic kidney disease after intravenous contrast material exposure Mayo Clin Proc ###;##(#) ###-## McDonald RJ, McDonald JS, Bida JP, et al Intravenous contrast material-induced nephropathy causal or coincident McDonald RJ, McDonald JS, Carter RE, et al Intravenous contrast material exposure is not an independent risk factor for kidney disease after intravenous contrast material exposure In <PERSOON-##> A, et al <PERSOON> effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting <PERSOON-##> ### <PERSOON-##>;###(#) ### <PERSOON-##> ED, Nikolsky E, et al A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention development and initial validation <PERSOON-##> Cardiol ###;##(#) ###-#.
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Effects of hydration in contrast-induced acute kidney injury after primary angioplasty a <PERSOON> AL Hemofiltration in the prevention of radiocontrast agent induced nephropathy <PERSOON> EW, et al Posttraumatic contrast-induced acute kidney injury minimal consequences or McDonald JS, Katzberg RW, McDonald RJ, et al Is the presence of a solitary kidney an independent risk factor for for McDonald JS, McDonald RJ, Carter RE, et al Risk of intravenous contrast material-mediated acute kidney injury <PERSOON> JS, McDonald RJ, <PERSOON> JC, et al Risk of acute kidney injury, dialysis, and mortality in patients with chronic kidney disease after intravenous contrast material exposure Mayo Clin Proc ###;##(#) ###-## McDonald RJ, McDonald JS, Bida JP, et al Intravenous contrast material-induced nephropathy causal or coincident McDonald RJ, McDonald JS, Carter RE, et al Intravenous contrast material exposure is not an independent risk factor for kidney disease after intravenous contrast material exposure In <PERSOON> A, et al <PERSOON> effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting <PERSOON> ### <PERSOON>;###(#) ### <PERSOON> ED, Nikolsky E, et al A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention development and initial validation <PERSOON-##> Cardiol ###;##(#) ###<DATUM> Additional value of the red blood cell distribution width to the <PERSOON-##> risk score for predicting contrast-induced acute kidney injury in patients with ST-elevation acute myocardial infarction <PERSOON-##> G, et al Prediction of presence of kidney disease in a general patient population undergoing Nikolsky E, <PERSOON-##> Z, et al Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary <PERSOON-##> P, et al Contrast medium dose-to-GFR ratio a measure of systemic exposure to predict <PERSOON-##> H, et al Iodine contrast iso-attenuating with diagnostic gadolinium doses in CTA and angiography results in ultra-low iodine doses A way to avoid both CIN and NSF in azotemic patients? Eur Radiol <PERSOON-##> OU, Adanir EH, Gulec S, et al Impact of metabolic syndrome on development of contrast-induced nephropathy after elective percutaneous coronary intervention among nondiabetic patients <PERSOON-##> M, et al Utility of the Logistic Clinical Syntax Score in the Prediction of <PERSOON-##> MH, Malekmakan L, et al Risk Factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions <PERSOON-##> B, et al; Surgical and Clinical Outcome Research (SCORE) Group Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day.
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value of the red blood cell distribution width to the <PERSOON> risk score for predicting contrast-induced acute kidney injury in patients with ST-elevation acute myocardial infarction <PERSOON> G, et al Prediction of presence of kidney disease in a general patient population undergoing Nikolsky E, <PERSOON> Z, et al Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary <PERSOON> P, et al Contrast medium dose-to-GFR ratio a measure of systemic exposure to predict <PERSOON> H, et al Iodine contrast iso-attenuating with diagnostic gadolinium doses in CTA and angiography results in ultra-low iodine doses A way to avoid both CIN and NSF in azotemic patients? Eur Radiol <PERSOON> OU, Adanir EH, Gulec S, et al Impact of metabolic syndrome on development of contrast-induced nephropathy after elective percutaneous coronary intervention among nondiabetic patients <PERSOON> M, et al Utility of the Logistic Clinical Syntax Score in the Prediction of <PERSOON> MH, Malekmakan L, et al Risk Factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions <PERSOON> B, et al; Surgical and Clinical Outcome Research (SCORE) Group Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day ### Feb;##(#) #<DATUM> <PERSOON-##> B, <PERSOON-##> MM, et al Lower blood vitamin D levels are associated with an increased incidence of contrastinduced nephropathy in patients undergoing coronary angiography <PERSOON-##> K, et al CINC-J study investigators Proteinuria and reduced estimated glomerular filtration rate are independent risk factors for contrast-induced nephropathy after cardiac catheterization <PERSOON-##> VC, Dubourg L, et al Contrast-induced nephropathy after computed tomography <PERSOON-##> D, et al <PERSOON> contrast-induced nephropathy risk score predicts short-and long-term <PERSOON-##> M, et al Intravenous contrast medium administration for computed tomography scan in <PERSOON-##> H, et al Contrast induced exacerbation of renal dysfunction in the advanced chronic kidney <PERSOON-##> M, et al Metabolic syndrome as a risk factor for contrast-induced nephropathy in non-diabetic elderly patients with renal impairment <PERSOON-##> M, Esi E, et al Hyperuricemia as a risk factor for contrast-induced nephropathy in patients with chronic <PERSOON-##> M, et al Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease Nephrol Dial Transplant ### Mar;##(#) ###-## Trivedi HS, Moore H, <PERSOON-##> S, et al.
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#<DATUM> <PERSOON> B, <PERSOON> MM, et al Lower blood vitamin D levels are associated with an increased incidence of contrastinduced nephropathy in patients undergoing coronary angiography <PERSOON> K, et al CINC-J study investigators Proteinuria and reduced estimated glomerular filtration rate are independent risk factors for contrast-induced nephropathy after cardiac catheterization <PERSOON> VC, Dubourg L, et al Contrast-induced nephropathy after computed tomography <PERSOON> D, et al <PERSOON> contrast-induced nephropathy risk score predicts short-and long-term <PERSOON> M, et al Intravenous contrast medium administration for computed tomography scan in <PERSOON> H, et al Contrast induced exacerbation of renal dysfunction in the advanced chronic kidney <PERSOON> M, et al Metabolic syndrome as a risk factor for contrast-induced nephropathy in non-diabetic elderly patients with renal impairment <PERSOON-##> M, Esi E, et al Hyperuricemia as a risk factor for contrast-induced nephropathy in patients with chronic <PERSOON> M, et al Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease Nephrol Dial Transplant ### Mar;##(#) ###-## Trivedi HS, Moore H, <PERSOON-##> S, et al <PERSOON-##> D, et al Development of an easily applicable risk score model for contrast-induced nephropathy prediction after percutaneous coronary intervention a novel approach tailored to current practice <PERSOON-##> D, et al Validation of a new risk score to predict contrast-induced nephropathy after <PERSOON-##> A, et al Increased aortic stiffness predicts contrast-induced nephropathy in patients with stable coronary artery disease undergoing percutaneous coronary intervention Angiology ### Oct;##(#) #<DATUM> <PERSOON-##> SM, Gnanaraj A, S V, et al Risk scoring system to predict contrast induced nephropathy following percutaneous <PERSOON-##> T, <PERSOON-##> A, et al Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed <PERSOON-##> K, et al Prediction of contrast-induced nephropathy by the serum creatinine level on the day <PERSOON-##> Y, et al Association between serum ferritin and contrast-induced nephropathy in patients with acute <PERSOON-##> L, Mao S, et al Hyperuricemia and contrast-induced acute kidney injury A systematic review and meta-analysis Hoe dient nierfunctie te worden gemeten voor en na jodiumhoudend contrastmiddel toediening? # Wanneer dient een eGFR schatting te worden uitgevoerd vooraf aan toediening van jodiumhoudend # Wanneer dient een eGFR schatting te worden uitgevoerd na toediening van jodiumhoudend contrast? # Indien PC-AKI wordt gediagnosticeerd, hoe dient de patiënt vervolgd te worden? Bepaal de eGFR bij elke patiënt die een CT-scan of angiografie met of zonder interventie en gebruik van maximaal # dagen.
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easily applicable risk score model for contrast-induced nephropathy prediction after percutaneous coronary intervention a novel approach tailored to current practice <PERSOON> D, et al Validation of a new risk score to predict contrast-induced nephropathy after <PERSOON> A, et al Increased aortic stiffness predicts contrast-induced nephropathy in patients with stable coronary artery disease undergoing percutaneous coronary intervention Angiology ### Oct;##(#) #<DATUM> <PERSOON> SM, Gnanaraj A, S V, et al Risk scoring system to predict contrast induced nephropathy following percutaneous <PERSOON> T, <PERSOON> A, et al Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed <PERSOON> K, et al Prediction of contrast-induced nephropathy by the serum creatinine level on the day <PERSOON> Y, et al Association between serum ferritin and contrast-induced nephropathy in patients with acute <PERSOON> L, Mao S, et al Hyperuricemia and contrast-induced acute kidney injury A systematic review and meta-analysis Hoe dient nierfunctie te worden gemeten voor en na jodiumhoudend contrastmiddel toediening? # Wanneer dient een eGFR schatting te worden uitgevoerd vooraf aan toediening van jodiumhoudend # Wanneer dient een eGFR schatting te worden uitgevoerd na toediening van jodiumhoudend contrast? # Indien PC-AKI wordt gediagnosticeerd, hoe dient de patiënt vervolgd te worden? Bepaal de eGFR bij elke patiënt die een CT-scan of angiografie met of zonder interventie en gebruik van maximaal # dagen maximaal # maanden wanneer de patiënt een chronische ziekte heeft met een stabiele nierfunctie; Bepaal de eGFR binnen # tot # dagen na intravasculaire jodiumhoudende contrastmiddel toediening bij elke Indien er PC-AKI wordt gediagnostiseerd (volgens Kidney Disease Improving Global Outcomes criteria), vervolg de patiënt gedurende minstens ## dagen na de diagnose en bepaal het serum-kreatinine Gebruik de kreatinine-gebaseerde Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formule voor Note that Cr denotes creatinine concentration in both plasma and serum in µmol/<PERSOON> of Diabetes and Digestive and Kidney Diseases (US) Currently, the measurement of creatinine using Isotope Dilution Mass Spectrometry (IDMS) is standardized Worldwide standardization of creatinine measurement has been accomplished, but selectivity issues remain due to persistence of non-selective methods leading to inaccurate creatinine and eGFR results It is the endresponsibility of the lab professional to select and implement accurate - selective - creatinine measurement In addition, it should be noted that glomerular filtration rate (GFR), defined as ml/minute passing through the kidneys as a substitute for kidney function, essentially differs from creatinine clearance which is defined as Urinary volume * ([creatinine]urine /[creatinine]pla s ma ) In case of creatinine clearance, especially with low kidney filtration, creatinine clearance may exceed GFR up to ##% due to active tubular secretion of creatinine Assessment of eGFR in children is outside the scope of this guideline Specific equations for the calculation of addition, it is not necessary to adapt the CKD-EPI formula for patients )## years of age.
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# maanden wanneer de patiënt een chronische ziekte heeft met een stabiele nierfunctie; Bepaal de eGFR binnen # tot # dagen na intravasculaire jodiumhoudende contrastmiddel toediening bij elke Indien er PC-AKI wordt gediagnostiseerd (volgens Kidney Disease Improving Global Outcomes criteria), vervolg de patiënt gedurende minstens ## dagen na de diagnose en bepaal het serum-kreatinine Gebruik de kreatinine-gebaseerde Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formule voor Note that Cr denotes creatinine concentration in both plasma and serum in µmol/<PERSOON> of Diabetes and Digestive and Kidney Diseases (US) Currently, the measurement of creatinine using Isotope Dilution Mass Spectrometry (IDMS) is standardized Worldwide standardization of creatinine measurement has been accomplished, but selectivity issues remain due to persistence of non-selective methods leading to inaccurate creatinine and eGFR results It is the endresponsibility of the lab professional to select and implement accurate - selective - creatinine measurement In addition, it should be noted that glomerular filtration rate (GFR), defined as ml/minute passing through the kidneys as a substitute for kidney function, essentially differs from creatinine clearance which is defined as Urinary volume * ([creatinine]urine /[creatinine]pla s ma ) In case of creatinine clearance, especially with low kidney filtration, creatinine clearance may exceed GFR up to ##% due to active tubular secretion of creatinine Assessment of eGFR in children is outside the scope of this guideline Specific equations for the calculation of addition, it is not necessary to adapt the CKD-EPI formula for patients )## years of age Netherlands Due to extensive standardization efforts both at the international and the national level, the inter- laboratory variability is far below ##% As a result of ongoing improvements in creatinine assays, methods are now available for selective measurement of creatinine with high reproducibility and small variation As a measurement is currently the most suitable test for assessment of kidney function On the basis of its high reproducibility and low variability, the serum or plasma creatinine test is suitable for detection of minimal changes during treatment (Fraser, ###), for monitoring kidney function after kidney transplantation or after Currently no alternative test of kidney function other than creatinine is available that is reimbursed and offers high analytical reliability and low biological variation <PERSOON> use of beta-trace and Cystatin C has not been validated adequately for large cohorts and these tests are not widely available in Dutch clinical chemistry <PERSOON> current use of generic and broad reference values for creatinine covers up significant changes of kidney function within the reference interval In addition, the use of broad reference values does not permit the followup of vulnerable patients with slowly deteriorating kidney function As a consequence, it is suggested that in vulnerable patients, measurement of creatinine with increased frequency leads to early detection of kidney function deterioration Using the formula for determination of the critical difference based upon individual and analytical variability (Fraser ###), a deterioration of kidney function can be detected with high reliability.
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Due to extensive standardization efforts both at the international and the national level, the inter- laboratory variability is far below ##% As a result of ongoing improvements in creatinine assays, methods are now available for selective measurement of creatinine with high reproducibility and small variation As a measurement is currently the most suitable test for assessment of kidney function On the basis of its high reproducibility and low variability, the serum or plasma creatinine test is suitable for detection of minimal changes during treatment (Fraser, ###), for monitoring kidney function after kidney transplantation or after Currently no alternative test of kidney function other than creatinine is available that is reimbursed and offers high analytical reliability and low biological variation <PERSOON> use of beta-trace and Cystatin C has not been validated adequately for large cohorts and these tests are not widely available in Dutch clinical chemistry <PERSOON> current use of generic and broad reference values for creatinine covers up significant changes of kidney function within the reference interval In addition, the use of broad reference values does not permit the followup of vulnerable patients with slowly deteriorating kidney function As a consequence, it is suggested that in vulnerable patients, measurement of creatinine with increased frequency leads to early detection of kidney function deterioration Using the formula for determination of the critical difference based upon individual and analytical variability (Fraser ###), a deterioration of kidney function can be detected with high reliability detected with ##% certainty (Z value #,##, Critical difference (%) = #,## * â(#)* â(â(CVa) + â(CVw))) when the two consecutive measurements of creatinine differ by at least ##,#%, e g when a value of ### µmol/L increases to at least ### µmol/L or a value of ### µmol/L increases to at least ### µmol/<PERSOON> the recent validation of the CKD-EPI formula in a large cohort by Levey et al (Levey, ###) and by using serum creatinine standardized to the IDMS reference system, the use of the CKD-EPI equation in Dutch not deemed usable given the specific Swedish (Caucasian) population from which this formula was derived and validated (Nyman, ###) As per ###, the Dutch SKML chemistry section advises the use of the creatinine based CKD-EPI formula given its improved performance for CKD risk classification compared to the MDRD In case the patientâs specific body surface area (BSA) is available, eGFR can be adjusted for BSA (also termed Based upon a recent pilot study on differences in type and severity of comorbidity (Björk, ###) and by using techniques of population weighted means, it can be estimated whether a patient has an eGFR (## ml/min/#,##m# or â¥## ml/min/#,##m# By stratifying patients according to their algorithms, the authors came to a preselection of patients with low or normal kidney function In case a preselection is available of patients with increased risk for CKD or CIN follow up of these patients may be adjusted <PERSOON> efficacy of these stratification.
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difference (%) = #,## * â(#)* â(â(CVa) + â(CVw))) when the two consecutive measurements of creatinine differ by at least ##,#%, e g when a value of ### µmol/L increases to at least ### µmol/L or a value of ### µmol/L increases to at least ### µmol/<PERSOON> the recent validation of the CKD-EPI formula in a large cohort by Levey et al (Levey, ###) and by using serum creatinine standardized to the IDMS reference system, the use of the CKD-EPI equation in Dutch not deemed usable given the specific Swedish (Caucasian) population from which this formula was derived and validated (Nyman, ###) As per ###, the Dutch SKML chemistry section advises the use of the creatinine based CKD-EPI formula given its improved performance for CKD risk classification compared to the MDRD In case the patientâs specific body surface area (BSA) is available, eGFR can be adjusted for BSA (also termed Based upon a recent pilot study on differences in type and severity of comorbidity (Björk, ###) and by using techniques of population weighted means, it can be estimated whether a patient has an eGFR (## ml/min/#,##m# or â¥## ml/min/#,##m# By stratifying patients according to their algorithms, the authors came to a preselection of patients with low or normal kidney function In case a preselection is available of patients with increased risk for CKD or CIN follow up of these patients may be adjusted <PERSOON> efficacy of these stratification So far, several biomarkers have been evaluated (e g creatinine, Cystatin C, beta trace), although only creatinine has thus far found widespread use in most clinical chemistry laboratories Serum creatinine measurements are the basis for creatinine-derived eGFR estimates Historically, routine measurement of creatinine was performed using colorimetric Jaffe methods <PERSOON> Jaffe method is however a chemical method affected by non-specificity since not only creatinine reacts with the alkaline picrate but also other analytes such as serum protein and <PERSOON> quality of the eGFR estimates is strongly dependent on serum creatinine measurement accuracy For this reason, selective measurement of serum creatinine with analytical performance in line with desirable bias and imprecision criteria based on biological variation is paramount for guaranteeing metrological traceability It should be kept in mind therefore that adequate risk classification using GFR critically depends on universal Following the first large study published in ### to estimate glomerular filtration rate (eGFR), from creatinine (Levey, ###), the MDRD formula was further improved by using isotope dilution mass spectrometry (IDMS), This succession of eGFR formula therefore illustrates an ongoing effort of methods to accurately estimate GFR rather than a defined endpoint In brief, the advantage of the CKD-EPI equation, is the higher accuracy of eGFR predictions for normal kidney function than the MDRD equation In addition, following the introduction of the CKD-EPI equation, a reduced number of patients is misclassified as compared with the MDRD equation, Kidney function is likely stable in patients without chronic kidney disease Extensive risk prediction model.
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g creatinine, Cystatin C, beta trace), although only creatinine has thus far found widespread use in most clinical chemistry laboratories Serum creatinine measurements are the basis for creatinine-derived eGFR estimates Historically, routine measurement of creatinine was performed using colorimetric Jaffe methods <PERSOON> Jaffe method is however a chemical method affected by non-specificity since not only creatinine reacts with the alkaline picrate but also other analytes such as serum protein and <PERSOON> quality of the eGFR estimates is strongly dependent on serum creatinine measurement accuracy For this reason, selective measurement of serum creatinine with analytical performance in line with desirable bias and imprecision criteria based on biological variation is paramount for guaranteeing metrological traceability It should be kept in mind therefore that adequate risk classification using GFR critically depends on universal Following the first large study published in ### to estimate glomerular filtration rate (eGFR), from creatinine (Levey, ###), the MDRD formula was further improved by using isotope dilution mass spectrometry (IDMS), This succession of eGFR formula therefore illustrates an ongoing effort of methods to accurately estimate GFR rather than a defined endpoint In brief, the advantage of the CKD-EPI equation, is the higher accuracy of eGFR predictions for normal kidney function than the MDRD equation In addition, following the introduction of the CKD-EPI equation, a reduced number of patients is misclassified as compared with the MDRD equation, Kidney function is likely stable in patients without chronic kidney disease Extensive risk prediction model failure or impaired ejection fraction, hypotension, hypertension or shock may correlate with the possible development of AKI but are not specific for <PERSOON> applicability of current risk models in clinical practice is With the use of an endogenous filtration marker it should be noted that any endogenous marker is influenced by several non-GFR determinants, such as body mass, diet, racial background, gender etc Important considerations are that eGFR is unreliable in patients with acute kidney failure and may overestimate renal function in patients with a reduced muscle mass When adapted for specific subpopulations e g on the basis of descend, improvements may be possible for eGFR values, this however lies outside of the scope of this When should an eGFR calculation be performed prior to contrast administration? Kidney function, assessed by eGFR is, according to the working group, likely stable in patients without chronic kidney disease or, underlying comorbidities such as heart failure or, hypertension and in the absence of the use of nephrotoxic medication In these patients, considered to have normal kidney function, an eGFR measurement should be available within approximately ## months before any CT imaging or angiography with or without intervention with the possible use of a contrast agent Patients who are followed-up for oncological diseases are It is the opinion of the working group that an eGFR result should not be more than # months old in patients with CKD, a known other chronic disease or the use of nephrotoxic drugs Chronic disease is defined in analogy to.
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hypotension, hypertension or shock may correlate with the possible development of AKI but are not specific for <PERSOON> applicability of current risk models in clinical practice is With the use of an endogenous filtration marker it should be noted that any endogenous marker is influenced by several non-GFR determinants, such as body mass, diet, racial background, gender etc Important considerations are that eGFR is unreliable in patients with acute kidney failure and may overestimate renal function in patients with a reduced muscle mass When adapted for specific subpopulations e g on the basis of descend, improvements may be possible for eGFR values, this however lies outside of the scope of this When should an eGFR calculation be performed prior to contrast administration? Kidney function, assessed by eGFR is, according to the working group, likely stable in patients without chronic kidney disease or, underlying comorbidities such as heart failure or, hypertension and in the absence of the use of nephrotoxic medication In these patients, considered to have normal kidney function, an eGFR measurement should be available within approximately ## months before any CT imaging or angiography with or without intervention with the possible use of a contrast agent Patients who are followed-up for oncological diseases are It is the opinion of the working group that an eGFR result should not be more than # months old in patients with CKD, a known other chronic disease or the use of nephrotoxic drugs Chronic disease is defined in analogy to chronic or non-communicable diseases are of long (more than # months) duration and generally slow progression <PERSOON> main types are cardiovascular diseases, diabetes, chronic kidney diseases, chronic respiratory system diseases, chronic gastro-intestinal diseases, and chronic connective tissue and auto-immune In patients with any acute disease or an acute deterioration of a chronic illness a recent eGFR, not more than # days old, is needed before CM administration Frequently occurring examples include acute infections, acute cardiovascular diseases, acute gastro-intestinal diseases, respiratory diseases, acute kidney diseases, and acute connective tissue and auto-immune diseases Also for all patients admitted to a hospital an eGFR (# days old is <PERSOON> nephrotoxicity of gadolinium-based contrast agents and/or microbubble contrast media and the recommendations for measurement of eGFR will be integrated with the guidelines for prevention of Nephrogenic Systemic Fibrosis These will be published in the guideline Safe Use of Contrast Media, part # (due When should an eGFR calculation be performed after the contrast administration? There is no clear consensus guidance in the literature on this point According to the Working Group, eGFR should be determined within <DATUM> days after contrast administration in every patient with high risk for developing PC-AKI that receives preventive hydration In patients requiring the continuation of metformin, an eGFR should be measured within # days In most patients, a decreased kidney function may spontaneously resolve In patients without chronic kidney disease or, underlying co-morbidities such as heart failure, hypertension and.
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chronic or non-communicable diseases are of long (more than # months) duration and generally slow progression <PERSOON> main types are cardiovascular diseases, diabetes, chronic kidney diseases, chronic respiratory system diseases, chronic gastro-intestinal diseases, and chronic connective tissue and auto-immune In patients with any acute disease or an acute deterioration of a chronic illness a recent eGFR, not more than # days old, is needed before CM administration Frequently occurring examples include acute infections, acute cardiovascular diseases, acute gastro-intestinal diseases, respiratory diseases, acute kidney diseases, and acute connective tissue and auto-immune diseases Also for all patients admitted to a hospital an eGFR (# days old is <PERSOON> nephrotoxicity of gadolinium-based contrast agents and/or microbubble contrast media and the recommendations for measurement of eGFR will be integrated with the guidelines for prevention of Nephrogenic Systemic Fibrosis These will be published in the guideline Safe Use of Contrast Media, part # (due When should an eGFR calculation be performed after the contrast administration? There is no clear consensus guidance in the literature on this point According to the Working Group, eGFR should be determined within <DATUM> days after contrast administration in every patient with high risk for developing PC-AKI that receives preventive hydration In patients requiring the continuation of metformin, an eGFR should be measured within # days In most patients, a decreased kidney function may spontaneously resolve In patients without chronic kidney disease or, underlying co-morbidities such as heart failure, hypertension and In studies, eGFR was assessed after <DATUM> days after CM administration to diagnose PC-AKI In case PC-AKI is diagnosed within <DATUM> days, additional follow-up is mandatory It is the expert opinion of the Working Group that further follow-up is mandatory for patients in whom PC-AKI is diagnosed, for at least ## days post-diagnosis In case of a major life-threatening medical condition requiring rapid decision-making including emergency imaging or intervention (e g stroke), the determination of the eGFR can be postponed or the imaging or intervention can be started while the eGFR is being determined in the laboratory If the possibility exists to wait a short time before commencing diagnosis or intervention, without doing harm to the patient, eGFR should be In the Netherlands, for practical purposes the VMS Quality Project (VMS, ###) has introduced to measure eGFR before every iodine-containing CM administration which has gained wide acceptance This is not in accordance with scientific data which suggest that eGFR measurements can be performed only in patients at risk Based on previously published risk factors (see also chapter ## on Risk Stratification) several patient questionnaires to guide clinicians when to assess eGFR have gained popularity, especially the #-question questionnaire (Choyke, ###); which formed the basis for the more extensive questionnaire for multiple aspects of CM safety by the ESUR Contrast Media Safety Committee (Morcos, ###) questionnaires ask the patient and referring physician about history of renal disease, history of renal surgery, and the presence of heart failure, diabetes, proteinuria, hypertension or gout.
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after CM administration to diagnose PC-AKI In case PC-AKI is diagnosed within <DATUM> days, additional follow-up is mandatory It is the expert opinion of the Working Group that further follow-up is mandatory for patients in whom PC-AKI is diagnosed, for at least ## days post-diagnosis In case of a major life-threatening medical condition requiring rapid decision-making including emergency imaging or intervention (e g stroke), the determination of the eGFR can be postponed or the imaging or intervention can be started while the eGFR is being determined in the laboratory If the possibility exists to wait a short time before commencing diagnosis or intervention, without doing harm to the patient, eGFR should be In the Netherlands, for practical purposes the VMS Quality Project (VMS, ###) has introduced to measure eGFR before every iodine-containing CM administration which has gained wide acceptance This is not in accordance with scientific data which suggest that eGFR measurements can be performed only in patients at risk Based on previously published risk factors (see also chapter ## on Risk Stratification) several patient questionnaires to guide clinicians when to assess eGFR have gained popularity, especially the #-question questionnaire (Choyke, ###); which formed the basis for the more extensive questionnaire for multiple aspects of CM safety by the ESUR Contrast Media Safety Committee (Morcos, ###) questionnaires ask the patient and referring physician about history of renal disease, history of renal surgery, and the presence of heart failure, diabetes, proteinuria, hypertension or gout simple questionnaires are sensitive in identifying patients with eGFR (## ml/min/# ##m# and can reduce the need for eGFR assessments via laboratory or point-of-care techniques, especially in patients younger than ## No literature search was performed for this chapter <PERSOON> working group did not expect to find evidence for this question, since the clinical question could not be answered in a controlled study Furthermore, the <PERSOON> HS Fluctuations in eGFR in relation to unenhanced and enhanced MRI and CT outpatients <PERSOON> G, et al A new tool for predicting the probability of chronic kidney disease from a specific value <PERSOON> SL, et al Determination of serum creatinine prior to iodine-containing contrast media is it <PERSOON> CW Prime time for enzymatic creatinine methods in pediatrics ClinChem Fraser CG Improved monitoring of differences in serial laboratory results <PERSOON> JP, <PERSOON> JB, et al A more accurate method to estimate glomerular filtration rate from serum creatinine <PERSOON> T, et al Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate <PERSOON> LA, Schmid CH, et al A new equation to estimate glomerular filtration rate <PERSOON-##> Med Morcos SK, Bellin MF, Thomsen HS, et al.
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identifying patients with eGFR (## ml/min/# ##m# and can reduce the need for eGFR assessments via laboratory or point-of-care techniques, especially in patients younger than ## No literature search was performed for this chapter <PERSOON> working group did not expect to find evidence for this question, since the clinical question could not be answered in a controlled study Furthermore, the <PERSOON> HS Fluctuations in eGFR in relation to unenhanced and enhanced MRI and CT outpatients <PERSOON> G, et al A new tool for predicting the probability of chronic kidney disease from a specific value <PERSOON> SL, et al Determination of serum creatinine prior to iodine-containing contrast media is it <PERSOON> CW Prime time for enzymatic creatinine methods in pediatrics ClinChem Fraser CG Improved monitoring of differences in serial laboratory results <PERSOON> JP, <PERSOON> JB, et al A more accurate method to estimate glomerular filtration rate from serum creatinine <PERSOON> T, et al Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate <PERSOON> LA, Schmid CH, et al A new equation to estimate glomerular filtration rate <PERSOON-##> Med Morcos SK, Bellin MF, Thomsen HS, et al <PERSOON-##> A, et al <PERSOON> revised Lund-Malmö GFR estimating equation outperforms MDRD and <PERSOON-##> L, et al <PERSOON-##> estimated glomerular filtration rate equation for the full age spectrum <PERSOON-##> P, et al Two novel equations to estimate kidney function in persons aged ## years or <PERSOON-##> MF, et al New equations to estimate GFR in children with <PERSOON-##> SA, <PERSOON-##> PM, Chertow GM, et al Risk prediction models for contrast induced nephropathy systematic review <PERSOON-##> WY, <PERSOON-##> CC, et al Screening for impaired renal function in outpatients before iodinated contrast injection <PERSOON-##> JA, <PERSOON-##> HL, et al Introduction of the CKD-EPI equation to estimate glomerular filtration <PERSOON-##> AJ, et al Serum creatinine measurements evaluation of a questionnaire according to the Welke hydratiestrategie dient te worden toegepast bij patiënten die intravasculair Voor patiënten met eGFR (## ml/min/#,##m# die intravasculair jodiumhoudend CM toediening ondergaan kan # <PERSOON-##> prehydratie toe met NaHCO<DATUM> #%, #ml/kg/uur gedurende # uur vooraf aan CM toediening # <PERSOON-##> pre- en posthydratie toe met NaHCO<DATUM> #%, #ml/kg/uur (of ### mL in totaal) gedurende # uur vooraf <PERSOON-##> geen hydratie met gecontroleerde diurese toe ter preventie van PC-AKI bij patiënten die (cardiale) <PERSOON> number of patients with eGFR (## ml/min/#.
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<PERSOON> A, et al <PERSOON> revised Lund-Malmö GFR estimating equation outperforms MDRD and <PERSOON> L, et al <PERSOON> estimated glomerular filtration rate equation for the full age spectrum <PERSOON> P, et al Two novel equations to estimate kidney function in persons aged ## years or <PERSOON> MF, et al New equations to estimate GFR in children with <PERSOON> SA, <PERSOON> PM, Chertow GM, et al Risk prediction models for contrast induced nephropathy systematic review <PERSOON> WY, <PERSOON-##> CC, et al Screening for impaired renal function in outpatients before iodinated contrast injection <PERSOON-##> JA, <PERSOON-##> HL, et al Introduction of the CKD-EPI equation to estimate glomerular filtration <PERSOON-##> AJ, et al Serum creatinine measurements evaluation of a questionnaire according to the Welke hydratiestrategie dient te worden toegepast bij patiënten die intravasculair Voor patiënten met eGFR (## ml/min/#,##m# die intravasculair jodiumhoudend CM toediening ondergaan kan # <PERSOON-##> prehydratie toe met NaHCO<DATUM> #%, #ml/kg/uur gedurende # uur vooraf aan CM toediening # <PERSOON-##> pre- en posthydratie toe met NaHCO<DATUM> #%, #ml/kg/uur (of ### mL in totaal) gedurende # uur vooraf <PERSOON-##> geen hydratie met gecontroleerde diurese toe ter preventie van PC-AKI bij patiënten die (cardiale) <PERSOON> number of patients with eGFR (## ml/min/# No RCT has been publshed focusing on patients with eGFR (## ml/min/# ##m# only, and subanalyses for this group within other RCTs were not performed Furthermore, independent of eGFR, all patients receiving CM should have a normal hydration status Dehydration should be corrected at all times before administering <PERSOON-##> most valuable new information comes from the study from <PERSOON-##>, ### This prospective randomised RCT in ### patients with eGFR ##-## ml/min/# ##m# , shows that the incidence of PC-AKI is het same in the group receiving pre- and post-hydration with NaCl # #% compared to the group withholding hydration, <DATUM> versus <DATUM> respectively (one-sided ##% CI -# ## to <DATUM> Further analyses showed no significant differences in the incidence of PC-AKI between patients receiving iv NaCl # #% and those not receiving prophylaxis in the subgroups with or without diabetes; eGFR ##-## ml/min/# ##m# or eGFR ##-## ml/min/# ##m# ; intra-arterial contrast administration or intra-venous contrast administration; and undergoing an interventional or diagnostic procedure As this study has been conducted in the Netherlands, these results are highly applicable to this <PERSOON> quality of evidence for the effectivity of oral hydration for the prevention of PC-AKI is low Furthermore, the oral intake of patients could not be quantified and could therefore lead to PC-AKI due to lack of adherence to oral hydration instructions Therefore, it is the recommendation of the working group that oral hydration should not be used in the prevention of PC-AKI.
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has been publshed focusing on patients with eGFR (## ml/min/# ##m# only, and subanalyses for this group within other RCTs were not performed Furthermore, independent of eGFR, all patients receiving CM should have a normal hydration status Dehydration should be corrected at all times before administering <PERSOON> most valuable new information comes from the study from <PERSOON>, ### This prospective randomised RCT in ### patients with eGFR ##-## ml/min/# ##m# , shows that the incidence of PC-AKI is het same in the group receiving pre- and post-hydration with NaCl # #% compared to the group withholding hydration, <DATUM> versus <DATUM> respectively (one-sided ##% CI -# ## to <DATUM> Further analyses showed no significant differences in the incidence of PC-AKI between patients receiving iv NaCl # #% and those not receiving prophylaxis in the subgroups with or without diabetes; eGFR ##-## ml/min/# ##m# or eGFR ##-## ml/min/# ##m# ; intra-arterial contrast administration or intra-venous contrast administration; and undergoing an interventional or diagnostic procedure As this study has been conducted in the Netherlands, these results are highly applicable to this <PERSOON> quality of evidence for the effectivity of oral hydration for the prevention of PC-AKI is low Furthermore, the oral intake of patients could not be quantified and could therefore lead to PC-AKI due to lack of adherence to oral hydration instructions Therefore, it is the recommendation of the working group that oral hydration should not be used in the prevention of PC-AKI Intravenous administration of NaCl # #% before, during and after CM administration will produce an infusion rate-dependent increase in tubular fluid volume, reduction in CM intratubular concentration, and slight increases in tubular pH <PERSOON> lower tubular concentrations of CM lead to reduced formation of reactive oxygen species Infusion of NaHCO <DATUM> #% has the same effects as NaCl # #% infusion with the additional benefit of a substantial increase in the bicarbonate anion buffer throughout the renal tubule Higher pH is known to decrease cellular apoptosis in the setting of ROS formation Prehydration with NaHCO # will raise the proximal tubular bicarbonate anion and pH levels close to those found in blood Maintainance of NaHCO # infusion will keep the For descriptive purposes, three hydration schedules have been described in the literature <PERSOON> landmark paper giving the first evidence on the effectiveness of NaHCO # pre- and post hydration was published in ### (Merten, ###) This group describes an RCT consisting of ### patients with a sCr ⥠##,# µmol/l undergoing either cardiac catheterizations (n=##) or CT (n=#) or other procedures involving intravascular contrast administration (n=##) Patients were randomly assigned to receive either ###mEq/l NaHCO # or ###mEq/l NaCl, both in dextrose #% in water <PERSOON> groups received the fluid mixture at a rate of #ml/kg/h for # hour pre CM injection and at a rate of #ml/kg/h for # hours after CM injection PC-AKI was defined as a rise of sCr â¥##% within # days after CM administration.
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NaCl # #% before, during and after CM administration will produce an infusion rate-dependent increase in tubular fluid volume, reduction in CM intratubular concentration, and slight increases in tubular pH <PERSOON> lower tubular concentrations of CM lead to reduced formation of reactive oxygen species Infusion of NaHCO <DATUM> #% has the same effects as NaCl # #% infusion with the additional benefit of a substantial increase in the bicarbonate anion buffer throughout the renal tubule Higher pH is known to decrease cellular apoptosis in the setting of ROS formation Prehydration with NaHCO # will raise the proximal tubular bicarbonate anion and pH levels close to those found in blood Maintainance of NaHCO # infusion will keep the For descriptive purposes, three hydration schedules have been described in the literature <PERSOON> landmark paper giving the first evidence on the effectiveness of NaHCO # pre- and post hydration was published in ### (Merten, ###) This group describes an RCT consisting of ### patients with a sCr ⥠##,# µmol/l undergoing either cardiac catheterizations (n=##) or CT (n=#) or other procedures involving intravascular contrast administration (n=##) Patients were randomly assigned to receive either ###mEq/l NaHCO # or ###mEq/l NaCl, both in dextrose #% in water <PERSOON> groups received the fluid mixture at a rate of #ml/kg/h for # hour pre CM injection and at a rate of #ml/kg/h for # hours after CM injection PC-AKI was defined as a rise of sCr â¥##% within # days after CM administration #% (# of <PERSOON> positive results of this relatively short NaHCO # hydration schedule triggered a boom in RCTs comparing NaHCO # vs <PERSOON> mixture used in the landmark paper is not commercially available <PERSOON> most resembling commercially available concentrations are NaHCO <DATUM> #% (i e ### mEq/<PERSOON> #) and NaCl #,#% Some RCTs used the commercially available solutions, others used the mixture described by Merten (###) Many studies are now available comparing the effect of bicarbonate hydration to saline hydration on the risk of PC-AKI However, these studies are very heterogenous in the hydration solutions, volumes and schedules Also, sample size is often small and confidence intervals are wide, also due to the low incidence of PC-AKI Therefore, the conclusions on the comparison of bicarbonate and saline in terms of prevention of CI-AKI are not certain, but overall, no difference in PC-AKI risk is found Also, when considering the literature results, no preference can Since bicarbonate can be given just # hour prior to CM administration and thus considered more patient-friendly and less burdensome on the healthcare system, the Working Group expresses a preference for this type of <PERSOON> literature on effectiveness of hydration schedules for prevention of PC-AKI would greatly benefit from optimized study designs with properly defined control populations (e g supported by propensity score matching) as has been done for PC-AKI risk stratification studies when CM is injected intravenously or for.
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#% (# of <PERSOON> positive results of this relatively short NaHCO # hydration schedule triggered a boom in RCTs comparing NaHCO # vs <PERSOON> mixture used in the landmark paper is not commercially available <PERSOON> most resembling commercially available concentrations are NaHCO <DATUM> #% (i e ### mEq/<PERSOON> #) and NaCl #,#% Some RCTs used the commercially available solutions, others used the mixture described by Merten (###) Many studies are now available comparing the effect of bicarbonate hydration to saline hydration on the risk of PC-AKI However, these studies are very heterogenous in the hydration solutions, volumes and schedules Also, sample size is often small and confidence intervals are wide, also due to the low incidence of PC-AKI Therefore, the conclusions on the comparison of bicarbonate and saline in terms of prevention of CI-AKI are not certain, but overall, no difference in PC-AKI risk is found Also, when considering the literature results, no preference can Since bicarbonate can be given just # hour prior to CM administration and thus considered more patient-friendly and less burdensome on the healthcare system, the Working Group expresses a preference for this type of <PERSOON> literature on effectiveness of hydration schedules for prevention of PC-AKI would greatly benefit from optimized study designs with properly defined control populations (e g supported by propensity score matching) as has been done for PC-AKI risk stratification studies when CM is injected intravenously or for congestive heart failure should be considered and weighed against its potential benefit, especially in patients on chronic dialysis and with poor cardiac function and critical illness related fluid overload Note In critically ill patients lactated Ringerâs, a balanced crystalloid, may be preferable to saline hydration because of it somewhat lower osmolality and the reduced chance of hyperchloremic acidosis, which may <PERSOON> ratio behind this technique is to increase renal blood flow and urinary output in a controlled environment, based on patientâs parameters, such as central venous pressure, left ventricular end diastolic pressure or urinary output <PERSOON> amount of additional intravenous fluids and, if necessary a low dose diuretic, is individualized by the abovementioned parameters These techniques can only be applied in an in-patient setting as intravenous or intra-arterial catheters are necessary, combined with a urinary catheter for monitoring urinary production This makes these techniques applicable for a subgroup of patients <PERSOON> Working Group thinks that controlled diuresis is a promising new invasive strategy to prevent PC-AKI in hospitalized patients undergoing (cardiac) angiography with or without intervention Which technique is optimal is unknown More information and research is needed before reliable conclusions can be drawn regarding the effectiveness and preferred type of controlled diuresis, or its application in an outpatient setting Therefore, the Working Group recommends that, for now, When it comes to prevention of PC-AKI, the cornerstone is hydration (volume expansion) In the literature, many hydration schedules, hydration fluids and routes of administration have been described These schedules have.
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weighed against its potential benefit, especially in patients on chronic dialysis and with poor cardiac function and critical illness related fluid overload Note In critically ill patients lactated Ringerâs, a balanced crystalloid, may be preferable to saline hydration because of it somewhat lower osmolality and the reduced chance of hyperchloremic acidosis, which may <PERSOON> ratio behind this technique is to increase renal blood flow and urinary output in a controlled environment, based on patientâs parameters, such as central venous pressure, left ventricular end diastolic pressure or urinary output <PERSOON> amount of additional intravenous fluids and, if necessary a low dose diuretic, is individualized by the abovementioned parameters These techniques can only be applied in an in-patient setting as intravenous or intra-arterial catheters are necessary, combined with a urinary catheter for monitoring urinary production This makes these techniques applicable for a subgroup of patients <PERSOON> Working Group thinks that controlled diuresis is a promising new invasive strategy to prevent PC-AKI in hospitalized patients undergoing (cardiac) angiography with or without intervention Which technique is optimal is unknown More information and research is needed before reliable conclusions can be drawn regarding the effectiveness and preferred type of controlled diuresis, or its application in an outpatient setting Therefore, the Working Group recommends that, for now, When it comes to prevention of PC-AKI, the cornerstone is hydration (volume expansion) In the literature, many hydration schedules, hydration fluids and routes of administration have been described These schedules have hydration of ###ml NaHCO # in the prevention of PC-AKI prior to computed tomography pulmonary angiography with intravenous iodine-containing CM administration for suspected There is a moderate level of evidence that no hydration is non-inferior in preventing PC-AKI compared with intravenous pre- and post- hydration in patients with an eGFR between ### ml/min/# ##m# There is a low level of evidence that oral hydration is as effective as intravenous hydration in No evidence was found regarding the effectiveness of oral hydration versus intravenous There is a moderate level of evidence that administration of ###ml NaHCO <DATUM> #% prehydration is as effective as <LOCATIE> NaCl # #% prehydration and <LOCATIE> NaCl # #% There is a low level of evidence that hydration with controlled diuresis is more effective than intravenous hydration alone in the prevention of PC-AKI in patients who underwent No evidence was found regarding the effectiveness of hydration with controlled diuresis versus intravenous hydration in the prevention of PC-AKI in patients who underwent CT with Six RCTs were found for this comparison (<PERSOON>, ###; <PERSOON> ###; Luo, ###; Maioli, Three of these involved comparisons for patients undergoing primary percutaneous intervention (PCI) <PERSOON> Jurado-<PERSOON>, ###, Luo, ### and Maioli, ### included myocardial infarction patients needing immediate PCI In all # studies, the majority of patients had eGFR )## ml/min/# ##m# , therefore these studies were <PERSOON>, ### used half saline (NaCl # ##%) as hydration fluid and only the patients with impaired kidney function received NAC orally.
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NaHCO # in the prevention of PC-AKI prior to computed tomography pulmonary angiography with intravenous iodine-containing CM administration for suspected There is a moderate level of evidence that no hydration is non-inferior in preventing PC-AKI compared with intravenous pre- and post- hydration in patients with an eGFR between ### ml/min/# ##m# There is a low level of evidence that oral hydration is as effective as intravenous hydration in No evidence was found regarding the effectiveness of oral hydration versus intravenous There is a moderate level of evidence that administration of ###ml NaHCO <DATUM> #% prehydration is as effective as <LOCATIE> NaCl # #% prehydration and <LOCATIE> NaCl # #% There is a low level of evidence that hydration with controlled diuresis is more effective than intravenous hydration alone in the prevention of PC-AKI in patients who underwent No evidence was found regarding the effectiveness of hydration with controlled diuresis versus intravenous hydration in the prevention of PC-AKI in patients who underwent CT with Six RCTs were found for this comparison (<PERSOON>, ###; <PERSOON> ###; Luo, ###; Maioli, Three of these involved comparisons for patients undergoing primary percutaneous intervention (PCI) <PERSOON> Jurado-<PERSOON>, ###, Luo, ### and Maioli, ### included myocardial infarction patients needing immediate PCI In all # studies, the majority of patients had eGFR )## ml/min/# ##m# , therefore these studies were <PERSOON>, ### used half saline (NaCl # ##%) as hydration fluid and only the patients with impaired kidney function received NAC orally Thus only two studies <PERSOON>, ### described ### patients with eGFR (## ml/min/# ##m# undergoing chest CT for suspected pulmonary embolism Sixty-seven patients received no hydration and the remaining ## patients received ###ml <PERSOON>, ### included ### high risk patients (â¥##y), as indicated by the local (Dutch) and European guidelines, with an eGFR of ##-## mL per min/# ##m# undergoing an elective procedure requiring ionidated contrast material which were randomly assigned to (#) intravenous NaCl (# #% NaCl <DATUM> ml/kg/h during # hrs pre- and <PERSOON>, ### reported a PC-AKI incidence of <DATUM> in the group withholding hydration versus <DATUM> in the group with #-hour pre-hydration with ###ml NaHCO #, RR # ## (##%CI # ## to <DATUM> None of the <PERSOON>, ### reported that PC-AKI occurred in eight (<DATUM> ) of ### intravenously hydrated patients and in eight (<DATUM> ) of the no-prophylaxis patients, with a nonsignificant absolute difference in proportions of -# #% (onesided ##% CI -# ## â <DATUM> one-tailed p=# ###) <PERSOON> level of evidence was graded as low for <PERSOON>, ### due to imprecision and indirectness (only patients with suspicion of pulmonary embolism were included); thus the evidence was downgraded by # levels <PERSOON> level of evidence was graded as moderate for <PERSOON>, ###, downgraded # level, due to imprecision Power analysis indicated that ### patients would give a reasonable (##%) chance of detecting a difference between groups (as estimated using the expected H+ group CIN incidence #.
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<PERSOON>, ### described ### patients with eGFR (## ml/min/# ##m# undergoing chest CT for suspected pulmonary embolism Sixty-seven patients received no hydration and the remaining ## patients received ###ml <PERSOON>, ### included ### high risk patients (â¥##y), as indicated by the local (Dutch) and European guidelines, with an eGFR of ##-## mL per min/# ##m# undergoing an elective procedure requiring ionidated contrast material which were randomly assigned to (#) intravenous NaCl (# #% NaCl <DATUM> ml/kg/h during # hrs pre- and <PERSOON>, ### reported a PC-AKI incidence of <DATUM> in the group withholding hydration versus <DATUM> in the group with #-hour pre-hydration with ###ml NaHCO #, RR # ## (##%CI # ## to <DATUM> None of the <PERSOON>, ### reported that PC-AKI occurred in eight (<DATUM> ) of ### intravenously hydrated patients and in eight (<DATUM> ) of the no-prophylaxis patients, with a nonsignificant absolute difference in proportions of -# #% (onesided ##% CI -# ## â <DATUM> one-tailed p=# ###) <PERSOON> level of evidence was graded as low for <PERSOON>, ### due to imprecision and indirectness (only patients with suspicion of pulmonary embolism were included); thus the evidence was downgraded by # levels <PERSOON> level of evidence was graded as moderate for <PERSOON>, ###, downgraded # level, due to imprecision Power analysis indicated that ### patients would give a reasonable (##%) chance of detecting a difference between groups (as estimated using the expected H+ group CIN incidence <DATUM> , and given a conventional level of alpha (# ##), only ### patients were included (<PERSOON>, ###) A total of nine RCTs on this subject have been published, but only two were considered suitable to be included in this literature summary Four RCTs included patients with normal kidney function (Trivedi, ###; Kong, ###; Akyuz, ###; <PERSOON>, ###) Two RCTs described a mixture of oral and intravenous hydration, compared to intravenous hydration alone (<PERSOON> ###) One RCT did not define PC-AKI (Wrobel, ###), only describing serum creatinine changes <PERSOON> last excluded RCT described # research arms, three with intravenous hydration and one with extra NaCl orally, but no extra fluid orally Therefore, this RCT was excluded Cho, ### the RCT using both pre- and post hydration consisted of ## patients with sCr )##,# µmol/l or eGFR (## ml/min/# ##m# undergoing elective CAG They were randomly assigned into # groups <PERSOON> ###mEq (# #%)/l #ml/kg/h # hour pre and #ml/kg/h # hours post <PERSOON> <DATUM> Eq/l, same schedule as NaCl C ###ml of water, <DATUM> hours pre CM administration, followed by ###ml of water post contrast administration D, Cho, ### also found no significant difference in the incidence of PC-AKI in all # groups; A <DATUM> , B <DATUM> , C For the comparison oral versus intravenous hydration in all patients the level of evidence was graded as low due.
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a conventional level of alpha (# ##), only ### patients were included (<PERSOON>, ###) A total of nine RCTs on this subject have been published, but only two were considered suitable to be included in this literature summary Four RCTs included patients with normal kidney function (Trivedi, ###; Kong, ###; Akyuz, ###; <PERSOON>, ###) Two RCTs described a mixture of oral and intravenous hydration, compared to intravenous hydration alone (<PERSOON> ###) One RCT did not define PC-AKI (Wrobel, ###), only describing serum creatinine changes <PERSOON> last excluded RCT described # research arms, three with intravenous hydration and one with extra NaCl orally, but no extra fluid orally Therefore, this RCT was excluded Cho, ### the RCT using both pre- and post hydration consisted of ## patients with sCr )##,# µmol/l or eGFR (## ml/min/# ##m# undergoing elective CAG They were randomly assigned into # groups <PERSOON> ###mEq (# #%)/l #ml/kg/h # hour pre and #ml/kg/h # hours post <PERSOON> <DATUM> Eq/l, same schedule as NaCl C ###ml of water, <DATUM> hours pre CM administration, followed by ###ml of water post contrast administration D, Cho, ### also found no significant difference in the incidence of PC-AKI in all # groups; A <DATUM> , B <DATUM> , C For the comparison oral versus intravenous hydration in all patients the level of evidence was graded as low due # Short schedule NaHCO # vs short schedule NaCl in patients with impaired kidney function undergoing <PERSOON> ###) with #,### patients were identified, that compared bicarbonate and saline hydration in a similar hydration scheme for coronary angiography All the studies were performed in patients with # Short schedule NaHCO # vs long schedule NaCl (#ml/kg/h for ##h pre- and ##h post-CM administration) in patients with impaired kidney function undergoing CAG and/or PCI A total of # RCTs (Briguori, ###; ###) with #,### patients were identified that compared bicarbonate hydration to saline pre- and # All other hydration schedules comparing bicarbonate plus saline to saline or to bicarbonate only Four bicarbonate to saline hydration with divergent hydration schemes for coronary angiography, like adding a bolus NaHCO # to saline hydration or exchanging saline by NaHCO # hydration for multiple hours; # One RCT compared in a non-inferiority trial, a #-hour schedule of ###ml NaHCO <DATUM> #% versus ### ml # Short schedule NaHCO # (#ml/kg/h # hour pre and #ml/kg/h # hours post CM administration) vs short schedule NaCl in patients with impaired kidney function undergoing CAG and/or PCI A total of ## RCTs <PERSOON> ###) No significant difference was found between patients that underwent bicarbonate versus # Short schedule NaHCO # (#ml/kg/h # hour pre and #ml/kg/h # hours post CM administration) vs long schedule NaCl (#ml/kg/h ## hours before and after CM administration) in patients with impaired kidney ### PC-AKI events were identified that compared bicarbonate hydration to saline pre- and posthydration.
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with impaired kidney function undergoing <PERSOON> ###) with #,### patients were identified, that compared bicarbonate and saline hydration in a similar hydration scheme for coronary angiography All the studies were performed in patients with # Short schedule NaHCO # vs long schedule NaCl (#ml/kg/h for ##h pre- and ##h post-CM administration) in patients with impaired kidney function undergoing CAG and/or PCI A total of # RCTs (Briguori, ###; ###) with #,### patients were identified that compared bicarbonate hydration to saline pre- and # All other hydration schedules comparing bicarbonate plus saline to saline or to bicarbonate only Four bicarbonate to saline hydration with divergent hydration schemes for coronary angiography, like adding a bolus NaHCO # to saline hydration or exchanging saline by NaHCO # hydration for multiple hours; # One RCT compared in a non-inferiority trial, a #-hour schedule of ###ml NaHCO <DATUM> #% versus ### ml # Short schedule NaHCO # (#ml/kg/h # hour pre and #ml/kg/h # hours post CM administration) vs short schedule NaCl in patients with impaired kidney function undergoing CAG and/or PCI A total of ## RCTs <PERSOON> ###) No significant difference was found between patients that underwent bicarbonate versus # Short schedule NaHCO # (#ml/kg/h # hour pre and #ml/kg/h # hours post CM administration) vs long schedule NaCl (#ml/kg/h ## hours before and after CM administration) in patients with impaired kidney ### PC-AKI events were identified that compared bicarbonate hydration to saline pre- and posthydration No significant difference was found between patients that underwent bicarbonate versus saline hydration Risk Ratio (RR) # ## (##% CI # ## â # ##), # All other hydration schedules comparing bicarbonate plus saline to saline or to bicarbonate only A total cases, were considered suitable for this literature summary <PERSOON> studies were considered too heterogenous in terms of hydration fluid content and hydration schemes in control group and treatment group to be considered for pooling <PERSOON>, ### reported that PC-AKI incidences were <DATUM> (<DATUM> ) in the group receiving NaCl plus NAC, and <DATUM> (<DATUM> ) in the group bicarbonate plus <PERSOON> difference in PC-AKI incidence between groups was not significant Motohiro, ### reported that #/## patients in the bicarbonate plus saline group versus ##/## in the standard hydration group (RR # ##, ##% CI # ## to # ##) developed PC-AKI, thus the incidence of PC-AKI was lower in the combination group Tamura, ### also reported lower rates of PC-AKI in the bolus group #/## versus #/## (RR #,##; ##% CI # ## to # ## <PERSOON> results of Ueda, ### were similar, although the difference in incidence of <PERSOON>, ### reported a PC-AKI incidence of <DATUM> in CT patients receiving ###ml NaHCO # (ultrashort schedule) precontrast versus <DATUM> (p=# ##) receiving pre- and post-CM hydration with NaCl #,#% No.
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No significant difference was found between patients that underwent bicarbonate versus saline hydration Risk Ratio (RR) # ## (##% CI # ## â # ##), # All other hydration schedules comparing bicarbonate plus saline to saline or to bicarbonate only A total cases, were considered suitable for this literature summary <PERSOON> studies were considered too heterogenous in terms of hydration fluid content and hydration schemes in control group and treatment group to be considered for pooling <PERSOON>, ### reported that PC-AKI incidences were <DATUM> (<DATUM> ) in the group receiving NaCl plus NAC, and <DATUM> (<DATUM> ) in the group bicarbonate plus <PERSOON> difference in PC-AKI incidence between groups was not significant Motohiro, ### reported that #/## patients in the bicarbonate plus saline group versus ##/## in the standard hydration group (RR # ##, ##% CI # ## to # ##) developed PC-AKI, thus the incidence of PC-AKI was lower in the combination group Tamura, ### also reported lower rates of PC-AKI in the bolus group #/## versus #/## (RR #,##; ##% CI # ## to # ## <PERSOON> results of Ueda, ### were similar, although the difference in incidence of <PERSOON>, ### reported a PC-AKI incidence of <DATUM> in CT patients receiving ###ml NaHCO # (ultrashort schedule) precontrast versus <DATUM> (p=# ##) receiving pre- and post-CM hydration with NaCl #,#% No oedema) are shown in Table # for all the saline versus sodium bicarbonate hydration comparisons <PERSOON> number of adverse events was often not reported, and when reported was low In the <PERSOON> ### study, mentioned in the paragraph above, Acute heart failure due to volume expansion (based on the treating physicianâs clinical judgement) occurred in none of the patients in the NaHCO # group versus # of ### patients in the saline group For the comparison bicarbonate versus saline, the level of evidence was graded as low (downgraded by # levels) due toe heterogeniety and imprecision For the comparison bicarbonate bolus versus saline bolus hydration for emergency angiography, followed by bicarbonate hydration in both groups, the level of evidence was downgraded with one more level for imprecision (very low number of events) One RCT compared in a non-inferiority trial, a #-hour schedule of ###ml NaHCO <DATUM> #% versus ### ml <PERSOON>, ### reported a PC-AKI incidence of <DATUM> in CT patients receiving ###ml NaHCO # (ultrashort schedule) pre-contrast versus <DATUM> (p=# ##) receiving pre- and post-CM hydration with NaCl #,#% No patients This non-inferiority study from the Netherlands has sufficient number of patients, therefore the evidence was Five Italian studies, all RCTs, describe the same technique, consisting of an extracorporeal circuit for continuous fluid infusion, combined with a Foley catheter for measuring urinary production (Barbanti, ###; Briguori, ###; is capable of delivering sterile replacement solution in an amount matched to the volume of urine produced, thereby avoiding hypovolemia and fluid overload.
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versus sodium bicarbonate hydration comparisons <PERSOON> number of adverse events was often not reported, and when reported was low In the <PERSOON> ### study, mentioned in the paragraph above, Acute heart failure due to volume expansion (based on the treating physicianâs clinical judgement) occurred in none of the patients in the NaHCO # group versus # of ### patients in the saline group For the comparison bicarbonate versus saline, the level of evidence was graded as low (downgraded by # levels) due toe heterogeniety and imprecision For the comparison bicarbonate bolus versus saline bolus hydration for emergency angiography, followed by bicarbonate hydration in both groups, the level of evidence was downgraded with one more level for imprecision (very low number of events) One RCT compared in a non-inferiority trial, a #-hour schedule of ###ml NaHCO <DATUM> #% versus ### ml <PERSOON>, ### reported a PC-AKI incidence of <DATUM> in CT patients receiving ###ml NaHCO # (ultrashort schedule) pre-contrast versus <DATUM> (p=# ##) receiving pre- and post-CM hydration with NaCl #,#% No patients This non-inferiority study from the Netherlands has sufficient number of patients, therefore the evidence was Five Italian studies, all RCTs, describe the same technique, consisting of an extracorporeal circuit for continuous fluid infusion, combined with a Foley catheter for measuring urinary production (Barbanti, ###; Briguori, ###; is capable of delivering sterile replacement solution in an amount matched to the volume of urine produced, thereby avoiding hypovolemia and fluid overload the fluid bag or drain the urine bag After an initial bolus of ###ml NaCl # #% infused over ## minutes, patients receive furosemide, # ##mg/kg, to achieve a urinary flow of at least ###ml/h Once this is achieved, the procedure is performed <PERSOON> system keeps urinary flow )###ml/h for the next # hours, balancing between more papers describe patients undergoing Transcatheter Aortic Valve Implantation (TAVI) (Barbanti, ###; Visconti, ###) and one describes a mixed group of CAG and peripheral angiography (Briguori, ###) All patients had had a different hydration schedule (saline versus bicarbonate versus a combination of both) Therefore, pooling Regarding the control group, Briguori, ### used ### mEq/L of sodium bicarbonate in dextrose and water, mixed in the hospital pharmacy by adding ###mL of ### mEq/L sodium bicarbonate (i e sodium bicarbonate <DATUM> ) to ### mL of #% dextrose in water (D#W), slightly diluting the dextrose concentration to # ##% <PERSOON> initial intravenous bolus was # mL/kg per hour for at least # hour before contrast injection Then, all patients received the same fluid at a rate of # mL/kg per hour during contrast exposure and for # hours after the procedure All patients enrolled in this group received NAC orally at a dose of ### mg twice daily the day before and the day of administration of the contrast agent (for a total of # days) In this group, an additional NAC dose (### mg diluted in ### mL normal saline) was administered intravenously during the procedure.
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urine bag After an initial bolus of ###ml NaCl # #% infused over ## minutes, patients receive furosemide, # ##mg/kg, to achieve a urinary flow of at least ###ml/h Once this is achieved, the procedure is performed <PERSOON> system keeps urinary flow )###ml/h for the next # hours, balancing between more papers describe patients undergoing Transcatheter Aortic Valve Implantation (TAVI) (Barbanti, ###; Visconti, ###) and one describes a mixed group of CAG and peripheral angiography (Briguori, ###) All patients had had a different hydration schedule (saline versus bicarbonate versus a combination of both) Therefore, pooling Regarding the control group, Briguori, ### used ### mEq/L of sodium bicarbonate in dextrose and water, mixed in the hospital pharmacy by adding ###mL of ### mEq/L sodium bicarbonate (i e sodium bicarbonate <DATUM> ) to ### mL of #% dextrose in water (D#W), slightly diluting the dextrose concentration to # ##% <PERSOON> initial intravenous bolus was # mL/kg per hour for at least # hour before contrast injection Then, all patients received the same fluid at a rate of # mL/kg per hour during contrast exposure and for # hours after the procedure All patients enrolled in this group received NAC orally at a dose of ### mg twice daily the day before and the day of administration of the contrast agent (for a total of # days) In this group, an additional NAC dose (### mg diluted in ### mL normal saline) was administered intravenously during the procedure <PERSOON> control group of Marenzi, ### recieved a continuous intravenous infusion of isotonic saline at a rate of # ml/kg/h (# # ml/kg/h in case of left ventricular ejection fraction (##%) for at least ## h before and ## h after the procedure <PERSOON> control group of Usmiani, ### recieved ### mL isotonic saline i v administration ## h before mL/h if LVEF )##%), plus # mL/kg/h sodium bicarbonate # #% solution by i v infusion for # h before procedure, plus ###mg> of Vitamin C and <LOCATIE> NAC administered orally After the procedure the patients received #mL/kg/h sodium bicarbonate <DATUM> solution IV for # hours, plus <LOCATIE> of vitamin C and <LOCATIE ###mg NAC Barbanti, ### included ### patients undergoing Transcatheter Aortic Valve Implantation (TAVI) who were randomly assigned to either the controlled diuresis group (n=##) or the control group (intravenous saline solution at a rate of # ml/kg/h ## h before TAVI, during contrast exposure, and for # h after the procedure) Viconti, ### describes also a group of patients undergoing TAVI (n=##) with either controlled diuresis or bicarbonate schedule (same schedule as Briguori, ###) In total, ## patients were assigned (non-randomly) to the RenalGuard therapy group (n=##) or the control group (n=##) Because the above-mentioned studies used Brar, ### described a slightly different approach during CAG, a left ventricular catheter was placed in order to measure left ventricular end-diastolic pressure This was done in ### patients with eGFR (## ml/min/# ##m#.
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control group of Marenzi, ### recieved a continuous intravenous infusion of isotonic saline at a rate of # ml/kg/h (# # ml/kg/h in case of left ventricular ejection fraction (##%) for at least ## h before and ## h after the procedure <PERSOON> control group of Usmiani, ### recieved ### mL isotonic saline i v administration ## h before mL/h if LVEF )##%), plus # mL/kg/h sodium bicarbonate # #% solution by i v infusion for # h before procedure, plus ###mg> of Vitamin C and <LOCATIE> NAC administered orally After the procedure the patients received #mL/kg/h sodium bicarbonate <DATUM> solution IV for # hours, plus <LOCATIE> of vitamin C and <LOCATIE> control group consisted of ### patients with the same characteristics, undergoing the same procedure <PERSOON> groups received a bolus infusion, NaCl # #%, #ml/kg/h, # hour pre <PERSOON> control group received the same fluid at the same rate for # hours post <PERSOON> rate of post contrast fluid in the research Another approach, described by Qian, ###, is invasively measuring central venous pressure (CVP) and CVPguided fluid administration in ### patients CVP (#mmHg #ml/kg/h, CVP <DATUM> mHg <DATUM> l/kg/h, CVP)##mmHg #ml/kg/h NaCl # #% # hours pre and ## hours post CM administration <PERSOON> control group received NaCl #ml/kg/h # hours pre and ## hours post CM administration All patients were scheduled for CAG Briguori, ###, Marenzi, ### and Usmiani, ### all reported a significantly lower incidence of PC-AKI in patients who received controlled diuresis Briguori, ### found an incidence of PC-AKI of ##% in the forced diuresis group versus <DATUM> in the control group (p=# ###) in patients with an eGFR (##mL/min/# ##m# After # month, mortality was similar in the intervention (<DATUM> and control (<DATUM> group, p=# ##; need for dialysis arose in <DATUM> patients in the control group versus <DATUM> in the intervention group, p=# ## Marenzi, ### found an incidence of PC-AKI of #,#% in the forced diuresis group versus ##% in the control group (p=# ###) In-hospital mortality was similar in the intervention (#/##) and control (#/##) group, p=# ##.
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consisted of ### patients with the same characteristics, undergoing the same procedure <PERSOON> groups received a bolus infusion, NaCl # #%, #ml/kg/h, # hour pre <PERSOON> control group received the same fluid at the same rate for # hours post <PERSOON> rate of post contrast fluid in the research Another approach, described by Qian, ###, is invasively measuring central venous pressure (CVP) and CVPguided fluid administration in ### patients CVP (#mmHg #ml/kg/h, CVP <DATUM> mHg <DATUM> l/kg/h, CVP)##mmHg #ml/kg/h NaCl # #% # hours pre and ## hours post CM administration <PERSOON> control group received NaCl #ml/kg/h # hours pre and ## hours post CM administration All patients were scheduled for CAG Briguori, ###, Marenzi, ### and Usmiani, ### all reported a significantly lower incidence of PC-AKI in patients who received controlled diuresis Briguori, ### found an incidence of PC-AKI of ##% in the forced diuresis group versus <DATUM> in the control group (p=# ###) in patients with an eGFR (##mL/min/# ##m# After # month, mortality was similar in the intervention (<DATUM> and control (<DATUM> group, p=# ##; need for dialysis arose in <DATUM> patients in the control group versus <DATUM> in the intervention group, p=# ## Marenzi, ### found an incidence of PC-AKI of #,#% in the forced diuresis group versus ##% in the control group (p=# ###) In-hospital mortality was similar in the intervention (#/##) and control (#/##) group, p=# ## ## Usmiani, ### found an incidence of PC-AKI of #% in the forced diuresis group versus ##% in the control group (p=# ##) One-year mortality was not significantly different in the intervention (#/##) and control (#/##) group, p=# ## Need for dialysis arose in #/## patients in the intervention group versus #/## in the control group, (pvalue not reported) Barbanti reported that the incidence of CI-AKI was lower in the controlled diuresis group compared to the Visconti, ### reported that PC-AKI occurred in ##/## (#<DATUM> ) patients in the control group and in #/## (<DATUM> ) Brar, ### described that PC-AKI occured in <DATUM> of the patients in the control group vs <DATUM> in the research group (p=# ###) After # months, mortality was lower in the intervention (<DATUM> compared to the control (<DATUM> group, p=# ### Need for dialysis arose in <DATUM> patients in the intervention group versus <DATUM> in the Qian, ### reported that PC-AKI occured in <DATUM> in the CVP group vs <DATUM> in the standard hydration group (p=# ###) Need for dialysis arose in <DATUM-##> patients in the intervention group versus <DATUM-##> in the control group, p=# ### Acute pulmonary edema occurred in <DATUM-##> patients in the intervention group versus <DATUM-##> in the For the comparison controlled diuresis versus IV hydration in all patients the level of evidence was graded as low Figure # Pooled analysis of PC-AKI risk in patients receiving short schedules of hydration with.
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of #% in the forced diuresis group versus ##% in the control group (p=# ##) One-year mortality was not significantly different in the intervention (#/##) and control (#/##) group, p=# ## Need for dialysis arose in #/## patients in the intervention group versus #/## in the control group, (pvalue not reported) Barbanti reported that the incidence of CI-AKI was lower in the controlled diuresis group compared to the Visconti, ### reported that PC-AKI occurred in ##/## (#<DATUM> ) patients in the control group and in #/## (<DATUM> ) Brar, ### described that PC-AKI occured in <DATUM> of the patients in the control group vs <DATUM> in the research group (p=# ###) After # months, mortality was lower in the intervention (<DATUM> compared to the control (<DATUM> group, p=# ### Need for dialysis arose in <DATUM> patients in the intervention group versus <DATUM> in the Qian, ### reported that PC-AKI occured in <DATUM> in the CVP group vs <DATUM> in the standard hydration group (p=# ###) Need for dialysis arose in <DATUM> patients in the intervention group versus <DATUM> in the control group, p=# ### Acute pulmonary edema occurred in <DATUM> patients in the intervention group versus <DATUM> in the For the comparison controlled diuresis versus IV hydration in all patients the level of evidence was graded as low Figure # Pooled analysis of PC-AKI risk in patients receiving short schedules of hydration with Table # Adverse events in bicarbonate versus saline inf usion or controlled hydration versus Patients recieving short schedules of hydration with either bicarbonate or saline for CAG/PCI Patients recieving short schedules for bicarbonate versus long schedule for saline for CAG/PCI Patients recieving bicarbonate or saline hydration in âotherâ hydration schemes for coronary angiography To answer our clinical question a systematic literature analysis was performed for the following research What type of hydration reduces the risk of contrast-associated acute kidney injury best in patients undergoing P (patient category) patients undergoing radiological examinations with iodine-containing contrast media; I (intervention) hydration with NaCl i v , hydration with bicarbonate, oral hydration, hydration, pre- and O (outcome) post-contrast acute kideny injury (PC-AKI), start dialysis, decrease in residual kidney function, costeffectivity <PERSOON> working group considered PC-AKI, mortality, start dialysis, decrease in residual kidney function, critical outcome measures for the decision making process and adverse effects of hydration and cost-effectivity important outcome measures for the decision-making process <PERSOON> working group defined the outcome A difference of at least ##% in relative risk was defined as a clinically relevant difference; by expert opinion of the working group (no literature was available to substantiate the decision) To illustrate, if PC-AKI occurs with an incidence of ##% in the patient population, a difference of ##% of relative risk would mean a difference of #% in absolute risk Thus, the number needed to treat would be ###, ergo a doctor would need to treat ### patients to prevent one case of PC-AKI.
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or controlled hydration versus Patients recieving short schedules of hydration with either bicarbonate or saline for CAG/PCI Patients recieving short schedules for bicarbonate versus long schedule for saline for CAG/PCI Patients recieving bicarbonate or saline hydration in âotherâ hydration schemes for coronary angiography To answer our clinical question a systematic literature analysis was performed for the following research What type of hydration reduces the risk of contrast-associated acute kidney injury best in patients undergoing P (patient category) patients undergoing radiological examinations with iodine-containing contrast media; I (intervention) hydration with NaCl i v , hydration with bicarbonate, oral hydration, hydration, pre- and O (outcome) post-contrast acute kideny injury (PC-AKI), start dialysis, decrease in residual kidney function, costeffectivity <PERSOON> working group considered PC-AKI, mortality, start dialysis, decrease in residual kidney function, critical outcome measures for the decision making process and adverse effects of hydration and cost-effectivity important outcome measures for the decision-making process <PERSOON> working group defined the outcome A difference of at least ##% in relative risk was defined as a clinically relevant difference; by expert opinion of the working group (no literature was available to substantiate the decision) To illustrate, if PC-AKI occurs with an incidence of ##% in the patient population, a difference of ##% of relative risk would mean a difference of #% in absolute risk Thus, the number needed to treat would be ###, ergo a doctor would need to treat ### patients to prevent one case of PC-AKI would mean a difference of # #% in absolute risk, and a number needed to treat of ### <PERSOON> databases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) Search terms are shown in the <PERSOON> literature search procured ### hits ### SRs, ### RCTs and ### OBS <PERSOON> update of the search on April ##th ### retrevied an additional ### Adult patients who underwent radiological examination using contrast media (including radiological Hydration types hydration with NaCl i v , hydration with bicarbonate, oral hydration, pre-hydration, preand posthydration At least one of the outcome measures was described <PERSOON>-contrast acute kidney injury (PC-AKI), Contrast-induced nephropathy (CIN)/contrast-induced acute kidney injury (CI-AKI), start dialysis, decrease in residual kidney function, adverse effects of hydration (overfilling, intensive care unit admittance, Follow-up time after hydration was at least ## hours Based on title and abstract a total of ## studies were initially selected, and a total of ## studies based on the updated search (## in total) After examination of full tekst a total of ## + ## (## in total) studies were excluded Thirty-five studies were included in the literature analysis, the most important study characteristics and results were included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are <PERSOON> T, et al Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE) a.
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risk, and a number needed to treat of ### <PERSOON> databases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) Search terms are shown in the <PERSOON> literature search procured ### hits ### SRs, ### RCTs and ### OBS <PERSOON> update of the search on April ##th ### retrevied an additional ### Adult patients who underwent radiological examination using contrast media (including radiological Hydration types hydration with NaCl i v , hydration with bicarbonate, oral hydration, pre-hydration, preand posthydration At least one of the outcome measures was described <PERSOON>-contrast acute kidney injury (PC-AKI), Contrast-induced nephropathy (CIN)/contrast-induced acute kidney injury (CI-AKI), start dialysis, decrease in residual kidney function, adverse effects of hydration (overfilling, intensive care unit admittance, Follow-up time after hydration was at least ## hours Based on title and abstract a total of ## studies were initially selected, and a total of ## studies based on the updated search (## in total) After examination of full tekst a total of ## + ## (## in total) studies were excluded Thirty-five studies were included in the literature analysis, the most important study characteristics and results were included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are <PERSOON> T, et al Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE) a <PERSOON> Oz T, et al Efficacy of oral hydration in the prevention of contrast-induced acute kidney <PERSOON> P, et al Acute kidney injury with the renalguard system in patients undergoing <PERSOON> O, et al Prevention of contrast-induced nephropathy in diabetic patients with impaired renal function a randomized, double blind trial of sodium bicarbonate versus sodium chloride-based hydration <PERSOON-##> P, et al Haemodynamic-guided fluid administration for the prevention of contrastinduced acute kidney injury the POSEIDON randomised controlled trial Lancet ###;###(###) ###-## Brar SS, Shen AY, Jorgensen MB, et al Sodium bicarbonate vs sodium chloride for the prevention of contrast mediumâinduced nephropathy in patients undergoing coronary angiography a randomized trial <PERSOON-##> A, et al Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) <PERSOON-##> D, et al Renal insufficiency following contrast media administration trial (REMEDIAL) a <PERSOON-##> PJ Mechanisms of contrast-induced nephropathy reduction for saline (NaCl) and sodium bicarbonate <PERSOON-##> L, et al Prevention of Contrast-induced <PERSOON-##> J, Yei F, Et al Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous <PERSOON-##> D, et al Oral Hydration and Alkalinization is Noninferior to Intravenous Therapy for Prevention of.
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Kemaloglu Oz T, et al Efficacy of oral hydration in the prevention of contrast-induced acute kidney <PERSOON> P, et al Acute kidney injury with the renalguard system in patients undergoing <PERSOON> O, et al Prevention of contrast-induced nephropathy in diabetic patients with impaired renal function a randomized, double blind trial of sodium bicarbonate versus sodium chloride-based hydration <PERSOON> P, et al Haemodynamic-guided fluid administration for the prevention of contrastinduced acute kidney injury the POSEIDON randomised controlled trial Lancet ###;###(###) ###-## Brar SS, Shen AY, Jorgensen MB, et al Sodium bicarbonate vs sodium chloride for the prevention of contrast mediumâinduced nephropathy in patients undergoing coronary angiography a randomized trial <PERSOON> A, et al Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) <PERSOON> D, et al Renal insufficiency following contrast media administration trial (REMEDIAL) a <PERSOON> PJ Mechanisms of contrast-induced nephropathy reduction for saline (NaCl) and sodium bicarbonate <PERSOON> L, et al Prevention of Contrast-induced <PERSOON> J, Yei F, Et al Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous <PERSOON> D, et al Oral Hydration and Alkalinization is Noninferior to Intravenous Therapy for Prevention of <PERSOON-##> E, Poh KK, Lu Q, Et al Comparison of combination therapy of high-dose oral N-acetylcysteine and intravenous <PERSOON-##> A, et al A randomized trial of saline hydration to prevent contrast nephropathy in chronic <PERSOON-##> VO, Lasevitch R, <PERSOON-##> VC, et al Hydration with sodium bicarbonate does not prevent contrast nephropathy a Hafiz AM, <PERSOON-##> MF, Mori N, et al Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions Randomized comparison of two Klima T, <PERSOON-##> I, et al Sodium chloride vs sodium bicarbonate for the prevention of contrast medium-induced <PERSOON-##> F, et al Sodium bicarbonate versus isotonic saline for the prevention of contrast-induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention a multicentre Kong DG, Hou YF, Ma LL, et al Comparison of oral and intravenous hydration strategies for the prevention of contrastinduced nephropathy in patients undergoing coronary angiography or angioplasty a randomized clinical trial Acta Cardiol with chronic kidney disease undergoing acute computed tomographyâpulmonary angiography <PERSOON-##> G, et al Prevention of contrast-induced nephropathy in vascular surgery patients <PERSOON-##> SW, <PERSOON-##> WJ, <PERSOON-##> YH, et al Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention <PERSOON-##> M, et al.
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###;##(#) ###-# <PERSOON> E, Poh KK, Lu Q, Et al Comparison of combination therapy of high-dose oral N-acetylcysteine and intravenous <PERSOON> A, et al A randomized trial of saline hydration to prevent contrast nephropathy in chronic <PERSOON> VO, Lasevitch R, <PERSOON> VC, et al Hydration with sodium bicarbonate does not prevent contrast nephropathy a Hafiz AM, <PERSOON> MF, Mori N, et al Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions Randomized comparison of two Klima T, <PERSOON> I, et al Sodium chloride vs sodium bicarbonate for the prevention of contrast medium-induced <PERSOON> F, et al Sodium bicarbonate versus isotonic saline for the prevention of contrast-induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention a multicentre Kong DG, Hou YF, Ma LL, et al Comparison of oral and intravenous hydration strategies for the prevention of contrastinduced nephropathy in patients undergoing coronary angiography or angioplasty a randomized clinical trial Acta Cardiol with chronic kidney disease undergoing acute computed tomographyâpulmonary angiography <PERSOON> G, et al Prevention of contrast-induced nephropathy in vascular surgery patients <PERSOON> SW, <PERSOON-##> WJ, <PERSOON-##> YH, et al Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention <PERSOON-##> M, et al patients with renal dysfunction undergoing coronary angiography or intervention <PERSOON-##> M, et al Effects of hydration in contrast-induced acute kidney injury after primary angioplasty a <PERSOON-##> E, et al Acute kidney injury after primary angioplasty effect of different hydration <PERSOON-##> I, et al Prevention of contrast nephropathy by furosemide with matched hydration the MYTHOS (induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy <PERSOON-##> E, et al Comparison of intravenous and oral hydration in the prevention of <PERSOON-##> T, <PERSOON-##> T, et al Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent Merten GJ, Burgess WP, Gray LV, et al Prevention of contrast-induced nephropathy with sodium bicarbonate a <PERSOON-##> S, et al A new protocol using sodium bicarbonate for the prevention of contrastinduced nephropathy in patients undergoing coronary angiography <PERSOON-##> JF, Salazar WA, Sánchez OM, et al Prevention of contrast induced nephropathy with sodium bicarbonate (the <PERSOON-##> PJ, et al Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING) a prospective, randomised, <PERSOON-##> B, et al Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrastinduced nephropathy.
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coronary angiography or intervention <PERSOON> M, et al Effects of hydration in contrast-induced acute kidney injury after primary angioplasty a <PERSOON> E, et al Acute kidney injury after primary angioplasty effect of different hydration <PERSOON> I, et al Prevention of contrast nephropathy by furosemide with matched hydration the MYTHOS (induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy <PERSOON> E, et al Comparison of intravenous and oral hydration in the prevention of <PERSOON> T, <PERSOON> T, et al Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent Merten GJ, Burgess WP, Gray LV, et al Prevention of contrast-induced nephropathy with sodium bicarbonate a <PERSOON> S, et al A new protocol using sodium bicarbonate for the prevention of contrastinduced nephropathy in patients undergoing coronary angiography <PERSOON> JF, Salazar WA, Sánchez OM, et al Prevention of contrast induced nephropathy with sodium bicarbonate (the <PERSOON> PJ, et al Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING) a prospective, randomised, <PERSOON-##> B, et al Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrastinduced nephropathy Qian G, Fu Z, Guo J, et al Prevention of contrast-induced nephropathy by central venous pressureâguided fluid administration in chronic kidney disease and congestive heart failure patients JACC Cardiovasc Intervent ###;#(#) ##-## Ratcliffe JA, Thiagarajah P, <PERSOON-##> J, et al Prevention of contrast-induced nephropathy A randomized controlled trial of <PERSOON-##> B, et al <PERSOON-##> reno-protective effect of hydration with sodium bicarbonate plus Nacetylcysteine in patients undergoing emergency percutaneous coronary intervention the <PERSOON-##> M, et al Sodium bicarbonate versus sodium chloride and oral N-acetylcysteine for the prevention of contrast-induced nephropathy in advanced chronic kidney disease <PERSOON-##> ###;##(#) ###-## <PERSOON-##> R, <PERSOON-##> SV, et al Randomized trial of bicarbonate or saline study for the prevention of contrastinduced nephropathy in patients with <PERSOON-##> K, et al Efficacy of single-bolus administration of sodium bicarbonate to prevent contrastinduced nephropathy in patients with mild renal insufficiency undergoing an elective coronary procedure <PERSOON-##> RW, et al PREPARED Preparation for Angiography in Renal Dysfunction a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction <PERSOON-##> M, et al Prevention of contrast-induced nephropathy by bolus injection of sodium bicarbonate.
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et al Prevention of contrast-induced nephropathy by central venous pressureâguided fluid administration in chronic kidney disease and congestive heart failure patients JACC Cardiovasc Intervent ###;#(#) ##-## Ratcliffe JA, Thiagarajah P, <PERSOON> J, et al Prevention of contrast-induced nephropathy A randomized controlled trial of <PERSOON> B, et al <PERSOON> reno-protective effect of hydration with sodium bicarbonate plus Nacetylcysteine in patients undergoing emergency percutaneous coronary intervention the <PERSOON> M, et al Sodium bicarbonate versus sodium chloride and oral N-acetylcysteine for the prevention of contrast-induced nephropathy in advanced chronic kidney disease <PERSOON> ###;##(#) ###-## <PERSOON> R, <PERSOON> SV, et al Randomized trial of bicarbonate or saline study for the prevention of contrastinduced nephropathy in patients with <PERSOON> K, et al Efficacy of single-bolus administration of sodium bicarbonate to prevent contrastinduced nephropathy in patients with mild renal insufficiency undergoing an elective coronary procedure <PERSOON> RW, et al PREPARED Preparation for Angiography in Renal Dysfunction a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction <PERSOON-##> M, et al Prevention of contrast-induced nephropathy by bolus injection of sodium bicarbonate <PERSOON-##> C, et al AKIGUARD (Acute Kidney Injury GUARding Device) trial in-hospital and one-year <PERSOON-##> M, et al RenalGuard System for the prevention of acute kidney injury in patients <PERSOON-##> W, <PERSOON-##> M, et al Oral versus intravenous hydration and renal function in diabetic patients Use of Statins and hydration to reduce the incidence of PC-AKI in patients with pre-existent reduced kidney function receiving intravascular contrast medium Dienen statines te worden aanbevolen naast hydratie om de kans om PC-AKI te verkleinen bij patiënten met Overweeg het gebruik van een kortdurende (## uur) hoge dosering atorvastatine of rosuvastatine naast hydratie Patients with reduced renal function have a higher chance to develop PC-AKI There have been multiple randomized clinical trials performed to evaluate the efficacy of statin pretreatment with conflicting results <PERSOON> results of this meta-analysis strongly support the benefit of pretreatment with high doses of atorvastatin and rosuvastatin in patients with impaired renal function undergoing coronary angiography or percutaneous coronary intervention (PCI) Since most of the included trials have excluded patients with a GFR (##ml/min/# ##m# , it remains unclear whether statins will be beneficial in patients with chronic kidney disease stage # or # Uncertainty remains about the timing and duration of pretreatment Furthermore, the additional effect of temporarily increasing the dosage of statin for a planned procedure in chronic statin using patients is unknown.
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<PERSOON> C, et al AKIGUARD (Acute Kidney Injury GUARding Device) trial in-hospital and one-year <PERSOON> M, et al RenalGuard System for the prevention of acute kidney injury in patients <PERSOON> W, <PERSOON> M, et al Oral versus intravenous hydration and renal function in diabetic patients Use of Statins and hydration to reduce the incidence of PC-AKI in patients with pre-existent reduced kidney function receiving intravascular contrast medium Dienen statines te worden aanbevolen naast hydratie om de kans om PC-AKI te verkleinen bij patiënten met Overweeg het gebruik van een kortdurende (## uur) hoge dosering atorvastatine of rosuvastatine naast hydratie Patients with reduced renal function have a higher chance to develop PC-AKI There have been multiple randomized clinical trials performed to evaluate the efficacy of statin pretreatment with conflicting results <PERSOON> results of this meta-analysis strongly support the benefit of pretreatment with high doses of atorvastatin and rosuvastatin in patients with impaired renal function undergoing coronary angiography or percutaneous coronary intervention (PCI) Since most of the included trials have excluded patients with a GFR (##ml/min/# ##m# , it remains unclear whether statins will be beneficial in patients with chronic kidney disease stage # or # Uncertainty remains about the timing and duration of pretreatment Furthermore, the additional effect of temporarily increasing the dosage of statin for a planned procedure in chronic statin using patients is unknown during administration of intravenous contrast or during percutaneous replacement of aortic valves (TAVR) or In conclusion, atorvastatin and rosuvastatin, when administered at high doses and before iodine-containing contrast administration in statin-naïve patients with reduced renal function undergoing coronary angiography or percutaneous coronary intervention (PCI), have a beneficial effect on the prevention of PC-AKI Statins are primarily used in cardiovascular medicine for their lipid lowering effects In addition to their impact on cholesterol, statins are known to have multiple non-lipid inhibiting effects on endothelial function, inflammation responses, oxidative stress, and apoptotic pathways <PERSOON> pathophysiology of PC-AKI is not completely statins may be beneficial for the prevention of PC-AKI Clinical studies with statins to prevent PC-AKI have shown conflicting results, but there seems to be a beneficial effect in patients undergoing coronary angiography or percutaneous coronary intervention (PCI), especially in the setting of an acute coronary syndrome There is evidence of low quality that short-term high dose rosuvastatin or atorvastatin in addition to hydration is more effective than hydration alone in the prevention of PC-AKI in statin-naive patients with eGFR (## ml/min/# ##m# undergoing coronary angiography or <PERSOON> effects of statins on mortality start of dialysis and number of ICU admissions are uncertain in statin-naive patients with impaired kidney function undergoing coronary No studies were found evaluating the effects of statins on PC-AKI in patients receiving No studies were found evaluating the effects of short term high dose statins on PC-AKI in It is unclear whether increasing the dosage of statin prior to an iodinated CM administration.
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valves (TAVR) or In conclusion, atorvastatin and rosuvastatin, when administered at high doses and before iodine-containing contrast administration in statin-naïve patients with reduced renal function undergoing coronary angiography or percutaneous coronary intervention (PCI), have a beneficial effect on the prevention of PC-AKI Statins are primarily used in cardiovascular medicine for their lipid lowering effects In addition to their impact on cholesterol, statins are known to have multiple non-lipid inhibiting effects on endothelial function, inflammation responses, oxidative stress, and apoptotic pathways <PERSOON> pathophysiology of PC-AKI is not completely statins may be beneficial for the prevention of PC-AKI Clinical studies with statins to prevent PC-AKI have shown conflicting results, but there seems to be a beneficial effect in patients undergoing coronary angiography or percutaneous coronary intervention (PCI), especially in the setting of an acute coronary syndrome There is evidence of low quality that short-term high dose rosuvastatin or atorvastatin in addition to hydration is more effective than hydration alone in the prevention of PC-AKI in statin-naive patients with eGFR (## ml/min/# ##m# undergoing coronary angiography or <PERSOON> effects of statins on mortality start of dialysis and number of ICU admissions are uncertain in statin-naive patients with impaired kidney function undergoing coronary No studies were found evaluating the effects of statins on PC-AKI in patients receiving No studies were found evaluating the effects of short term high dose statins on PC-AKI in It is unclear whether increasing the dosage of statin prior to an iodinated CM administration <PERSOON> systematic review and meta-analysis of <PERSOON>, ### evaluated the protective effects of statins on PC-AKI, renal replacement therapy and mortality in patients undergoing coronary angiography/percutaneous intervention Here we encompassed only the # RCTs (n=###) that were included in the subgroup analysis that focused on patients with renal dysfunction <PERSOON> intervention protocol differed across studies (table) In # of the # studies both patients in the intervention as the control group were given N-acetylcysteine <PERSOON> definition of PC-AKI varied (table) Where possible, the definition of PCAKI as described in the introduction of the guideline was used to interpret the results <PERSOON>, ### did not include specific subgroup analyses including patients with renal dysfunction for the outcomes renal replacement therapy and all-cause death; the data of the original articles were included Abaci, ### was a RCT exploring the efficacy of high-dose rosuvastatin in decreasing the incidence of PC-AKI in statin-naive patients with an eGFR between ## and ##mL/min/# ##m# the day before elective coronary angiography ### patients completed the study Patients in the intervention group were given ##mg rosuvastatin (##h before the procedure and ##mg/day for the # days hereafter Patients in the control group did not get statins All patients received intravenous hydration <PERSOON> primary outcome measure was the incidence of PC-AKI, defined as a rise of â¥##% or â¥# #mg/dl in serum creatinine from baseline, (## or ## hours after.
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<PERSOON>, ### evaluated the protective effects of statins on PC-AKI, renal replacement therapy and mortality in patients undergoing coronary angiography/percutaneous intervention Here we encompassed only the # RCTs (n=###) that were included in the subgroup analysis that focused on patients with renal dysfunction <PERSOON> intervention protocol differed across studies (table) In # of the # studies both patients in the intervention as the control group were given N-acetylcysteine <PERSOON> definition of PC-AKI varied (table) Where possible, the definition of PCAKI as described in the introduction of the guideline was used to interpret the results <PERSOON>, ### did not include specific subgroup analyses including patients with renal dysfunction for the outcomes renal replacement therapy and all-cause death; the data of the original articles were included Abaci, ### was a RCT exploring the efficacy of high-dose rosuvastatin in decreasing the incidence of PC-AKI in statin-naive patients with an eGFR between ## and ##mL/min/# ##m# the day before elective coronary angiography ### patients completed the study Patients in the intervention group were given ##mg rosuvastatin (##h before the procedure and ##mg/day for the # days hereafter Patients in the control group did not get statins All patients received intravenous hydration <PERSOON> primary outcome measure was the incidence of PC-AKI, defined as a rise of â¥##% or â¥# #mg/dl in serum creatinine from baseline, (## or ## hours after kidney diseases were included <PERSOON> participants in the intervention group in the study of Shehata, ### received oral atorvastatin (## mg daily for ## h) before PCI Qiao, ### treated the intervention group with rosuvastatin (## mg everyday for at least ## hours before and ## hours after CM administration for PCI) Shehata, ### provided both the intervention and control group in addition to periprocedural intravenous infusion of isotonic No studies were found where statins were compared to a control group in terms of PC-AKI, in patients Table # Description of the study population, def inition of PC-AKI, type and dose of the statins Pooled results of <PERSOON> (###) showed that statin pretreatment significantly decreased the risk of PC-AKI compared to placebo treatment risk ratio # ## (##% CI # ## to # ##), fixed effects model However, this metaanalysis might have overestimated the effects of statins, as the results of one study (Quintavalle, ###) in which PC-AKI was primarily defined as an increase CysC concentration of ##% above the baseline value at ##h after Abaci (###) reported that # of the ### patients in de rosuvastatin group and # of the ### patients in the <PERSOON> six studies from the subgroup analysis of <PERSOON>, ### (adapted results for Quintavalle, ###) and the studies Statins significantly decreased the risk of PC-AKI risk ratio # ## (##% CI # ##; # ##, p=# ###, random effects A separate meta-analysis (Figure #) was performed to determine the effects of high dose rosuvastatin or High dose rosuvastatin or atorvastatin significantly decreased the risk of PC-AKI risk ratio #.
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oral atorvastatin (## mg daily for ## h) before PCI Qiao, ### treated the intervention group with rosuvastatin (## mg everyday for at least ## hours before and ## hours after CM administration for PCI) Shehata, ### provided both the intervention and control group in addition to periprocedural intravenous infusion of isotonic No studies were found where statins were compared to a control group in terms of PC-AKI, in patients Table # Description of the study population, def inition of PC-AKI, type and dose of the statins Pooled results of <PERSOON> (###) showed that statin pretreatment significantly decreased the risk of PC-AKI compared to placebo treatment risk ratio # ## (##% CI # ## to # ##), fixed effects model However, this metaanalysis might have overestimated the effects of statins, as the results of one study (Quintavalle, ###) in which PC-AKI was primarily defined as an increase CysC concentration of ##% above the baseline value at ##h after Abaci (###) reported that # of the ### patients in de rosuvastatin group and # of the ### patients in the <PERSOON> six studies from the subgroup analysis of <PERSOON>, ### (adapted results for Quintavalle, ###) and the studies Statins significantly decreased the risk of PC-AKI risk ratio # ## (##% CI # ##; # ##, p=# ###, random effects A separate meta-analysis (Figure #) was performed to determine the effects of high dose rosuvastatin or High dose rosuvastatin or atorvastatin significantly decreased the risk of PC-AKI risk ratio # # ##; Figure # <PERSOON>-analysis of studies that evaluated the ef f ects of high dose rosuvastatin or In the study of <PERSOON> (###) one patient in the placebo group needed haemodialysis for renal failure # days after coronary angiography Toso (###) reported one case of temporally hemofiltration in the placebo group In five need of dialysis, the studies did not report on this outcome, did not provide the results for this specific subgroup of patients (impaired kidney function) or did not report the results for the control and intervention group separately Thus, in the studies that examined start of dialysis, #/### patients in the statin group versus <DATUM> in the control group developed need of dialysis after CAG None of the included studies were powered to detect differences in the outcome start of dialysis and the incidence of this outcome was very low Because this very low number of cases, no conclusions can be drawn for this outcome Only Toso (###) reported one death; one patient in the atorvastatin group died from acute heart failure ###) did not report on this outcome, reported zero mortality, did not provide the results for this specific group separately None of the included studies were powered to detect differences in the outcome start of dialysis and the incidence of this outcome was very low Because the very low number of cases, no conclusions.
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# ##; Figure # <PERSOON>-analysis of studies that evaluated the ef f ects of high dose rosuvastatin or In the study of <PERSOON> (###) one patient in the placebo group needed haemodialysis for renal failure # days after coronary angiography Toso (###) reported one case of temporally hemofiltration in the placebo group In five need of dialysis, the studies did not report on this outcome, did not provide the results for this specific subgroup of patients (impaired kidney function) or did not report the results for the control and intervention group separately Thus, in the studies that examined start of dialysis, #/### patients in the statin group versus <DATUM> in the control group developed need of dialysis after CAG None of the included studies were powered to detect differences in the outcome start of dialysis and the incidence of this outcome was very low Because this very low number of cases, no conclusions can be drawn for this outcome Only Toso (###) reported one death; one patient in the atorvastatin group died from acute heart failure ###) did not report on this outcome, reported zero mortality, did not provide the results for this specific group separately None of the included studies were powered to detect differences in the outcome start of dialysis and the incidence of this outcome was very low Because the very low number of cases, no conclusions heterogeneity in statin types and protocol and imprecision (total number of events (### per group) For the outcomes start dialysis and mortality, the level of evidence was decreased from high to very low, # point <PERSOON> statins when compared to no statins reduce the incidence of PC-AKI in patients with pre-existent reduced P (patient category) patients undergoing radiological examinations with reduced kidney function receiving <PERSOON> working group considered PC-AKI, mortality and start dialysis critical outcome measures for the decision making process and the intensive care admission important outcome measures for the decision-making #% in absolute risk Thus the number needed to treat would be ###, ergo a doctor would need to treat ### <PERSOON> data bases Medline (OVID) and Embase were searched from January ### to ## Augustus ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) This search was A total of ### studies were found <PERSOON> initial literature search produced ### hits and the update produced ## adult patients who underwent radiological examination using intravascular contrast media; the intervention arm consisted of patients that received statins and hydration All types of statins and the control arm consisted of patients that received hydration only or no preventive measures; studies that provided N-acetylcysteine (NAC) were included, when both groups received the same doses; at least one of the outcome measures was described PC-AKI, start dialysis, mortality, and intensive care Based on title and abstract ## studies were selected After examination of full text, ## studies were excluded.
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the outcomes start dialysis and mortality, the level of evidence was decreased from high to very low, # point <PERSOON> statins when compared to no statins reduce the incidence of PC-AKI in patients with pre-existent reduced P (patient category) patients undergoing radiological examinations with reduced kidney function receiving <PERSOON> working group considered PC-AKI, mortality and start dialysis critical outcome measures for the decision making process and the intensive care admission important outcome measures for the decision-making #% in absolute risk Thus the number needed to treat would be ###, ergo a doctor would need to treat ### <PERSOON> data bases Medline (OVID) and Embase were searched from January ### to ## Augustus ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) This search was A total of ### studies were found <PERSOON> initial literature search produced ### hits and the update produced ## adult patients who underwent radiological examination using intravascular contrast media; the intervention arm consisted of patients that received statins and hydration All types of statins and the control arm consisted of patients that received hydration only or no preventive measures; studies that provided N-acetylcysteine (NAC) were included, when both groups received the same doses; at least one of the outcome measures was described PC-AKI, start dialysis, mortality, and intensive care Based on title and abstract ## studies were selected After examination of full text, ## studies were excluded Four studies were included in the literature analysis, one meta-analysis and three randomized controlled studies <PERSOON> most important study characteristics and results are included in the evidence tables <PERSOON> C, et al Impact of Rosuvastatin on contrast-induced acute kidney injury in patients at high <PERSOON> G, <PERSOON> L, et al Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease <PERSOON> Cardiol ### <PERSOON> #-##;##(#) ##-## <PERSOON> SH, Koo BK, Park JS, Et al Prevention of radiocontrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial--arandomized controlled <PERSOON> M, et al Early high-dose rosuvastatin and cardioprotection in the protective effect of rosuvastatin and antiplatelet therapy on contrast-induced acute kidney injury and myocardial damage in patients with acute <PERSOON> CY, et al Statins for the Prevention of <PERSOON> A, et al Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the <PERSOON-##> J, <PERSOON-##> Y, <PERSOON-##> X, <PERSOON-##> attenuated contrast-induced nephropathy in diabetes patients with renal <PERSOON-##> D, De Micco F, et al Impact of a high loading dose of atorvastatin on contrast-induced acute kidney Shehata M, <PERSOON-##> of high loading dose of atorvastatin in diabetic patients with renal dysfunction undergoing.
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randomized controlled studies <PERSOON> most important study characteristics and results are included in the evidence tables <PERSOON> C, et al Impact of Rosuvastatin on contrast-induced acute kidney injury in patients at high <PERSOON> G, <PERSOON> L, et al Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease <PERSOON> Cardiol ### <PERSOON> #-##;##(#) ##-## <PERSOON> SH, Koo BK, Park JS, Et al Prevention of radiocontrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial--arandomized controlled <PERSOON> M, et al Early high-dose rosuvastatin and cardioprotection in the protective effect of rosuvastatin and antiplatelet therapy on contrast-induced acute kidney injury and myocardial damage in patients with acute <PERSOON> CY, et al Statins for the Prevention of <PERSOON> A, et al Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the <PERSOON-##> J, <PERSOON-##> Y, <PERSOON-##> X, <PERSOON-##> attenuated contrast-induced nephropathy in diabetes patients with renal <PERSOON-##> D, De Micco F, et al Impact of a high loading dose of atorvastatin on contrast-induced acute kidney Shehata M, <PERSOON-##> of high loading dose of atorvastatin in diabetic patients with renal dysfunction undergoing a randomized controlled trial <PERSOON-##> M, et al Pharmacologic prophylaxis for contrast-induced acute kidney injury Intervent Cardiol Use of prophylactic N-acetylcysteine (NAC) in addition to hydration to reduce Dient profylaxe met N-acetylcysteine (NAC) te worden aanbevolen naast hydratie om de kans om PC-AKI te verkleinen bij patiënten met een normale nierfunctie of met een chronische nierziekte die intravasculair CM Geef geen NAC ter preventie van PC-AKI aan patiënten met een normale of verminderde (eGFR (## Our meta-analysis regarding patients with a normal renal function yielded no benefit of NAC for prevention of PC-AKI, both for patients receiving CT scan and/or for patients undergoing <PERSOON-##> evidence regarding NAC benefit for prevention of PC-AKI in patients with an impaired renal function is weak due to the quality of the trials and the heterogeneity of the results For example, follow-up time was only # to # days in the majority of included studies; thus meaningful conclusions could not be drawn about the powered to draw conclusions about morbidity and mortality, only for the short-term PC-AKI laboratory inconsistent to determine the efficacy Another meta-analysis concluded that NAC may help to prevent PC-AKI in patients undergoing coronary angiography, but does not have any impact on clinical outcomes such as dialysis or mortality (Submaramiam, ###) Furthermore, the dose and route of administration of NAC differed decrease the risk of PC-AKI significantly Of note, only studies that described hydration strategies representative.
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controlled trial <PERSOON> M, et al Pharmacologic prophylaxis for contrast-induced acute kidney injury Intervent Cardiol Use of prophylactic N-acetylcysteine (NAC) in addition to hydration to reduce Dient profylaxe met N-acetylcysteine (NAC) te worden aanbevolen naast hydratie om de kans om PC-AKI te verkleinen bij patiënten met een normale nierfunctie of met een chronische nierziekte die intravasculair CM Geef geen NAC ter preventie van PC-AKI aan patiënten met een normale of verminderde (eGFR (## Our meta-analysis regarding patients with a normal renal function yielded no benefit of NAC for prevention of PC-AKI, both for patients receiving CT scan and/or for patients undergoing <PERSOON> evidence regarding NAC benefit for prevention of PC-AKI in patients with an impaired renal function is weak due to the quality of the trials and the heterogeneity of the results For example, follow-up time was only # to # days in the majority of included studies; thus meaningful conclusions could not be drawn about the powered to draw conclusions about morbidity and mortality, only for the short-term PC-AKI laboratory inconsistent to determine the efficacy Another meta-analysis concluded that NAC may help to prevent PC-AKI in patients undergoing coronary angiography, but does not have any impact on clinical outcomes such as dialysis or mortality (Submaramiam, ###) Furthermore, the dose and route of administration of NAC differed decrease the risk of PC-AKI significantly Of note, only studies that described hydration strategies representative No studies were found that compared oral to intravenous N-acetylcysteine route of administration in patients undergoing intravascular contrast Intervention with NAC is without risk, cheap, and generally available, and there are theoretical arguments that NAC may provide reduction of CI-AKI Despite the theoretically potential kidney protection arguments, we do not recommend adding NAC to hydration routinely in patients with an impaired kidney function Reason is that the level of evidence is weak and the demonstrated benefit is small at best, and clinically not proven relevant Moreover, the low costs of NAC itself is offset by extra handling time and a more complex AKI preventive protocol, which are unnecessary confounding and cost enhancing factors None of the studies showed significant differences in clinical meaningful endpoints such as need of renal replacement therapy and/or <PERSOON> mechanism of PC-AKI is not completely understood Direct cell damage by the iodine-containing contrast medium with subsequent oxidative stress, endothelial dysfunction and decreased nitric oxide (NO) availability is supposed to play major role Intrarenal NO is crucial for maintaining perfusion and oxygen supply in the renal medulla NO depletion causes vasoconstriction with hypoperfusion of the renal medulla and local hypoxia In addition, NO depletion affects tubular fluid composition, tubule-glomerular feed-back signalling and decreases However, some experts have questioned whether acute kidney injury occurring after intravascular administration of iodine-containing CM is not caused by co-existing risk factors and only coincidentally related to the CM especially if contrast media are administered by the intravenous route.
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found that compared oral to intravenous N-acetylcysteine route of administration in patients undergoing intravascular contrast Intervention with NAC is without risk, cheap, and generally available, and there are theoretical arguments that NAC may provide reduction of CI-AKI Despite the theoretically potential kidney protection arguments, we do not recommend adding NAC to hydration routinely in patients with an impaired kidney function Reason is that the level of evidence is weak and the demonstrated benefit is small at best, and clinically not proven relevant Moreover, the low costs of NAC itself is offset by extra handling time and a more complex AKI preventive protocol, which are unnecessary confounding and cost enhancing factors None of the studies showed significant differences in clinical meaningful endpoints such as need of renal replacement therapy and/or <PERSOON> mechanism of PC-AKI is not completely understood Direct cell damage by the iodine-containing contrast medium with subsequent oxidative stress, endothelial dysfunction and decreased nitric oxide (NO) availability is supposed to play major role Intrarenal NO is crucial for maintaining perfusion and oxygen supply in the renal medulla NO depletion causes vasoconstriction with hypoperfusion of the renal medulla and local hypoxia In addition, NO depletion affects tubular fluid composition, tubule-glomerular feed-back signalling and decreases However, some experts have questioned whether acute kidney injury occurring after intravascular administration of iodine-containing CM is not caused by co-existing risk factors and only coincidentally related to the CM especially if contrast media are administered by the intravenous route the incidence of acute kidney injury was similar between patients receiving IV contrast and patients receiving an In addition, it is also difficult to distinguish the effects of contrast media from the effects of physiologic confounders that could either elevate or reduce serum creatinine in patients undergoing radiologic studies There is also a possibility that the effectiveness of NAC could vary by type of iodine-containing contrast A recent analysis did not demonstrate a clear benefit of NAC for patients receiving IV contrast media (<PERSOON> same analysis found no association between the effect of NAC on the incidence of <PERSOON> argument for NAC in the decision making process has always been the low risk, the low costs and general availability of the NAC intervention However, the low costs of NAC itself is offset by extra handling time and a more complex AKI preventive protocol, which are also confounding factors Thus, it is unclear whether NAC-administration should be recommended to prevent PC-AKI There is evidence of low quality that N-acetylcysteine does not reduce the risk of PC-AKI in patients with normal kidney function undergoing computer tomography with intravascular patients with impaired kidney function undergoing computed tomography with intravascular patients with normal kidney function undergoing coronary angiography with intravascular patients with decreased kidney function undergoing coronary angiography with intravascular No studies were found that compared oral to intravenous N-acetylcysteine route of One RCT (Hsu, ###) reported on effects of NAC plus saline hydration (n=###) versus saline hydration only.
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injury was similar between patients receiving IV contrast and patients receiving an In addition, it is also difficult to distinguish the effects of contrast media from the effects of physiologic confounders that could either elevate or reduce serum creatinine in patients undergoing radiologic studies There is also a possibility that the effectiveness of NAC could vary by type of iodine-containing contrast A recent analysis did not demonstrate a clear benefit of NAC for patients receiving IV contrast media (<PERSOON> same analysis found no association between the effect of NAC on the incidence of <PERSOON> argument for NAC in the decision making process has always been the low risk, the low costs and general availability of the NAC intervention However, the low costs of NAC itself is offset by extra handling time and a more complex AKI preventive protocol, which are also confounding factors Thus, it is unclear whether NAC-administration should be recommended to prevent PC-AKI There is evidence of low quality that N-acetylcysteine does not reduce the risk of PC-AKI in patients with normal kidney function undergoing computer tomography with intravascular patients with impaired kidney function undergoing computed tomography with intravascular patients with normal kidney function undergoing coronary angiography with intravascular patients with decreased kidney function undergoing coronary angiography with intravascular No studies were found that compared oral to intravenous N-acetylcysteine route of One RCT (Hsu, ###) reported on effects of NAC plus saline hydration (n=###) versus saline hydration only A total of # RCTs (Kama, ###; Kitzler, ###; Poletti, ###; Poletti, ###; Tepel, ###) with ### patients was included Three studies described emergency patients (Kama, ###; Poletti, ###; Poletti, ###) while two administered orally (Kitzler, ###; Tepel, ###), with the total doses varying between <DATUM> and <DATUM> In three doses varying between <DATUM> g (###mg/kg) and #g <PERSOON> follow-up time in the studies varied between # days and Coronary angiography and/or percutaneous intervention, normal kidney function ###; <PERSOON>, ###) with ### patients was included Four studies described emergency patients <PERSOON>, ###) with total doses varying between #g and #g <PERSOON> follow-up time in the studies varied between # Coronary angiography and/or percutaneous intervention, impaired kidney function A total of ## RCTs was included (<PERSOON> study described emergency patients (Seyon, ###) while # studies described elective patients (ACT, ###; Castini, ###; Ferrario, ###; Gulel, ###; Izani <PERSOON>, ###; Koc, ###; Kotlyar, ###) In # RCTs the Nacetylcysteine was administered orally (<PERSOON>, ###), with the total doses varying between <DATUM> and <DATUM> In # RCTs the N-acetylcysteine was administered intravenously (Koc, ###; Kotlyar, ###) with total doses varying between # #g and <DATUM> <PERSOON> follow-up time (for laboratory parameters) in the studies varied between # days and ## days Hsu (###) reported that <DATUM> patients in the NAC group versus <DATUM> patients in the control group.
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Poletti, ###; Poletti, ###; Tepel, ###) with ### patients was included Three studies described emergency patients (Kama, ###; Poletti, ###; Poletti, ###) while two administered orally (Kitzler, ###; Tepel, ###), with the total doses varying between <DATUM> and <DATUM> In three doses varying between <DATUM> g (###mg/kg) and #g <PERSOON> follow-up time in the studies varied between # days and Coronary angiography and/or percutaneous intervention, normal kidney function ###; <PERSOON>, ###) with ### patients was included Four studies described emergency patients <PERSOON>, ###) with total doses varying between #g and #g <PERSOON> follow-up time in the studies varied between # Coronary angiography and/or percutaneous intervention, impaired kidney function A total of ## RCTs was included (<PERSOON> study described emergency patients (Seyon, ###) while # studies described elective patients (ACT, ###; Castini, ###; Ferrario, ###; Gulel, ###; Izani <PERSOON>, ###; Koc, ###; Kotlyar, ###) In # RCTs the Nacetylcysteine was administered orally (<PERSOON>, ###), with the total doses varying between <DATUM> and <DATUM> In # RCTs the N-acetylcysteine was administered intravenously (Koc, ###; Kotlyar, ###) with total doses varying between # #g and <DATUM> <PERSOON> follow-up time (for laboratory parameters) in the studies varied between # days and ## days Hsu (###) reported that <DATUM> patients in the NAC group versus <DATUM> patients in the control group <PERSOON>, ###) with ### patients with ### events showed that risk ratio of PC-AKI was not ###; Koc, ###; Kotlyar, ###; Sadineni, ###; Seyon, ###) with ### patients with ### events showed that <PERSOON> quality of evidence for the outcome PC-AKI was downgraded by two for imprecision (low number of events Figure # <PERSOON>-analysis of NAC vs Placebo in CT with intravenous CM administration in patients <PERSOON> prophylactic N-acetylcysteine in addition to hydration reduce the incidence of CI-AKI in patients receiving intravascular contrast in certain subgroups of <PERSOON> example, patients with reduced kidney function)? P (patient category) adult patients undergoing radiological examinations receiving intravascular contrast; O (outcome) post-contrast acute kidney injury (PC-AKI), start dialysis, decrease in residual kidney function, adverse effects of hydration (congestion, intensive care unit admittance, and mortality), cost-effectiveness <PERSOON> databases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##rd of <PERSOON-##> ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) This A total of ### studies were found <PERSOON> initial literature search produced ### hits and the update produced ## patients with impaired kidney function, at least eGFR (## ml/min# ##m# were analysed separately from the control arm consisted of patients that received hydration or no hydration; at least one of the outcome measures was described Contrast-induced nephropathy (CIN) / contrastinduced acute kidney injury (CI-AKI), start dialysis, decrease in residual kidney function, adverse effects of.
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###; <PERSOON>, ###) with ### patients with ### events showed that risk ratio of PC-AKI was not ###; Koc, ###; Kotlyar, ###; Sadineni, ###; Seyon, ###) with ### patients with ### events showed that <PERSOON> quality of evidence for the outcome PC-AKI was downgraded by two for imprecision (low number of events Figure # <PERSOON>-analysis of NAC vs Placebo in CT with intravenous CM administration in patients <PERSOON> prophylactic N-acetylcysteine in addition to hydration reduce the incidence of CI-AKI in patients receiving intravascular contrast in certain subgroups of <PERSOON> example, patients with reduced kidney function)? P (patient category) adult patients undergoing radiological examinations receiving intravascular contrast; O (outcome) post-contrast acute kidney injury (PC-AKI), start dialysis, decrease in residual kidney function, adverse effects of hydration (congestion, intensive care unit admittance, and mortality), cost-effectiveness <PERSOON> databases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##rd of <PERSOON> ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) This A total of ### studies were found <PERSOON> initial literature search produced ### hits and the update produced ## patients with impaired kidney function, at least eGFR (## ml/min# ##m# were analysed separately from the control arm consisted of patients that received hydration or no hydration; at least one of the outcome measures was described Contrast-induced nephropathy (CIN) / contrastinduced acute kidney injury (CI-AKI), start dialysis, decrease in residual kidney function, adverse effects of After examination of full texts a total of ## studies were excluded and ## studies definitely included in the literature summary Reasons for exclusion are described in the exclusion table During the search update, no more papers were included that described patients with a normal kidney function (eGFRâ¥## ml/min# ##m# ) <PERSOON> reason for this was that the working group decided to focus the recommendations on patients with an impaired eGFR ((## ml/min# ##m# ) only, because in regular clinical practice no one will consider inserting the administration of NAC in the study protocol in the ## studies were included in the literature analysis, the most important study characteristics and results were included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are included ACT Investigators Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography main results from the randomized Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) <PERSOON> AB, Sousa AM, et al Acetylcysteine for the Prevention of Renal Outcomes in Patients With Diabetes Mellitus Undergoing Coronary and <PERSOON> R, et al Intravenous N-acetylcysteine for preventing contrast-induced nephropathy a <PERSOON> MT, Landoni G, et al Acetylcysteine and non-ionic isosmolar contrast-induced nephropathyâa randomized <PERSOON-##> H, et al Prophylactic acetylcysteine usage for prevention of contrast nephropathy after coronary <PERSOON-##> A N-acetylcysteine and/or ascorbic acid versus placebo to prevent contrast-induced.
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## studies were excluded and ## studies definitely included in the literature summary Reasons for exclusion are described in the exclusion table During the search update, no more papers were included that described patients with a normal kidney function (eGFRâ¥## ml/min# ##m# ) <PERSOON> reason for this was that the working group decided to focus the recommendations on patients with an impaired eGFR ((## ml/min# ##m# ) only, because in regular clinical practice no one will consider inserting the administration of NAC in the study protocol in the ## studies were included in the literature analysis, the most important study characteristics and results were included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are included ACT Investigators Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography main results from the randomized Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) <PERSOON> AB, Sousa AM, et al Acetylcysteine for the Prevention of Renal Outcomes in Patients With Diabetes Mellitus Undergoing Coronary and <PERSOON> R, et al Intravenous N-acetylcysteine for preventing contrast-induced nephropathy a <PERSOON> MT, Landoni G, et al Acetylcysteine and non-ionic isosmolar contrast-induced nephropathyâa randomized <PERSOON> H, et al Prophylactic acetylcysteine usage for prevention of contrast nephropathy after coronary <PERSOON> A N-acetylcysteine and/or ascorbic acid versus placebo to prevent contrast-induced <PERSOON> value of N-acetylcysteine in the prevention of radiocontrast agent-induced <PERSOON> MK, <PERSOON> SH, et al N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency Izani <PERSOON> in prevention of contrast induced nephropathy following <PERSOON-##> CJ, et al A randomized trial of intravenous N-acetylcysteine to prevent contrast induced Kama A, <PERSOON-##> E, et al Comparison of Short-term Infusion Regimens of <PERSOON-##> Plus Intravenous Fluids, Sodium Bicarbonate Plus Intravenous Fluids, and Intravenous Fluids Alone for Prevention of Contrast-induced Nephropathy <PERSOON-##> BJ, Sung KC, <PERSOON-##> BS, et al Effect of N-acetylcysteine on cystatin C-based renal function after elective coronary <PERSOON-##> N, et al Efficacy of N-acetylcysteine and aminophylline in preventing contrast-induced <PERSOON-##> G, et al Efficacy of vitamin E and N-acetylcysteine in the prevention of contrast induced kidney injury in patients with chronic kidney disease a double blind, randomized controlled trial <PERSOON-##> K, <PERSOON-##> MG, et al Intravenous N-acetylcysteine plus high-dose hydration versus high-dose hydration and standard hydration for the prevention of contrast-induced nephropathy CASISâa multicenter prospective controlled trial <PERSOON-##> AM, Thavapalachandran S, et al Prehydration alone is sufficient to prevent contrast-induced nephropathy Krasuski RA, Beard BM, Geoghagan JD, et al Optimal timing of hydration to erase contrast-associated nephropathy the <PERSOON-##> G, et al.
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<PERSOON> value of N-acetylcysteine in the prevention of radiocontrast agent-induced <PERSOON> MK, <PERSOON> SH, et al N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency Izani <PERSOON> in prevention of contrast induced nephropathy following <PERSOON> CJ, et al A randomized trial of intravenous N-acetylcysteine to prevent contrast induced Kama A, <PERSOON> E, et al Comparison of Short-term Infusion Regimens of <PERSOON> Plus Intravenous Fluids, Sodium Bicarbonate Plus Intravenous Fluids, and Intravenous Fluids Alone for Prevention of Contrast-induced Nephropathy <PERSOON> BJ, Sung KC, <PERSOON> BS, et al Effect of N-acetylcysteine on cystatin C-based renal function after elective coronary <PERSOON> N, et al Efficacy of N-acetylcysteine and aminophylline in preventing contrast-induced <PERSOON-##> G, et al Efficacy of vitamin E and N-acetylcysteine in the prevention of contrast induced kidney injury in patients with chronic kidney disease a double blind, randomized controlled trial <PERSOON-##> K, <PERSOON-##> MG, et al Intravenous N-acetylcysteine plus high-dose hydration versus high-dose hydration and standard hydration for the prevention of contrast-induced nephropathy CASISâa multicenter prospective controlled trial <PERSOON-##> AM, Thavapalachandran S, et al Prehydration alone is sufficient to prevent contrast-induced nephropathy Krasuski RA, Beard BM, Geoghagan JD, et al Optimal timing of hydration to erase contrast-associated nephropathy the <PERSOON-##> G, et al <PERSOON-##> ZZ, Schmerbach K, Lu Y, et al Iodinated contrast media cause direct tubular cell damage, leading to oxidative stress, low nitric oxide, and impairment of tubuloglomerular feedbackAm <PERSOON-##> JS, McDonald RJ, Carter RE, et al Risk of intravenous contrast materialâmediated acute kidney injury a <PERSOON-##> DA, Moloney MC, et al <PERSOON> role of N--acetylcysteine in the prevention of contrast-induced nephropathy Poletti PA, Platon A, De Seigneux S, et al N-acetylcysteine does not prevent contrast nephropathy in patients with renal <PERSOON-##> A, et al Iv N-acetylcysteine and emergency CT use of serum creatinine and cystatin C as <PERSOON-##> SR, Norden AG, et al <PERSOON-##> oral N-acetylcysteine reduce contrast-induced renal injury in patients with <PERSOON-##> G, et al N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease A randomized controlled trial <PERSOON-##> role of N-acetylcysteine in the prevention of contrast-induced nephrotoxicity Seyon RA, Jensen LA, Ferguson IA, et al Efficacy of N-acetylcysteine and hydration versus placebo and hydration in decreasing contrast-induced renal dysfunction in patients undergoing coronary angiography with or without concomitant <PERSOON-##> N, et al <PERSOON-##> N-acetylcysteine reduce the incidence of contrast-induced nephropathy and.
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<PERSOON> ZZ, Schmerbach K, Lu Y, et al Iodinated contrast media cause direct tubular cell damage, leading to oxidative stress, low nitric oxide, and impairment of tubuloglomerular feedbackAm <PERSOON> JS, McDonald RJ, Carter RE, et al Risk of intravenous contrast materialâmediated acute kidney injury a <PERSOON> DA, Moloney MC, et al <PERSOON> role of N--acetylcysteine in the prevention of contrast-induced nephropathy Poletti PA, Platon A, De Seigneux S, et al N-acetylcysteine does not prevent contrast nephropathy in patients with renal <PERSOON> A, et al Iv N-acetylcysteine and emergency CT use of serum creatinine and cystatin C as <PERSOON> SR, Norden AG, et al <PERSOON> oral N-acetylcysteine reduce contrast-induced renal injury in patients with <PERSOON> G, et al N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease A randomized controlled trial <PERSOON> role of N-acetylcysteine in the prevention of contrast-induced nephrotoxicity Seyon RA, Jensen LA, Ferguson IA, et al Efficacy of N-acetylcysteine and hydration versus placebo and hydration in decreasing contrast-induced renal dysfunction in patients undergoing coronary angiography with or without concomitant <PERSOON-##> N, et al <PERSOON> N-acetylcysteine reduce the incidence of contrast-induced nephropathy and ###;##(#) ##<DATUM> <PERSOON-##> C, et al Prevention of radiographic-contrast-agentâinduced reductions in renal <PERSOON-##> C, et al Impact of high-dose N-acetylcysteine versus placebo on contrast-induced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) <PERSOON-##> Use of prophylactic Vitamin C in addition to hydration to reduce the incidence of PC-AKI in patients with pre-existent reduced kidney function receiving iodinecontaining intravascular contrast medium Dient profylaxe met Vitamine C te worden aanbevolen naast hydratie om de kans om PC-AKI te verkleinen bij Geef Vitamine C niet exclusief ter preventie van PC-AKI bij patiënten met een normale of verminderde (eGFR <PERSOON> present search shows that that vitamin C offers some protection against PC-AKI in patients with CKD undergoing coronary angiography with or without intervention However, the risk reduction was less than of ##% and therefore not considered to be clinically relevant Furthermore, the evidence is weak due to the quality of the trials and the heterogeneity of the results Finally, the dose and route of administration of vitamin C differed between studies, and the incidence of PC-AKI in the control arm greatly differed among studies, ranging from Because of this marginal protection, the Working Group does not recommend adding vitamin C to hydration routinely in patients with an increased risk of PC-AKI Reasons are that the level of evidence is weak and the.
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<PERSOON> C, et al Prevention of radiographic-contrast-agentâinduced reductions in renal <PERSOON> C, et al Impact of high-dose N-acetylcysteine versus placebo on contrast-induced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) <PERSOON> Use of prophylactic Vitamin C in addition to hydration to reduce the incidence of PC-AKI in patients with pre-existent reduced kidney function receiving iodinecontaining intravascular contrast medium Dient profylaxe met Vitamine C te worden aanbevolen naast hydratie om de kans om PC-AKI te verkleinen bij Geef Vitamine C niet exclusief ter preventie van PC-AKI bij patiënten met een normale of verminderde (eGFR <PERSOON> present search shows that that vitamin C offers some protection against PC-AKI in patients with CKD undergoing coronary angiography with or without intervention However, the risk reduction was less than of ##% and therefore not considered to be clinically relevant Furthermore, the evidence is weak due to the quality of the trials and the heterogeneity of the results Finally, the dose and route of administration of vitamin C differed between studies, and the incidence of PC-AKI in the control arm greatly differed among studies, ranging from Because of this marginal protection, the Working Group does not recommend adding vitamin C to hydration routinely in patients with an increased risk of PC-AKI Reasons are that the level of evidence is weak and the In addition, none of the studies showed significant differences in clinical meaningful endpoints such as need of renal replacement therapy Since the risk of renal replacement therapy after intravascular contrast media administration is low, none of the studies was powered Intervention with vitamin C is without risk, cheap, and generally available, and some protection seems likely <PERSOON> addition of vitamin C to hydration may therefore be considered in patients with a very high risk of PC-AKI such as those with eGFR (## ml/min/# ## m# Although several doses of vitamin C were used, most positive studies used a dose of # g orally # hours before the contrast, and # g the night before and day after the contrast administration Since oral vitamin C is generally available and the oral route is cheapest, we suggest using this dose if the risk of AKI is considered extremely high and maximal renal protection is wanted However, the <PERSOON> mechanism of PC-AKI is not completely understood However, direct cell damage by the contrast medium with subsequent oxidative stress, endothelial dysfunction and decreased nitric oxide (NO) availability are supposed to play a major role Intrarenal NO is crucial for maintaining perfusion and oxygen supply in the renal addition, NO depletion affects tubular fluid composition, tubuloglomerular feed-back signaling and decreases Vitamin C (ascorbic acid) is the most effective circulating antioxidant (Frei, ###) Ascorbate specifically protects vitamin C may reduce renal oxidative damage and improve the renal microcirculation For an optimal antioxidant.
| 576 | fms |
studies showed significant differences in clinical meaningful endpoints such as need of renal replacement therapy Since the risk of renal replacement therapy after intravascular contrast media administration is low, none of the studies was powered Intervention with vitamin C is without risk, cheap, and generally available, and some protection seems likely <PERSOON> addition of vitamin C to hydration may therefore be considered in patients with a very high risk of PC-AKI such as those with eGFR (## ml/min/# ## m# Although several doses of vitamin C were used, most positive studies used a dose of # g orally # hours before the contrast, and # g the night before and day after the contrast administration Since oral vitamin C is generally available and the oral route is cheapest, we suggest using this dose if the risk of AKI is considered extremely high and maximal renal protection is wanted However, the <PERSOON> mechanism of PC-AKI is not completely understood However, direct cell damage by the contrast medium with subsequent oxidative stress, endothelial dysfunction and decreased nitric oxide (NO) availability are supposed to play a major role Intrarenal NO is crucial for maintaining perfusion and oxygen supply in the renal addition, NO depletion affects tubular fluid composition, tubuloglomerular feed-back signaling and decreases Vitamin C (ascorbic acid) is the most effective circulating antioxidant (Frei, ###) Ascorbate specifically protects vitamin C may reduce renal oxidative damage and improve the renal microcirculation For an optimal antioxidant There is evidence of low quality that administration of vitamin C (oral or intravenous) in addition to hydration is more effective than no administration of vitamin C for the prevention No studies were found evaluating the effects of vitamin C administration on PC-AKI in All studies were performed in patients undergoing CAG with or without <PERSOON> contrast medium was therefore administered via the arterial route before the kidneys in all patients <PERSOON> systematic review and meta-analysis of Sadat, ### included a total of ### patients in nine studies We excluded four of the studies included in the Sadat meta-analysis One of these because the control arm used Nacetylcysteine (<PERSOON>), one study because it did not restrict inclusion to patients with chronic kidney dysfunction randomized controlled trials are presented in table # Vitamin C was administered orally in four studies, intravenously in two and both orally and intravenously in two All patients received hydration Definition for inclusion kidney dysfunction differed between studies (sCr ) <DATUM> to <DATUM> g/dl in # studies; CrCl â¤## ml/min in # study) <PERSOON> two studies that were only available in abstract form did not report renal dysfunction inclusion We additionally included # RCTs that appeared after the Sadat meta-analysis These trials included a total of ### patients undergoing coronary angiography with or without intervention comparing oral vitamin C to control No studies were found evaluating effects of ascorbic acid administration on post-contrast acute kidney injury in.
| 590 | fms |
low quality that administration of vitamin C (oral or intravenous) in addition to hydration is more effective than no administration of vitamin C for the prevention No studies were found evaluating the effects of vitamin C administration on PC-AKI in All studies were performed in patients undergoing CAG with or without <PERSOON> contrast medium was therefore administered via the arterial route before the kidneys in all patients <PERSOON> systematic review and meta-analysis of Sadat, ### included a total of ### patients in nine studies We excluded four of the studies included in the Sadat meta-analysis One of these because the control arm used Nacetylcysteine (<PERSOON>), one study because it did not restrict inclusion to patients with chronic kidney dysfunction randomized controlled trials are presented in table # Vitamin C was administered orally in four studies, intravenously in two and both orally and intravenously in two All patients received hydration Definition for inclusion kidney dysfunction differed between studies (sCr ) <DATUM> to <DATUM> g/dl in # studies; CrCl â¤## ml/min in # study) <PERSOON> two studies that were only available in abstract form did not report renal dysfunction inclusion We additionally included # RCTs that appeared after the Sadat meta-analysis These trials included a total of ### patients undergoing coronary angiography with or without intervention comparing oral vitamin C to control No studies were found evaluating effects of ascorbic acid administration on post-contrast acute kidney injury in Table # Description of the studies regarding dose and route of vitamin C, type of hydration and not included in the f inal meta-analysis because the study has appeared only in abstract f orm not included in the f inal meta-analysis because the study did not report restricting inclusion to DvorÅ¡ak, ### and Komiyama, ### reported that of the patients in the ascorbic acid group #/## (#%) and <DATUM> (#%) developed PC-AKI, respectively (rise in serum creatinine )##%), compared to #/## (#%) and <DATUM> (#%) patients in the placebo group <PERSOON> difference in the study of Komiyama, ### was statistically significant (p=# ###), but not in the study of DvorÅ¡ak None of patients required dialysis treatment Sadat, ### found # RCTs with a total of ### patients, ### in the ascorbic acid group and ### in the control group; and a total of ### events, a total of ## in the ascorbic acid group and ### in the control group Pooled results of Sadat, ### showed that ascorbic acid significantly decreased the risk of CI-Aki compared to no First, in the final meta-analysis (figure #), we pooled the results of # RCTs from the meta-analysis of Sadat, ### (see above) and the studies of DvorÅ¡ak, ### and Komiyama, ### Ascorbic acid appears to significantly decrease the risk of CI-AKI risk ratio # ## (##% CI # ### â # ##, p=# ##, random effects model) in patients Due to high heterogeneity of the included studies and the high imprecision noted in the meta-analysis of pooled.
| 699 | fms |
and route of vitamin C, type of hydration and not included in the f inal meta-analysis because the study has appeared only in abstract f orm not included in the f inal meta-analysis because the study did not report restricting inclusion to DvorÅ¡ak, ### and Komiyama, ### reported that of the patients in the ascorbic acid group #/## (#%) and <DATUM> (#%) developed PC-AKI, respectively (rise in serum creatinine )##%), compared to #/## (#%) and <DATUM> (#%) patients in the placebo group <PERSOON> difference in the study of Komiyama, ### was statistically significant (p=# ###), but not in the study of DvorÅ¡ak None of patients required dialysis treatment Sadat, ### found # RCTs with a total of ### patients, ### in the ascorbic acid group and ### in the control group; and a total of ### events, a total of ## in the ascorbic acid group and ### in the control group Pooled results of Sadat, ### showed that ascorbic acid significantly decreased the risk of CI-Aki compared to no First, in the final meta-analysis (figure #), we pooled the results of # RCTs from the meta-analysis of Sadat, ### (see above) and the studies of DvorÅ¡ak, ### and Komiyama, ### Ascorbic acid appears to significantly decrease the risk of CI-AKI risk ratio # ## (##% CI # ### â # ##, p=# ##, random effects model) in patients Due to high heterogeneity of the included studies and the high imprecision noted in the meta-analysis of pooled Two other meta-analyses are presented as well in the Appendix One that includes the studies that appeared in abstract form as well (figure #) and one that includes all RCTs on vitamin C (figure #) <PERSOON> demonstrate a similar <PERSOON> level of quality of evidence was decreased from level high to level moderate, due to imprecision (total number of events (### per group) and inconsistency (inexplicable variation in incidence of events between Figure # <PERSOON>-analysis also including the studies published in abstract f orm only Figure # <PERSOON>-analysis including all RCTs on vitamin C (both impaired kidney f unction and kidney <PERSOON> prophylactic intravenous Vitamin C/ascorbic acid in addition to hydration reduce the incidence of CI-AKI in patients with pre-existent reduced kidney function receiving intravascular contrast? P (patient category) patients undergoing radiological examinations or interventions with reduced kidney function O (outcome) <PERSOON>-Contrast AKI (PC-AKI), start renal replacement therapy, or chronic decrease in residual kidney <PERSOON> working group considered PC-AKI, mortality, start renal replacement therapy, decrease in residual kidney function, critical outcome measures and the low risk, costs and general availability of the vitamin C intervention <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) This search was updated on <PERSOON> #rd ### A total of ### studies were found <PERSOON> initial literature search procured ### hits and a total of ## were added after the update.
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other meta-analyses are presented as well in the Appendix One that includes the studies that appeared in abstract form as well (figure #) and one that includes all RCTs on vitamin C (figure #) <PERSOON> demonstrate a similar <PERSOON> level of quality of evidence was decreased from level high to level moderate, due to imprecision (total number of events (### per group) and inconsistency (inexplicable variation in incidence of events between Figure # <PERSOON>-analysis also including the studies published in abstract f orm only Figure # <PERSOON>-analysis including all RCTs on vitamin C (both impaired kidney f unction and kidney <PERSOON> prophylactic intravenous Vitamin C/ascorbic acid in addition to hydration reduce the incidence of CI-AKI in patients with pre-existent reduced kidney function receiving intravascular contrast? P (patient category) patients undergoing radiological examinations or interventions with reduced kidney function O (outcome) <PERSOON>-Contrast AKI (PC-AKI), start renal replacement therapy, or chronic decrease in residual kidney <PERSOON> working group considered PC-AKI, mortality, start renal replacement therapy, decrease in residual kidney function, critical outcome measures and the low risk, costs and general availability of the vitamin C intervention <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) This search was updated on <PERSOON> #rd ### A total of ### studies were found <PERSOON> initial literature search procured ### hits and a total of ## were added after the update hydration types hydration with intravenous (i v ) NaCl or bicarbonate, oral hydration; the control arm consisted of patients that received hydration only; at least one of the outcome measures was described PC-AKI, start dialysis, chronic decrease in kidney function, adverse effects of hydration (fluid overload, intensive care unit admission, and mortality), and Based on title and abstract ## studies were initially selected After examination of full text, ## studies were excluded, leaving # studies to be included in the literature summary Reasons for exclusion are described in the Three studies were included in the literature analysis, one meta-analysis and two randomized controlled studies <PERSOON> most important study characteristics and results are included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are included in the <PERSOON> H, et al Efficacy of ascorbic acid, N-acetylcysteine, or combination of both on top of saline hydration versus saline hydration alone on prevention of contrast-Induced nephropathy a prospective randomized <PERSOON> B, et al Failure of ascorbic acid to prevent contrast-media induced nephropathy in Brueck M, <PERSOON-##> R, et al Usefulness of N-acetylcysteine or ascorbic acid versus placebo to prevent contrastinduced acute kidney injury in patients undergoing elective cardiac catheterization a single-center, prospective, Dvorâak <PERSOON-##> R, et al Ascorbic Acid for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography in <PERSOON-##>.
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types hydration with intravenous (i v ) NaCl or bicarbonate, oral hydration; the control arm consisted of patients that received hydration only; at least one of the outcome measures was described PC-AKI, start dialysis, chronic decrease in kidney function, adverse effects of hydration (fluid overload, intensive care unit admission, and mortality), and Based on title and abstract ## studies were initially selected After examination of full text, ## studies were excluded, leaving # studies to be included in the literature summary Reasons for exclusion are described in the Three studies were included in the literature analysis, one meta-analysis and two randomized controlled studies <PERSOON> most important study characteristics and results are included in the evidence tables <PERSOON> evidence tables and assessment of individual study quality are included in the <PERSOON> H, et al Efficacy of ascorbic acid, N-acetylcysteine, or combination of both on top of saline hydration versus saline hydration alone on prevention of contrast-Induced nephropathy a prospective randomized <PERSOON> B, et al Failure of ascorbic acid to prevent contrast-media induced nephropathy in Brueck M, <PERSOON> R, et al Usefulness of N-acetylcysteine or ascorbic acid versus placebo to prevent contrastinduced acute kidney injury in patients undergoing elective cardiac catheterization a single-center, prospective, Dvorâak <PERSOON> R, et al Ascorbic Acid for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography in <PERSOON> L, et al Ascorbate the most effective antioxidant in human blood plasma Adv Exp Med Biol <PERSOON> A, et al Prevention of contrast induced nephropathy in patients undergoing coronarography <PERSOON> Y, et al Is ascorbic acid effective in preventing contrast-induced acute kidney injury? <PERSOON> D, et al Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of ContrastInduced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization Circ J ###;##(#) ###-## <PERSOON-##> R, <PERSOON-##> of contrast-induced nephropathy with ascorbic acid Heart ###-## E### low nitric oxide, and impairment of tubuloglomerular feedback <PERSOON-##> MC Vitamin C revisited Crit Care ###;##(#) ### Sadat U, <PERSOON-##> JH, et al <PERSOON-##> ascorbic acid protect against contrast-induced acute kidney injury in patients undergoing coronary angiography a systematic review with meta-analysis of randomized, controlled trials <PERSOON-##> S, et al Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention <PERSOON-##> L, <PERSOON-##> of contrast-induced nephropathy with ascorbic acid Intern Med ###;##(#) #<DATUM> [corrected.
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###;##(#) ### <PERSOON> L, et al Ascorbate the most effective antioxidant in human blood plasma Adv Exp Med Biol <PERSOON> A, et al Prevention of contrast induced nephropathy in patients undergoing coronarography <PERSOON> Y, et al Is ascorbic acid effective in preventing contrast-induced acute kidney injury? <PERSOON> D, et al Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of ContrastInduced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization Circ J ###;##(#) ###-## <PERSOON> R, <PERSOON> of contrast-induced nephropathy with ascorbic acid Heart ###-## E### low nitric oxide, and impairment of tubuloglomerular feedback <PERSOON> MC Vitamin C revisited Crit Care ###;##(#) ### Sadat U, <PERSOON> JH, et al <PERSOON> ascorbic acid protect against contrast-induced acute kidney injury in patients undergoing coronary angiography a systematic review with meta-analysis of randomized, controlled trials <PERSOON-##> S, et al Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention <PERSOON-##> L, <PERSOON> of contrast-induced nephropathy with ascorbic acid Intern Med ###;##(#) #<DATUM> [corrected Dient nefrotoxische medicatie te worden gestaakt vooraf aan intravasculaire jodiumhoudend contrastmiddel Staak ACE-remmers, angiotensine II receptorantagonisten of diuretica niet routinematig vooraf aan De werkgroep beveelt een nefrologisch consult aan, vooraf aan jodiumhoudend CM toediening, bij patiënten met een eGFR (## ml/kg/#,##m# , zodat er op individuele basis kan worden besloten om ACE-remmers, has been associated with an increased risk of acute kidney injury following intravascular iodine-containing contrast administration This has led to the perception that withholding these agents is a useful strategy to prevent acute kidney injury However, there is insufficient scientific evidence to support this hypothesis First of all, the only two randomized controlled trials regarding this research question address discontinuation of Second, the two RCTs that have been performed included a small number of patients and restricted their inclusion to patients undergoing coronary angiography/catheterization Hence, no information is available on the effect of withholding or continuing ACE-inhibitors or angiotensin receptor blockers in chronic kidney disease <PERSOON-##> important aspect that should be taken into consideration is the <INSTELLING> that observational studies showing an association between the risk of PC-AKI and the use of diuretics, ACE-inhibitors or angiotensin receptor blockers might have been confounded by the indication for the use of these drugs Patients with congestive heart failure, Finally, and most importantly, ACE-inhibitors and angiotensin receptor blockers are not nephrotoxic, although they are referred to as nephrotoxic drugs by guidelines and in literature ACE-inhibitors and angiotensin improve medullary perfusion and may therefore be nephroprotective under certain conditions However, post- glomerular vasoconstriction increases filtration pressure.
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contrastmiddel Staak ACE-remmers, angiotensine II receptorantagonisten of diuretica niet routinematig vooraf aan De werkgroep beveelt een nefrologisch consult aan, vooraf aan jodiumhoudend CM toediening, bij patiënten met een eGFR (## ml/kg/#,##m# , zodat er op individuele basis kan worden besloten om ACE-remmers, has been associated with an increased risk of acute kidney injury following intravascular iodine-containing contrast administration This has led to the perception that withholding these agents is a useful strategy to prevent acute kidney injury However, there is insufficient scientific evidence to support this hypothesis First of all, the only two randomized controlled trials regarding this research question address discontinuation of Second, the two RCTs that have been performed included a small number of patients and restricted their inclusion to patients undergoing coronary angiography/catheterization Hence, no information is available on the effect of withholding or continuing ACE-inhibitors or angiotensin receptor blockers in chronic kidney disease <PERSOON> important aspect that should be taken into consideration is the <INSTELLING> that observational studies showing an association between the risk of PC-AKI and the use of diuretics, ACE-inhibitors or angiotensin receptor blockers might have been confounded by the indication for the use of these drugs Patients with congestive heart failure, Finally, and most importantly, ACE-inhibitors and angiotensin receptor blockers are not nephrotoxic, although they are referred to as nephrotoxic drugs by guidelines and in literature ACE-inhibitors and angiotensin improve medullary perfusion and may therefore be nephroprotective under certain conditions However, post- glomerular vasoconstriction increases filtration pressure cardiac output, the use ACE-inhibitors and angiotensin receptor blockers can reduce glomerular filtration, a fully reversible process Thus, patients with very low glomerular reserve capacity which are dependent of postglomerular vasoconstriction may benefit from a temporary discontinuation of ACE-inhibitors and angiotensin receptor blockers regarding maintenance of glomerular filtration Anyway, hypovolemia should always be corrected before administering iodine-containing <PERSOON> working group therefore considers nephrology consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# crucial to To our knowledge, no RCTs have been performed on cessation of diuretics or non-steroidal anti-inflammatory which medullary perfusion is dependent in conditions with diminished glomerular flow such as heart failure Despite the lack of evidence, it may be considered to discontinue non-steroidal anti-inflammatory drugs in patients with chronic kidney disease undergoing contrast administration <PERSOON> working group therefore considers nephrology consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# No RCTs were found comparing the discontinuation of diuretics to continuation of diuretics as sole intervention in the setting of intravascular contrast However, several RCTs have been published comparing the use of diuretics in combination with different types of controlled hydration to hydration alone in patients receiving intraarterial contrast for CAG and or PCI These studies are reported in the chapter on optimal hydration strategy In most of the studies, the combination of diuretics and controlled hydration was superior in preventing the risk of PC-AKI indirectly supporting the concept that the use of diuretics before using intravascular contrast does not.
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and angiotensin receptor blockers can reduce glomerular filtration, a fully reversible process Thus, patients with very low glomerular reserve capacity which are dependent of postglomerular vasoconstriction may benefit from a temporary discontinuation of ACE-inhibitors and angiotensin receptor blockers regarding maintenance of glomerular filtration Anyway, hypovolemia should always be corrected before administering iodine-containing <PERSOON> working group therefore considers nephrology consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# crucial to To our knowledge, no RCTs have been performed on cessation of diuretics or non-steroidal anti-inflammatory which medullary perfusion is dependent in conditions with diminished glomerular flow such as heart failure Despite the lack of evidence, it may be considered to discontinue non-steroidal anti-inflammatory drugs in patients with chronic kidney disease undergoing contrast administration <PERSOON> working group therefore considers nephrology consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# No RCTs were found comparing the discontinuation of diuretics to continuation of diuretics as sole intervention in the setting of intravascular contrast However, several RCTs have been published comparing the use of diuretics in combination with different types of controlled hydration to hydration alone in patients receiving intraarterial contrast for CAG and or PCI These studies are reported in the chapter on optimal hydration strategy In most of the studies, the combination of diuretics and controlled hydration was superior in preventing the risk of PC-AKI indirectly supporting the concept that the use of diuretics before using intravascular contrast does not However, the use of diuretics may hamper glomerular filtration if their use causes hypovolemia and glomerular reserves are diminished In these cases, the additional use of iodine-containing CM may reduce glomerular filtration Finally, withholding diuretics might increase the risk of acute heart failure in chronic users of these agents, especially in the setting of preventive hydration that is given to patients with chronic kidney disease undergoing intravascular contrast administration <PERSOON> working group therefore considers nephrological consultation before administering iodine-containing CM in patients with eGFR No RCTâs have been published on the effect of discontinuation of PC-AKI on the reduction of PC-AKI Thus, there is no evidence whether discontinuation of nephrotoxic drugs will reduce the incidence of PC-AKI Their combined use with iodine-containing CM could however increase the risk of harm to the kidney <PERSOON> working group therefore recommends to consider other imaging techniques that avoid the use of iodine-containing CM and recommends nephrological consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# to individualize continuation or discontinuation of nephrotoxic drugs and weigh this against In summary, the lack of evidence of a protective effect of withholding diuretics, ACE-inhibitors or angiotensin receptor blockers, combined with the <INSTELLING> that withholding diuretics or ACE-inhibitors might be associated with an increased risk of acute heart failure, has resulted in the recommendation not to withhold these drugs in chronic kidney disease patients receiving intravascular contrast agents However, the working group considers nephrological consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m#.
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of diuretics may hamper glomerular filtration if their use causes hypovolemia and glomerular reserves are diminished In these cases, the additional use of iodine-containing CM may reduce glomerular filtration Finally, withholding diuretics might increase the risk of acute heart failure in chronic users of these agents, especially in the setting of preventive hydration that is given to patients with chronic kidney disease undergoing intravascular contrast administration <PERSOON> working group therefore considers nephrological consultation before administering iodine-containing CM in patients with eGFR No RCTâs have been published on the effect of discontinuation of PC-AKI on the reduction of PC-AKI Thus, there is no evidence whether discontinuation of nephrotoxic drugs will reduce the incidence of PC-AKI Their combined use with iodine-containing CM could however increase the risk of harm to the kidney <PERSOON> working group therefore recommends to consider other imaging techniques that avoid the use of iodine-containing CM and recommends nephrological consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# to individualize continuation or discontinuation of nephrotoxic drugs and weigh this against In summary, the lack of evidence of a protective effect of withholding diuretics, ACE-inhibitors or angiotensin receptor blockers, combined with the <INSTELLING> that withholding diuretics or ACE-inhibitors might be associated with an increased risk of acute heart failure, has resulted in the recommendation not to withhold these drugs in chronic kidney disease patients receiving intravascular contrast agents However, the working group considers nephrological consultation before administering iodine-containing CM in patients with eGFR (## ml/kg/# ##m# contrast Several international guidelines therefore advise to withhold these drugs in patients undergoing elective procedures requiring intravascular contrast administration Implementation is however difficult, discontinuation is not without risk and whether withholding these agents in the day(s) prior to or following iodine-containing contrast administration protects patients from developing adverse renal outcomes such as acute kidney injury, long term renal injury, or a need for dialysis is an issue of debate <PERSOON> present literature search aims to answer the following questions blockers ##-## hours prior to CM-enhanced CT reduce the risk of adverse renal outcomes? blockers ##-## hours following CM-enhanced CT reduce the risk of adverse renal outcomes? blockers ##-## hours prior to elective cardiovascular diagnostic or therapeutic contrast procedures reduce blockers ##-## hours following elective cardiovascular diagnostic or therapeutic contrast procedures There is a low level of evidence that discontinuation of ACE-inhibitors (on day of procedure up to ## hours after procedure) does not reduce the risk of post contrast acute kidney injury compared to continuing ACE-inhibitor use around angiography in patients with chronic There is a low level of evidence that discontinuation of Angiotensin-II receptor blockers (## hours before procedure up to ## hours after procedure) does not reduce the risk of post contrast acute kidney injury compared with continuing Angiotensin II receptor blocker use There is a very low level of evidence that continuation of Angiotensin II receptor blockers (## hours before procedure up to ## hours after procedure) could be associated with more.
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contrast Several international guidelines therefore advise to withhold these drugs in patients undergoing elective procedures requiring intravascular contrast administration Implementation is however difficult, discontinuation is not without risk and whether withholding these agents in the day(s) prior to or following iodine-containing contrast administration protects patients from developing adverse renal outcomes such as acute kidney injury, long term renal injury, or a need for dialysis is an issue of debate <PERSOON> present literature search aims to answer the following questions blockers ##-## hours prior to CM-enhanced CT reduce the risk of adverse renal outcomes? blockers ##-## hours following CM-enhanced CT reduce the risk of adverse renal outcomes? blockers ##-## hours prior to elective cardiovascular diagnostic or therapeutic contrast procedures reduce blockers ##-## hours following elective cardiovascular diagnostic or therapeutic contrast procedures There is a low level of evidence that discontinuation of ACE-inhibitors (on day of procedure up to ## hours after procedure) does not reduce the risk of post contrast acute kidney injury compared to continuing ACE-inhibitor use around angiography in patients with chronic There is a low level of evidence that discontinuation of Angiotensin-II receptor blockers (## hours before procedure up to ## hours after procedure) does not reduce the risk of post contrast acute kidney injury compared with continuing Angiotensin II receptor blocker use There is a very low level of evidence that continuation of Angiotensin II receptor blockers (## hours before procedure up to ## hours after procedure) could be associated with more There is no evidence that discontinuation of NSAIDs or diuretics before the administration of intravascular contrast in euvolemic patients reduces the risk of post contrast acute kidney This literature summary describes # randomized controlled trials (RCTs) (Bainey, ###; Rosenstock, ###) Rosenstock, ### compared discontinuation of angiotensin converting enzyme (ACE)-inhibitors to continuation of ACE-inhibitors prior to coronary angiography in terms of kidney damage A total of ### patients were enrolled in this study of whom ### patients were randomized ### chronic ()# months) ACE-inhibitor users who continued their therapy; ### chronic ACE-inhibitor users who discontinued ACE-inhibitors (withheld the morning of procedure to ## hours after procedure A third group of ## patients who were not using ACE-inhibitors was also followed All patients had chronic kidney disease (eGFR ##-##ml/min/# ##m# ) Patients were hydrated based on the institutionâs policies and medication such as metformin and diuretics were held prior to the procedure in all patients Creatinine values were measured at baseline and ## hours post-procedure; further Bainey, ### compared discontinuation of Angiotensin II blockade medication (combination of ACE inhibitors and angiotensin receptor blockers (ARB)) versus continuation of Angiotensin II blockade medication prior to Bainey, ### included ### patients with moderate renal insufficiency (⥠### µmol/l within # months or ⥠### µmol/l within one week of cardiac catheterisation) Use of Angiotensin II blockers were stopped in ### patients and continued in ### patients In the discontinuation group, Angiotensin II medication was stopped at least ## hours prior to catheterisation and restarted ## hours post procedurally.
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NSAIDs or diuretics before the administration of intravascular contrast in euvolemic patients reduces the risk of post contrast acute kidney This literature summary describes # randomized controlled trials (RCTs) (Bainey, ###; Rosenstock, ###) Rosenstock, ### compared discontinuation of angiotensin converting enzyme (ACE)-inhibitors to continuation of ACE-inhibitors prior to coronary angiography in terms of kidney damage A total of ### patients were enrolled in this study of whom ### patients were randomized ### chronic ()# months) ACE-inhibitor users who continued their therapy; ### chronic ACE-inhibitor users who discontinued ACE-inhibitors (withheld the morning of procedure to ## hours after procedure A third group of ## patients who were not using ACE-inhibitors was also followed All patients had chronic kidney disease (eGFR ##-##ml/min/# ##m# ) Patients were hydrated based on the institutionâs policies and medication such as metformin and diuretics were held prior to the procedure in all patients Creatinine values were measured at baseline and ## hours post-procedure; further Bainey, ### compared discontinuation of Angiotensin II blockade medication (combination of ACE inhibitors and angiotensin receptor blockers (ARB)) versus continuation of Angiotensin II blockade medication prior to Bainey, ### included ### patients with moderate renal insufficiency (⥠### µmol/l within # months or ⥠### µmol/l within one week of cardiac catheterisation) Use of Angiotensin II blockers were stopped in ### patients and continued in ### patients In the discontinuation group, Angiotensin II medication was stopped at least ## hours prior to catheterisation and restarted ## hours post procedurally normal saline at # mL/kg/hour for at least an hour before contrast injection, intravenous normal saline at # mL/kg/hour during contrast exposure and # hours after the procedure or until discharge Serum creatinine levels No literature was found describing discontinuation of NSAIDs or diuretics prior to CM-enhanced CT in patients <PERSOON> incidence of PC-AKI in the ### ACE-inhibitor users in whom medication was continued was <DATUM> (##% CI <DATUM> in the ACE-inhibitor naïve group (n=##) <PERSOON> differences in incidences were not significant (p=# ##) PC-AKI occurred in <DATUM> of the patients who continued Angiotensin II blockers and in <DATUM> of the patients in whom Angiotensin II receptor blockers were discontinued (hazard ratio (HR) of discontinuation group # ##, ##% CI # ## to # ##; p=# ##) <PERSOON> change in mean serum creatinine was ## (SD ##) µmol/L in the group that continued Angiotensin II blockers and # (SD ##) µmol/L, in the patients who discontinued the drug, p=# ## There was # death (#%), # ischemic stroke (#%) and # patients were re-hospitalized for cardiovascular cause (#%) in the group where ACE-inhibitors were continued; versus no clinical events in the discontinuation group For Rosenstock, ### the quality of evidence was downgraded by # levels due to indirectness (only kidney For Bainey, ### the quality of evidence was downgraded by # levels due to imprecision and limitations in study design and further downgraded for the outcomes mortality, dialysis and cardiovascular events for # more level.
| 741 | fms |
saline at # mL/kg/hour for at least an hour before contrast injection, intravenous normal saline at # mL/kg/hour during contrast exposure and # hours after the procedure or until discharge Serum creatinine levels No literature was found describing discontinuation of NSAIDs or diuretics prior to CM-enhanced CT in patients <PERSOON> incidence of PC-AKI in the ### ACE-inhibitor users in whom medication was continued was <DATUM> (##% CI <DATUM> in the ACE-inhibitor naïve group (n=##) <PERSOON> differences in incidences were not significant (p=# ##) PC-AKI occurred in <DATUM> of the patients who continued Angiotensin II blockers and in <DATUM> of the patients in whom Angiotensin II receptor blockers were discontinued (hazard ratio (HR) of discontinuation group # ##, ##% CI # ## to # ##; p=# ##) <PERSOON> change in mean serum creatinine was ## (SD ##) µmol/L in the group that continued Angiotensin II blockers and # (SD ##) µmol/L, in the patients who discontinued the drug, p=# ## There was # death (#%), # ischemic stroke (#%) and # patients were re-hospitalized for cardiovascular cause (#%) in the group where ACE-inhibitors were continued; versus no clinical events in the discontinuation group For Rosenstock, ### the quality of evidence was downgraded by # levels due to indirectness (only kidney For Bainey, ### the quality of evidence was downgraded by # levels due to imprecision and limitations in study design and further downgraded for the outcomes mortality, dialysis and cardiovascular events for # more level Due to heterogeneity in types of medications and interventions for which contrast administration was used, it blockers ##-## hours prior to CE-CT reduce the risk of adverse renal outcomes? blockers ##-## hours following CE-CT reduce the risk of adverse renal outcomes? P (patient category) patients with mild to moderate chronic kidney disease undergoing radiological examinations with intravascular contrast media and using diuretics, NSAIDS, angiotensin receptor blockers, or ACE-inhibitors); receptor blockers prior and/or after radiological examinations with contrast media; O (outcome) post-contrast acute kidney injury, start dialysis, decrease in residual kidney function, adverse outcome measures for the decision making process and adverse effects of withholding medication important <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) A search update was performed on the #rd of <PERSOON> terms are shown under the <PERSOON> literature search procured ### hits <PERSOON> initial search contained ### hits, adult patients who underwent diagnostic or therapeutic procedures requiring intravascular administration of contrast media (CE-CT and elective cardiovascular diagnostic or therapeutic contrast procedures) and patients with impaired kidney function, at least eGFR (## ml/min/#,##m# or serum creatinine ⥠### the use of NSAIDs, diuretics, ACE-inhibitors, or angiotensin receptor blockers was stopped at least ## hours prior to radiological examination using contrast media OR nephrotoxic medication was discontinued at least ## hours following radiological examination using contrast media;.
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Due to heterogeneity in types of medications and interventions for which contrast administration was used, it blockers ##-## hours prior to CE-CT reduce the risk of adverse renal outcomes? blockers ##-## hours following CE-CT reduce the risk of adverse renal outcomes? P (patient category) patients with mild to moderate chronic kidney disease undergoing radiological examinations with intravascular contrast media and using diuretics, NSAIDS, angiotensin receptor blockers, or ACE-inhibitors); receptor blockers prior and/or after radiological examinations with contrast media; O (outcome) post-contrast acute kidney injury, start dialysis, decrease in residual kidney function, adverse outcome measures for the decision making process and adverse effects of withholding medication important <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of <PERSOON> ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and observational studies (OBS) A search update was performed on the #rd of <PERSOON> terms are shown under the <PERSOON> literature search procured ### hits <PERSOON> initial search contained ### hits, adult patients who underwent diagnostic or therapeutic procedures requiring intravascular administration of contrast media (CE-CT and elective cardiovascular diagnostic or therapeutic contrast procedures) and patients with impaired kidney function, at least eGFR (## ml/min/#,##m# or serum creatinine ⥠### the use of NSAIDs, diuretics, ACE-inhibitors, or angiotensin receptor blockers was stopped at least ## hours prior to radiological examination using contrast media OR nephrotoxic medication was discontinued at least ## hours following radiological examination using contrast media; PC-AKI, start dialysis, decrease in residual kidney Based on title and abstract a total of ## studies were selected, all from the initial search After examination of full text a total of ## studies were excluded and # studies definitely included in the literature summary Two studies were included in the final literature analysis, the most important study characteristics and results Bainey KR, <PERSOON> K, Et al Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Rosenstock JL, <PERSOON> R, <PERSOON> JK, et al <PERSOON> effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to Use of prophylactic renal replacement therapy to reduce the risk of PC-AKI in patients with CKD stage # to # receiving intravascular contrast medium Dient profylactische nierfuncievervangende therapie te worden aanbevolen bij patiënten met chronisch nierfalen stadium <DATUM> die intravasculaire jodiumhoudend contrastmiddel toegediend krijgen bij coronaire angiografie met Should the dialysis schedule be adapted when a CKD stage-# patient receives intravascular contrast medium? Gebruik geen profylactische hemodialyse bij niet dialyse-afhankelijke patiënten met chronische nierschade stadium <DATUM> die intravasculair jodiumhoudend contrastmiddel toegediend krijgen bij coronaire angiografie met Gebruik profylactische hemofiltratie niet routinematig bij patiënten met chronische nierschade stadium <DATUM> die intravasculair jodiumhoudend contrastmiddel toegediend krijgen bij coronaire angiografie met of zonder <PERSOON> het hemodialyseschema van patiënten met chronische nierfunctievervangende therapie niet aan, wanneer.
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PC-AKI, start dialysis, decrease in residual kidney Based on title and abstract a total of ## studies were selected, all from the initial search After examination of full text a total of ## studies were excluded and # studies definitely included in the literature summary Two studies were included in the final literature analysis, the most important study characteristics and results Bainey KR, <PERSOON> K, Et al Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Rosenstock JL, <PERSOON> R, <PERSOON> JK, et al <PERSOON> effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to Use of prophylactic renal replacement therapy to reduce the risk of PC-AKI in patients with CKD stage # to # receiving intravascular contrast medium Dient profylactische nierfuncievervangende therapie te worden aanbevolen bij patiënten met chronisch nierfalen stadium <DATUM> die intravasculaire jodiumhoudend contrastmiddel toegediend krijgen bij coronaire angiografie met Should the dialysis schedule be adapted when a CKD stage-# patient receives intravascular contrast medium? Gebruik geen profylactische hemodialyse bij niet dialyse-afhankelijke patiënten met chronische nierschade stadium <DATUM> die intravasculair jodiumhoudend contrastmiddel toegediend krijgen bij coronaire angiografie met Gebruik profylactische hemofiltratie niet routinematig bij patiënten met chronische nierschade stadium <DATUM> die intravasculair jodiumhoudend contrastmiddel toegediend krijgen bij coronaire angiografie met of zonder <PERSOON> het hemodialyseschema van patiënten met chronische nierfunctievervangende therapie niet aan, wanneer (In andere woorden bij het inplannen van een onderzoek met jodiumhoudend CM hoeft er geen rekening gehouden worden met het <PERSOON> present systematic review and meta-analysis shows that prophylactic HD increases the risk of PC-AKI in patient with CKD stage # to # (eGFR (## ml/min/# ##m# ), (albeit not significantly) but also that prophylactic HF may reduce the risk of PC-AKI, the need of acute RRT and possible long term outcome, especially if applied A limitation of using PC-AKI as an endpoint is that creatinine, which forms the base of the PC-AKI definition, is A possible explanation for the harmful effect of prophylactic HD is that the risk of RRT-induced hypotension is greater when using HD compared to <PERSOON> risk of hypotension may especially be increased in the patients with diminished myocardial function Continuous hemofiltration further allows for guided fluid removal and thereby prevents hydration-associated pulmonary oedema, for which patients with combined cardiac and However, the beneficial effects of pre-and post-hemofiltration with regard to lowering the risk of PC-AKI, are only reported by one centre, if the analysis is restricted to RCTs This limits the generalizability of the results For this reason, we do not recommend using prophylactic hemofiltration as standard intervention in patients considered in a dedicated population with combined severe renal and cardiac dysfunction having a high risk of pulmonary oedema during hydration and after intracoronary contrast administration There is no literature available that answers the question whether the timing of the dialysis in regard to the.
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woorden bij het inplannen van een onderzoek met jodiumhoudend CM hoeft er geen rekening gehouden worden met het <PERSOON> present systematic review and meta-analysis shows that prophylactic HD increases the risk of PC-AKI in patient with CKD stage # to # (eGFR (## ml/min/# ##m# ), (albeit not significantly) but also that prophylactic HF may reduce the risk of PC-AKI, the need of acute RRT and possible long term outcome, especially if applied A limitation of using PC-AKI as an endpoint is that creatinine, which forms the base of the PC-AKI definition, is A possible explanation for the harmful effect of prophylactic HD is that the risk of RRT-induced hypotension is greater when using HD compared to <PERSOON> risk of hypotension may especially be increased in the patients with diminished myocardial function Continuous hemofiltration further allows for guided fluid removal and thereby prevents hydration-associated pulmonary oedema, for which patients with combined cardiac and However, the beneficial effects of pre-and post-hemofiltration with regard to lowering the risk of PC-AKI, are only reported by one centre, if the analysis is restricted to RCTs This limits the generalizability of the results For this reason, we do not recommend using prophylactic hemofiltration as standard intervention in patients considered in a dedicated population with combined severe renal and cardiac dysfunction having a high risk of pulmonary oedema during hydration and after intracoronary contrast administration There is no literature available that answers the question whether the timing of the dialysis in regard to the It is the opinion of the working group that the scheduling of an iodine-containing contrast-enhanced imaging study does not need to be adapted to the dialysis schedule of the <PERSOON> vice versa the schedule of chronic dialysis does not need to be adapted PC-AKI may increase cardiovascular morbidity and mortality However, it should be noted, that the incidence of <PERSOON> impaired glomerular filtration rate, especially below ## ml/min/# ##m# , seems the most important risk factor of PC-AKI Adequate hydration during contrast administration seems the best preventive measure and bicarbonate hydration is recommended in this population (see <PERSOON> commonly used contrast media (CM) have a molecular weight below ### Da and are easily removed by hemofiltration <PERSOON> sieving coefficient of iohexol is approximately # at ultrafiltrate rates between # and # L/h (Yardman, ###) in vitro However, during haemodialysis, sieving coefficient was about # at # L/h but decreased to # ## at # L/h Thus hemofiltration reduced CM more effectively that haemodialysis In patients with an eGFR (## ml/min/# ##m# (CKD stage # to #), undergoing coronary angiography, the sieving coefficient of iopamidol during continuous hemofiltration was about # ## (Guastoni, ###) A #-hour session of continuous hemofiltration removed a similar amount of CM as did the kidneys in ##-hours (see figure #) Thus in patients with CKD stage <DATUM> hemofiltration significantly adds to the removal of the CM.
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It is the opinion of the working group that the scheduling of an iodine-containing contrast-enhanced imaging study does not need to be adapted to the dialysis schedule of the <PERSOON> vice versa the schedule of chronic dialysis does not need to be adapted PC-AKI may increase cardiovascular morbidity and mortality However, it should be noted, that the incidence of <PERSOON> impaired glomerular filtration rate, especially below ## ml/min/# ##m# , seems the most important risk factor of PC-AKI Adequate hydration during contrast administration seems the best preventive measure and bicarbonate hydration is recommended in this population (see <PERSOON> commonly used contrast media (CM) have a molecular weight below ### Da and are easily removed by hemofiltration <PERSOON> sieving coefficient of iohexol is approximately # at ultrafiltrate rates between # and # L/h (Yardman, ###) in vitro However, during haemodialysis, sieving coefficient was about # at # L/h but decreased to # ## at # L/h Thus hemofiltration reduced CM more effectively that haemodialysis In patients with an eGFR (## ml/min/# ##m# (CKD stage # to #), undergoing coronary angiography, the sieving coefficient of iopamidol during continuous hemofiltration was about # ## (Guastoni, ###) A #-hour session of continuous hemofiltration removed a similar amount of CM as did the kidneys in ##-hours (see figure #) Thus in patients with CKD stage <DATUM> hemofiltration significantly adds to the removal of the CM reduces the incidence of PC-AKI and associated complications in patients with CKD stage <DATUM> (eGFR (## There is a very low level of evidence that prophylactic haemodialysis does not reduce the risk of PC-AKI compared to standard medical treatment in patients with chronic kidney disease There is a very low level of evidence that prophylactic hemo(dia)filtration does not reduce the risk of PC-AKI compared to standard medical treatment in patients with Chronic Kidney There is a very low level of evidence that prophylactic hemo(dia)filtration reduces the risk of acute renal replacement therapy compared to standard medical treatment in patients with Chronic Kidney disease stage # or # receiving intravascular iodine-containing contrast There is a very low level of evidence that a combination of hemodiafiltration before and after contrast administration is more effective for the prevention of PC-AKI when compared to One systematic review (Cruz, ###) and a non-randomized controlled trial (Spini, ###) were included in this Cruz (###) studied whether periprocedural renal replacement therapy (RRT) decreased the risk of PC-AKI in patients receiving intravascular radiocontrast when compared to standard medical therapy (SMT) <PERSOON> search was preformed up to March ### A total of # randomized controlled trials (RCTs) with ### patients and # observational studies with ### patients (Hsieh, ###; Gabutti, ###) were included in this review Furthermore, # of the included RCTs contained patients with chronic kidney disease (CKD) stage # and # (n=###) (<PERSOON>); these were pooled separately in a sub analysis.
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CKD stage <DATUM> (eGFR (## There is a very low level of evidence that prophylactic haemodialysis does not reduce the risk of PC-AKI compared to standard medical treatment in patients with chronic kidney disease There is a very low level of evidence that prophylactic hemo(dia)filtration does not reduce the risk of PC-AKI compared to standard medical treatment in patients with Chronic Kidney There is a very low level of evidence that prophylactic hemo(dia)filtration reduces the risk of acute renal replacement therapy compared to standard medical treatment in patients with Chronic Kidney disease stage # or # receiving intravascular iodine-containing contrast There is a very low level of evidence that a combination of hemodiafiltration before and after contrast administration is more effective for the prevention of PC-AKI when compared to One systematic review (Cruz, ###) and a non-randomized controlled trial (Spini, ###) were included in this Cruz (###) studied whether periprocedural renal replacement therapy (RRT) decreased the risk of PC-AKI in patients receiving intravascular radiocontrast when compared to standard medical therapy (SMT) <PERSOON> search was preformed up to March ### A total of # randomized controlled trials (RCTs) with ### patients and # observational studies with ### patients (Hsieh, ###; Gabutti, ###) were included in this review Furthermore, # of the included RCTs contained patients with chronic kidney disease (CKD) stage # and # (n=###) (<PERSOON>); these were pooled separately in a sub analysis ml/min, submitted to Percutaneous coronary intervention (PCI), who received either continuous renal replacement therapy only after PCI (CRRTpost, n=##) or CRRT before and after PCI (CRRTpre-post, n=##) in CRRT consisted of continuous venovenous hemofiltration (CVVH) for patients with serum creatinine (### µmol/L or continuous venovenous hemodiafiltration (CVVHDF) for patients with serum creatinine )### µmol/L, initiated # to # hours before PCI and restarted immediately after PCI for ##-## hours (CRRTpre-post) or CRRT Of note, the study was not randomized Whether patients received either CRRTpost or CRRTpre-post depended on logistics and preference of the attendant physician Furthermore, the study did not include a control group receiving hydration only Finally, the type of replacement fluid was not specified <PERSOON> main characteristics of the individual studies included in the meta-analysis and the Spini study are presented Table # Description of the studies regarding renal replacement therapy, type of hydration and PC-AKI post contrast acute kidney injury; RRT renal replacement therapy; SMT standard medical therapy; RCT randomized controlled trial; CKD chronic kidney disease, stage (st) # eGFR ## to ## ml/min/# ##m# , Cruz (###) reported that in # RCTs and # observational studies; a total of ### patients (n=### for the RCTs) were included (see table #) All studies included patients who underwent coronary angiography (CAG), with or Studies were highly heterogeneous in type of RRT, timing of RRT, type of contrast given and type of hydration (Hsieh, ###) and two included patients with CKD stage stage # (Lehnert, ###; Reinecke, ###) These three.
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renal replacement therapy only after PCI (CRRTpost, n=##) or CRRT before and after PCI (CRRTpre-post, n=##) in CRRT consisted of continuous venovenous hemofiltration (CVVH) for patients with serum creatinine (### µmol/L or continuous venovenous hemodiafiltration (CVVHDF) for patients with serum creatinine )### µmol/L, initiated # to # hours before PCI and restarted immediately after PCI for ##-## hours (CRRTpre-post) or CRRT Of note, the study was not randomized Whether patients received either CRRTpost or CRRTpre-post depended on logistics and preference of the attendant physician Furthermore, the study did not include a control group receiving hydration only Finally, the type of replacement fluid was not specified <PERSOON> main characteristics of the individual studies included in the meta-analysis and the Spini study are presented Table # Description of the studies regarding renal replacement therapy, type of hydration and PC-AKI post contrast acute kidney injury; RRT renal replacement therapy; SMT standard medical therapy; RCT randomized controlled trial; CKD chronic kidney disease, stage (st) # eGFR ## to ## ml/min/# ##m# , Cruz (###) reported that in # RCTs and # observational studies; a total of ### patients (n=### for the RCTs) were included (see table #) All studies included patients who underwent coronary angiography (CAG), with or Studies were highly heterogeneous in type of RRT, timing of RRT, type of contrast given and type of hydration (Hsieh, ###) and two included patients with CKD stage stage # (Lehnert, ###; Reinecke, ###) These three <PERSOON> of the five RCTs comparing HD to standard medical treatment (SMT), two only reported creatinine change after contrast medium administration (<PERSOON>, ###; <PERSOON>, ###) and not PC-AKI risk, and thus these studies also were excluded from the analysis When the three RCTs ##% in the HD group and ##% in the SMT group There was no significant difference in risk op PC-AKI in the patients receiving HD versus those who received SMT risk ratio (RR) # ## (##% CI # ## to <DATUM> p=# ##) as Four of the included studies applied hemofiltration (HF) or hemodiafiltration (HDF) One of these compared HF before and after iodine-containing contrast (HFpre-post) to SMT (Marenzi, ###), one study compared three study compared HF-HDF pre-post to HF-HDF post <PERSOON> latter two studies had an observational design and were, therefore, not included in the main analysis When the two RCTs comparing HDF to SMT were pooled There was no significant difference in risk op PC-AKI in the patients receiving HDF versus those who received Figure # Pooled analysis of PC-AKI risk in CKD <DATUM> patient undergoing CAG and/or PCI and receiving Figure # Pooled analysis of PC-AKI risk in CKD <DATUM> patient undergoing CAG and/or PCI and receiving p=# ##), albeit this result was not statistically significant Meanwhile HF/HDF did not reduce the occurrence of PC-AKI, but appeared to reduce the risk of acute temporary RRT (RR # ##, # ##-# ##) Of note, ##% of the.
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RCTs comparing HD to standard medical treatment (SMT), two only reported creatinine change after contrast medium administration (<PERSOON>, ###; <PERSOON>, ###) and not PC-AKI risk, and thus these studies also were excluded from the analysis When the three RCTs ##% in the HD group and ##% in the SMT group There was no significant difference in risk op PC-AKI in the patients receiving HD versus those who received SMT risk ratio (RR) # ## (##% CI # ## to <DATUM> p=# ##) as Four of the included studies applied hemofiltration (HF) or hemodiafiltration (HDF) One of these compared HF before and after iodine-containing contrast (HFpre-post) to SMT (Marenzi, ###), one study compared three study compared HF-HDF pre-post to HF-HDF post <PERSOON> latter two studies had an observational design and were, therefore, not included in the main analysis When the two RCTs comparing HDF to SMT were pooled There was no significant difference in risk op PC-AKI in the patients receiving HDF versus those who received Figure # Pooled analysis of PC-AKI risk in CKD <DATUM> patient undergoing CAG and/or PCI and receiving Figure # Pooled analysis of PC-AKI risk in CKD <DATUM> patient undergoing CAG and/or PCI and receiving p=# ##), albeit this result was not statistically significant Meanwhile HF/HDF did not reduce the occurrence of PC-AKI, but appeared to reduce the risk of acute temporary RRT (RR # ##, # ##-# ##) Of note, ##% of the (# ###)) Furthermore, during a follow-up of ## months (median) a worsening of kidney function was observed In addition, three of the studies investigating pre- and post-contrast hemofiltration found a reduction in mortality Marenzi (###) and Marenzi (###) reported a reduction in hospital mortality, while <PERSOON> quality of evidence for the outcome PC-AKI in the comparison HD or HDF versus SMT in patients with CKD <DATUM> was downgraded by three points, from high to very low; one point due to heterogeneity of the included studies and two points due to wide confidence intervals of effect size (imprecision) <PERSOON> quality of evidence for the outcome PC-AKI in the comparison post-CRRT versus pre- and post-CRRT was downgraded by three points, from high to very low, due to wide confidence intervals of effect size (imprecision) <PERSOON> prophylactic hemofiltration reduce the risk of PC-AKI in patients with pre-existent reduced kidney function P (patient category) patients with impaired kidney function (eGFR less than ## ml/min/# ##m# ) undergoing radiological examinations or interventions with reduced kidney function receiving intravascular contrast; O (outcome) contrast-induced nephropathy (CIN) / contrast-associated acute kidney injury (CA-AKI), <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of October ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) A search update was performed on the #rd of <PERSOON> ### <PERSOON> literature search procured ### hits A total of ### hydration types hydration with intravenous (i v ) NaCl #.
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of ## months (median) a worsening of kidney function was observed In addition, three of the studies investigating pre- and post-contrast hemofiltration found a reduction in mortality Marenzi (###) and Marenzi (###) reported a reduction in hospital mortality, while <PERSOON> quality of evidence for the outcome PC-AKI in the comparison HD or HDF versus SMT in patients with CKD <DATUM> was downgraded by three points, from high to very low; one point due to heterogeneity of the included studies and two points due to wide confidence intervals of effect size (imprecision) <PERSOON> quality of evidence for the outcome PC-AKI in the comparison post-CRRT versus pre- and post-CRRT was downgraded by three points, from high to very low, due to wide confidence intervals of effect size (imprecision) <PERSOON> prophylactic hemofiltration reduce the risk of PC-AKI in patients with pre-existent reduced kidney function P (patient category) patients with impaired kidney function (eGFR less than ## ml/min/# ##m# ) undergoing radiological examinations or interventions with reduced kidney function receiving intravascular contrast; O (outcome) contrast-induced nephropathy (CIN) / contrast-associated acute kidney injury (CA-AKI), <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### to ##th of October ### using relevant search terms for systematic reviews (SRs) and randomized controlled trials (RCTs) A search update was performed on the #rd of <PERSOON> ### <PERSOON> literature search procured ### hits A total of ### hydration types hydration with intravenous (i v ) NaCl # #%, oral hydration; treatment arm consisted out of patients receiving renal replacement therapy (haemodialysis, at least one of the outcome measures was described Contrast-induced nephropathy (CIN) / contrastinduced acute kidney injury (CI-AKI)/PC-AKI, start dialysis, chronic decrease in kidney function, adverse Based on title and abstract ## studies were selected, all from the initial search After examination of full text, ## studies were excluded, leaving # studies to be included in the literature summary Reasons for exclusion are Two studies were included in the literature analysis, one meta-analysis and one non-randomized controlled study the most important study characteristics and results are included in the evidence tables <PERSOON> evidence <PERSOON>, E D , <PERSOON>, J et al, Contrast media-induced kidney failure cannot be prevented by hemodialysis Cruz DN, Goh CY, Marenzi G, et al Renal replacement therapies for prevention of radiocontrast-induced nephropathy a <PERSOON>, H , <PERSOON>, V et al, Simultaneous hemodialysis during coronary angiography fails to prevent <PERSOON-##> M, et al <PERSOON-##> continuous venovenous hemodiafiltration concomitant with radiological procedures provide a significant and safe removal of the iodinated contrast ioversol? Blood Purif ###;##(#) ##<DATUM> <PERSOON-##>, C P et al, Renal protection for coronary angiography in advanced renal failure patients by <PERSOON-##>, K et al, Effect of haemodialysis after contrast medium administration in patients with renal.
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treatment arm consisted out of patients receiving renal replacement therapy (haemodialysis, at least one of the outcome measures was described Contrast-induced nephropathy (CIN) / contrastinduced acute kidney injury (CI-AKI)/PC-AKI, start dialysis, chronic decrease in kidney function, adverse Based on title and abstract ## studies were selected, all from the initial search After examination of full text, ## studies were excluded, leaving # studies to be included in the literature summary Reasons for exclusion are Two studies were included in the literature analysis, one meta-analysis and one non-randomized controlled study the most important study characteristics and results are included in the evidence tables <PERSOON> evidence <PERSOON>, E D , <PERSOON>, J et al, Contrast media-induced kidney failure cannot be prevented by hemodialysis Cruz DN, Goh CY, Marenzi G, et al Renal replacement therapies for prevention of radiocontrast-induced nephropathy a <PERSOON>, H , <PERSOON>, V et al, Simultaneous hemodialysis during coronary angiography fails to prevent <PERSOON> M, et al <PERSOON> continuous venovenous hemodiafiltration concomitant with radiological procedures provide a significant and safe removal of the iodinated contrast ioversol? Blood Purif ###;##(#) ##<DATUM> <PERSOON>, C P et al, Renal protection for coronary angiography in advanced renal failure patients by <PERSOON>, K et al, Effect of haemodialysis after contrast medium administration in patients with renal N-acetylcysteine and contrast-induced nephropathy in primary angioplasty <PERSOON-##> I, <PERSOON-##> G, et al <PERSOON> prevention of radiocontrast-agent-induced nephropathy by hemofiltration <PERSOON-##>, J et al, A randomized controlled trial comparing hydration therapy to additional <PERSOON-##> M, et al Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures <PERSOON-##>, C et al, Prophylactic hemodialysis after radiocontrast media in patients with renal Dient metformine te worden gestaakt voorafgaand aan intravasculaire jodiumhoudend contrastmiddel Continueer metformine bij elke patiënt met een eGFR â¥## ml/min/#,##m# bij wie het jodiumhoudend Staak metformine bij alle patiënten met een eGFR (##ml/min/#,##m# bij wie intravasculair jodiumhoudend contrastmiddel wordt toegediend zodra dit niveau van nierschade is gedetecteerd, en informeer de aanvrager Metformin is the most frequently used oral glucose-lowering drug in patients with diabetes mellitus type # (DM#) Reduced hepatic glucose production and increased insulin sensitivity are major mechanisms of its antihyperglycaemic effect (Lalau, ###) Metformin inhibits the mitochondrial respiratory chain, impairing the main site of energy generation through aerobic metabolism This results in a shift toward anaerobic metabolism with lactate as a by-product and less energy for gluconeogenesis Compared to DM# patients taking other glucose-lowering drugs, metformin users have reported somewhat higher serum lactate levels, but almost always within the normal range (<PERSOON-##>, ###; Mongraw-Chaffin).
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primary angioplasty <PERSOON> I, <PERSOON> G, et al <PERSOON> prevention of radiocontrast-agent-induced nephropathy by hemofiltration <PERSOON>, J et al, A randomized controlled trial comparing hydration therapy to additional <PERSOON> M, et al Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures <PERSOON>, C et al, Prophylactic hemodialysis after radiocontrast media in patients with renal Dient metformine te worden gestaakt voorafgaand aan intravasculaire jodiumhoudend contrastmiddel Continueer metformine bij elke patiënt met een eGFR â¥## ml/min/#,##m# bij wie het jodiumhoudend Staak metformine bij alle patiënten met een eGFR (##ml/min/#,##m# bij wie intravasculair jodiumhoudend contrastmiddel wordt toegediend zodra dit niveau van nierschade is gedetecteerd, en informeer de aanvrager Metformin is the most frequently used oral glucose-lowering drug in patients with diabetes mellitus type # (DM#) Reduced hepatic glucose production and increased insulin sensitivity are major mechanisms of its antihyperglycaemic effect (Lalau, ###) Metformin inhibits the mitochondrial respiratory chain, impairing the main site of energy generation through aerobic metabolism This results in a shift toward anaerobic metabolism with lactate as a by-product and less energy for gluconeogenesis Compared to DM# patients taking other glucose-lowering drugs, metformin users have reported somewhat higher serum lactate levels, but almost always within the normal range (<PERSOON>, ###; Mongraw-Chaffin) Lactic acidosis is an anion-gap metabolic acidosis defined by serum lactate levels greater than # mmol/l and pH less than # ## and is a feared complication of the use of metformin Severe lactic acidosis causes multisystem fibrillation) dysfunction, and carries a )##% mortality risk There is no evidence that in patients with a normal kidney function metformin use is associated with an increased risk of lactic acidosis (Inzucchi, ###) In patients with impaired kidney function, metformin levels increase if the dose of metformin is not reduced, potentially increasing the risk of lactic acidosis However, case-reports of lactic acidosis in patients taking metformin indicate that lactic acidosis in most cases is unrelated to plasma metformin levels, challenging the concept of a causal relation between metformin use and the occurrence of lactic acidosis (Inzucchi, ###) Zeller, ### included ## patients not using metformin and ## patients using metformin with an eGFR (## ml/min <PERSOON> mean eGFR in the metformin users was ##±## ml/min Acute kidney injury following the PCI procedure occurred in ##% of patients versus in ##% of non-metformin users No case of lactic acidosis during hospital stay was observed Lactic acidosis solely induced by metformin use is exceptionally rare In patients who develop lactic acidosis, while using metformin, other comorbidities such as infection, acute kidney or liver failure or cardiac failure are almost always present These comorbidities are supposed to play a central role in the aetiology of lactic acidosis in metformin users.
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is an anion-gap metabolic acidosis defined by serum lactate levels greater than # mmol/l and pH less than # ## and is a feared complication of the use of metformin Severe lactic acidosis causes multisystem fibrillation) dysfunction, and carries a )##% mortality risk There is no evidence that in patients with a normal kidney function metformin use is associated with an increased risk of lactic acidosis (Inzucchi, ###) In patients with impaired kidney function, metformin levels increase if the dose of metformin is not reduced, potentially increasing the risk of lactic acidosis However, case-reports of lactic acidosis in patients taking metformin indicate that lactic acidosis in most cases is unrelated to plasma metformin levels, challenging the concept of a causal relation between metformin use and the occurrence of lactic acidosis (Inzucchi, ###) Zeller, ### included ## patients not using metformin and ## patients using metformin with an eGFR (## ml/min <PERSOON> mean eGFR in the metformin users was ##±## ml/min Acute kidney injury following the PCI procedure occurred in ##% of patients versus in ##% of non-metformin users No case of lactic acidosis during hospital stay was observed Lactic acidosis solely induced by metformin use is exceptionally rare In patients who develop lactic acidosis, while using metformin, other comorbidities such as infection, acute kidney or liver failure or cardiac failure are almost always present These comorbidities are supposed to play a central role in the aetiology of lactic acidosis in metformin users Metformin is cleared by the kidney and eliminated unchanged in the urine This drug may therefore accumulate in patients with impaired kidney function as can occur in response to administration of iodine-containing CM Below which level of kidney function metformin should no longer be described is open to discussion Until very recently, the advice was not to prescribe metformin in patients with an eGFR (## ml/min/# ## m# Based on the available literature, a recent report in the JAMA suggests that metformin prescription at a reduced dose of maximal ### mg per day can be considered in patients with a CKD grade #A (eGFR ##-## ml/min/# ##m# ), unless kidney function is expected to become unstable (Inzucchi, ###) In accordance with this suggestion, the FDA Drug Safety Communication recently has revised warnings regarding the use of metformin in patients with reduced kidney function (FDA website) According to this guideline metformin is contraindicated in patients with an eGFR (## ml/min/# ##m# and starting metformin in patients with an eGFR between ## to ## metformin at the time of or before an iodine-containing contrast imaging procedure in patients with an eGFR <PERSOON> guideline released by the CMSC of the ESUR (version # #, ###) for patients taking metformin is more liberal Patients with an eGFR ⥠## ml/min/# ## m# receiving i v iodine-containing CM can continue to take metformin, whereas patients receiving i v or i a CM with an eGFR between ## and ## ml/min/# ## m# should.
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by the kidney and eliminated unchanged in the urine This drug may therefore accumulate in patients with impaired kidney function as can occur in response to administration of iodine-containing CM Below which level of kidney function metformin should no longer be described is open to discussion Until very recently, the advice was not to prescribe metformin in patients with an eGFR (## ml/min/# ## m# Based on the available literature, a recent report in the JAMA suggests that metformin prescription at a reduced dose of maximal ### mg per day can be considered in patients with a CKD grade #A (eGFR ##-## ml/min/# ##m# ), unless kidney function is expected to become unstable (Inzucchi, ###) In accordance with this suggestion, the FDA Drug Safety Communication recently has revised warnings regarding the use of metformin in patients with reduced kidney function (FDA website) According to this guideline metformin is contraindicated in patients with an eGFR (## ml/min/# ##m# and starting metformin in patients with an eGFR between ## to ## metformin at the time of or before an iodine-containing contrast imaging procedure in patients with an eGFR <PERSOON> guideline released by the CMSC of the ESUR (version # #, ###) for patients taking metformin is more liberal Patients with an eGFR ⥠## ml/min/# ## m# receiving i v iodine-containing CM can continue to take metformin, whereas patients receiving i v or i a CM with an eGFR between ## and ## ml/min/# ## m# should CM if renal function has not deteriorated No advice is given for patients on metformin receiving i a contrast who have an eGFR ## to ## ml/min/# ## m# In agreement with the FDA guideline metformin is contraindicated Goergen, ### has performed a systematic review of five guidelines and their underlying evidence concerning the risk of lactic acidosis after administration of iodine-containing CM For their evaluation the authors used the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument <PERSOON> following five guidelines were assessed <PERSOON> American College of Radiology (ACR), the Royal Australian and New Zealand College of Radiologists (RANZCR), the British Royal College of Radiologists (RCR), the Canadian Association of Comparison of these guidelines with regard to recommendations about CM administration revealed inconsistency between and lack of clarity within many of the guidelines a that there are inconsistencies between the recommendations of the five international guidelines about CM b that these inconsistencies are in part caused by the low level or lack of evidence underlining guideline When translating their finding into implications for patient care, the conclusion of the authors is that there is no increased risk of lactic acidosis in patients taking metformin who have a stable normal renal function, obviating In our systematic search and appraisal of the literature no studies could be found that provide any high quality evidence concerning our question about the continuation or discontinuation of metformin in relation to eGFR in patients undergoing radiologic examination with CM.
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CM if renal function has not deteriorated No advice is given for patients on metformin receiving i a contrast who have an eGFR ## to ## ml/min/# ## m# In agreement with the FDA guideline metformin is contraindicated Goergen, ### has performed a systematic review of five guidelines and their underlying evidence concerning the risk of lactic acidosis after administration of iodine-containing CM For their evaluation the authors used the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument <PERSOON> following five guidelines were assessed <PERSOON> American College of Radiology (ACR), the Royal Australian and New Zealand College of Radiologists (RANZCR), the British Royal College of Radiologists (RCR), the Canadian Association of Comparison of these guidelines with regard to recommendations about CM administration revealed inconsistency between and lack of clarity within many of the guidelines a that there are inconsistencies between the recommendations of the five international guidelines about CM b that these inconsistencies are in part caused by the low level or lack of evidence underlining guideline When translating their finding into implications for patient care, the conclusion of the authors is that there is no increased risk of lactic acidosis in patients taking metformin who have a stable normal renal function, obviating In our systematic search and appraisal of the literature no studies could be found that provide any high quality evidence concerning our question about the continuation or discontinuation of metformin in relation to eGFR in patients undergoing radiologic examination with CM recommendations can be given It is the opinion of the workgroup that in patients with an eGFR ⥠## ml/min/# ##m# the disadvantage of discontinuation of metformin with respect to the development of hyperglycaemia and administrative procedures does not weigh against its continuation as the chance of developing PC-AKI in these patients is negligibly low when the usual preventive measures like prehydration (see Since the chance of kidney function deterioration with intravenous CM administration is neglectably low, In situations where the chance of kidney deterioration is greater, it is the advice of the working group to discontinue metformin immediately before the procedure and to inform the physician who requested the procedure with intravascular contrast According to the FDA guidelines metformin should always be Metformin-associated lactic acidosis (MALA) is a rare but severe complication Metformin is cleared by the kidney Therefore, increased circulating and tissue metformin levels may occur when kidney function is impaired temporarily impair kidney function, thereby increasing metformin levels and the risk of MALA In addition, the risk of kidney function impairment in response to iodine-containing CM administration may be greater in patients with diabetes Providing kidney function is normal or moderately impaired the risk of kidney function deterioration upon CM administration is extremely low, although the risk may vary between intravenous or intraarterial routes of contrast administration Is there evidence that below a certain level of kidney function, metformin should be discontinued before Should a distinction be made between the routes of administration of CM, i.
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can be given It is the opinion of the workgroup that in patients with an eGFR ⥠## ml/min/# ##m# the disadvantage of discontinuation of metformin with respect to the development of hyperglycaemia and administrative procedures does not weigh against its continuation as the chance of developing PC-AKI in these patients is negligibly low when the usual preventive measures like prehydration (see Since the chance of kidney function deterioration with intravenous CM administration is neglectably low, In situations where the chance of kidney deterioration is greater, it is the advice of the working group to discontinue metformin immediately before the procedure and to inform the physician who requested the procedure with intravascular contrast According to the FDA guidelines metformin should always be Metformin-associated lactic acidosis (MALA) is a rare but severe complication Metformin is cleared by the kidney Therefore, increased circulating and tissue metformin levels may occur when kidney function is impaired temporarily impair kidney function, thereby increasing metformin levels and the risk of MALA In addition, the risk of kidney function impairment in response to iodine-containing CM administration may be greater in patients with diabetes Providing kidney function is normal or moderately impaired the risk of kidney function deterioration upon CM administration is extremely low, although the risk may vary between intravenous or intraarterial routes of contrast administration Is there evidence that below a certain level of kidney function, metformin should be discontinued before Should a distinction be made between the routes of administration of CM, i intravenously or intraarterially? It is not clear whether cessation of metformin in patients undergoing intravascular contrast administration for radiological examination is effective for decreasing the risk of metforminassociated lactic acidosis and hyperglycaemia One systematic review (Georgen, ###) was identified that examined the question whether metformin was related to lactic acidosis after administration of intravascular contrast medium for radiological research Georgen (###) performed a literature search from ### onward to March ### This systematic review included the evidence base of # frequently cited guidelines that consisted of RCTs, observational studies, case series and case reports A total of # studies were deemed eligible and included in the review Georgen, ### found a total of # studies, # summaries of published case-reports (McCartney, ###; Stades, quality to provide evidence to answer our research question due to their study design A quality of evidence could not be determined, since no original studies were found in this search, or in the <PERSOON> discontinuation of metformin or reduction of metformin-dose in diabetic patients who are subjected to i v or i a contrast administration result in a lower risk of developing lactate acidosis and/or increase the risk of a P (patient category) diabetic patients on metformin with normal renal function or impaired renal function who are O (outcome) metformin associated lactate acidosis and risk of serious hyperglycaemia <PERSOON> working group considered lactate acidosis and risk of serious hyperglycaemia as critical outcome measures for the decision making process.
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intravenously or intraarterially? It is not clear whether cessation of metformin in patients undergoing intravascular contrast administration for radiological examination is effective for decreasing the risk of metforminassociated lactic acidosis and hyperglycaemia One systematic review (Georgen, ###) was identified that examined the question whether metformin was related to lactic acidosis after administration of intravascular contrast medium for radiological research Georgen (###) performed a literature search from ### onward to March ### This systematic review included the evidence base of # frequently cited guidelines that consisted of RCTs, observational studies, case series and case reports A total of # studies were deemed eligible and included in the review Georgen, ### found a total of # studies, # summaries of published case-reports (McCartney, ###; Stades, quality to provide evidence to answer our research question due to their study design A quality of evidence could not be determined, since no original studies were found in this search, or in the <PERSOON> discontinuation of metformin or reduction of metformin-dose in diabetic patients who are subjected to i v or i a contrast administration result in a lower risk of developing lactate acidosis and/or increase the risk of a P (patient category) diabetic patients on metformin with normal renal function or impaired renal function who are O (outcome) metformin associated lactate acidosis and risk of serious hyperglycaemia <PERSOON> working group considered lactate acidosis and risk of serious hyperglycaemia as critical outcome measures for the decision making process <PERSOON> data bases Medline (OVID), Embase and the Cochrane Library were searched from January ### up to April ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and adult patients who underwent radiological examination using contrast media (including radiological at least one of the outcome measures was described metformin associated lactate acidosis, risk of Based on title and abstract a total of ## studies were selected After examination of full text a total of ## studies were excluded and # study definitely included in the literature summary This was a systematic review of Studies were included in the literature analysis, the most important study characteristics and results were <PERSOON> CM Metformin treatment in NIDDM patients with mild renal impairment <PERSOON> on Contrast Media, v#, ### European Society of Urogenital Food and Drug Administration FDA Drug Safety Communication FDA revises warnings regarding use of the diabetes medicine metformin in patients with reduced kidney function Dated <DATUM> Available at <PERSOON> G, et al Systematic review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin Radiology ###;###(#) ##<DATUM> <PERSOON> M, et al , Clinical pharmacokinetics of metformin Clin Pharmacokinet ###;##(#) ##-## Inzucchi SE, Lipska KJ, Mayo H, et al.
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Embase and the Cochrane Library were searched from January ### up to April ### using relevant search terms for systematic reviews (SRs), randomized controlled trials (RCTs) and adult patients who underwent radiological examination using contrast media (including radiological at least one of the outcome measures was described metformin associated lactate acidosis, risk of Based on title and abstract a total of ## studies were selected After examination of full text a total of ## studies were excluded and # study definitely included in the literature summary This was a systematic review of Studies were included in the literature analysis, the most important study characteristics and results were <PERSOON> CM Metformin treatment in NIDDM patients with mild renal impairment <PERSOON> on Contrast Media, v#, ### European Society of Urogenital Food and Drug Administration FDA Drug Safety Communication FDA revises warnings regarding use of the diabetes medicine metformin in patients with reduced kidney function Dated <DATUM> Available at <PERSOON> G, et al Systematic review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin Radiology ###;###(#) ##<DATUM> <PERSOON> M, et al , Clinical pharmacokinetics of metformin Clin Pharmacokinet ###;##(#) ##-## Inzucchi SE, Lipska KJ, Mayo H, et al a systematic review <PERSOON> H, et al Metformin-associated lactic acidosis following contrast media-induced nephrotoxicity Lalau JD, Arnouts P, <PERSOON> A, et al Metformin and other antidiabetic agents in renal failure patients <PERSOON> ES, et al Lactate levels in Asian patients with type # diabetes mellitus on metformin and its association with dose of metformin and renal function <PERSOON> JL, et al Relationship of plasma creatinine and lactic acid in type # diabetic patients without renal McCartney MM, <PERSOON> FJ, Murchison LE, et al Metformin and contrast mediaâa dangerous combination? <PERSOON-##> FL, et al , Diabetes medication use and blood lactate level among participants with type # diabetes the atherosclerosis risk in communities carotid MRI study PLoS One ###;#(##) e### <PERSOON-##> PA, et al Clinical risk associated with contrast angiography in metformin treated patients a <PERSOON-##> DW, et al Metformin and lactic acidosis cause or coincidence? A review of case reports <PERSOON-##> JM, et al Metformin and contrast-induced acute kidney injury in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction A multicenter study In <PERSOON-##> compared to the CBO ### guideline on iodine-containing contrast media, several recommendations have been revised.
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Prabhakar H, et al Metformin-associated lactic acidosis following contrast media-induced nephrotoxicity Lalau JD, Arnouts P, <PERSOON> A, et al Metformin and other antidiabetic agents in renal failure patients <PERSOON> ES, et al Lactate levels in Asian patients with type # diabetes mellitus on metformin and its association with dose of metformin and renal function <PERSOON> JL, et al Relationship of plasma creatinine and lactic acid in type # diabetic patients without renal McCartney MM, <PERSOON> FJ, Murchison LE, et al Metformin and contrast mediaâa dangerous combination? <PERSOON> FL, et al , Diabetes medication use and blood lactate level among participants with type # diabetes the atherosclerosis risk in communities carotid MRI study PLoS One ###;#(##) e### <PERSOON> PA, et al Clinical risk associated with contrast angiography in metformin treated patients a <PERSOON> DW, et al Metformin and lactic acidosis cause or coincidence? A review of case reports <PERSOON> JM, et al Metformin and contrast-induced acute kidney injury in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction A multicenter study In <PERSOON> compared to the CBO ### guideline on iodine-containing contrast media, several recommendations have been revised an improved terminology and PC-AKI definition, a lower threshold of eGFR for hydration indication, another type of hydration (bicarbonate) as a recommended preventive measure and a conservative attitude towards preventive measures for PC-AKI other than hydration To enhance the implementation of this guideline, changes in the organizational structure are In the Netherlands, different electronic medical records (EMR) or Hospital Information Systems (HIS) are available We strongly recommend the same manner of implementation of this guideline, with at least application forms with eGFR, in combination with a medication order for intravascular contrast medium in the medication list, an overview of the administrated intravascular contrast media; a query regarding all imaging studies / procedures with intravascular iodine-containing contrast media, For optimal implementation of this guideline a hospital-based protocol describing preventive measures, workflow and responsibilities should be designed This protocol should be determined by a panel of various <PERSOON-##> referring physician is responsible for analysing and giving notice of the patientâs kidney function, instructing <PERSOON-##> decision on contrast administration should be taken by the physician (radiologist, cardiologist, etc ) responsible for the diagnostic or interventional procedure Actions can be delegated to others according to local rules and protocols For example, patients at risk can be referred to a nephrology outpatient clinic (or even a âCI-AKI Prevention Clinicâ) This has the advantage of a broader expertise and a better data acquisition Determine procedure protocol and choice of intravascular contrast medium Check eGFR and check whether hydration is administered correctly.
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PC-AKI definition, a lower threshold of eGFR for hydration indication, another type of hydration (bicarbonate) as a recommended preventive measure and a conservative attitude towards preventive measures for PC-AKI other than hydration To enhance the implementation of this guideline, changes in the organizational structure are In the Netherlands, different electronic medical records (EMR) or Hospital Information Systems (HIS) are available We strongly recommend the same manner of implementation of this guideline, with at least application forms with eGFR, in combination with a medication order for intravascular contrast medium in the medication list, an overview of the administrated intravascular contrast media; a query regarding all imaging studies / procedures with intravascular iodine-containing contrast media, For optimal implementation of this guideline a hospital-based protocol describing preventive measures, workflow and responsibilities should be designed This protocol should be determined by a panel of various <PERSOON> referring physician is responsible for analysing and giving notice of the patientâs kidney function, instructing <PERSOON> decision on contrast administration should be taken by the physician (radiologist, cardiologist, etc ) responsible for the diagnostic or interventional procedure Actions can be delegated to others according to local rules and protocols For example, patients at risk can be referred to a nephrology outpatient clinic (or even a âCI-AKI Prevention Clinicâ) This has the advantage of a broader expertise and a better data acquisition Determine procedure protocol and choice of intravascular contrast medium Check eGFR and check whether hydration is administered correctly intravascular iodine-containing contrast administration in this group Considering an alternative imaging modality Optimal nephrology care should always be mandatory If iodine-containing contrast medium needs to be given in patients with an eGFR ( ## ml/min/# ##m# , preventive hydration is advised, and when necessary individualized to the condition of the <PERSOON> elective examinations, consultation of a nephrologist is Optimal nephrology care is mandatory Dehydration of patients before intravascular contrast administration is undesirable and should be avoided or corrected by giving normal saline or Ringerâs lactate In patients with severe renal failure, the need for the use of contrast medium should be re-examined Some diagnoses may just as well be made with other potential imaging modalities, like MRI or ultrasound, or by performing an unenhanced study CO # angiography may be an alternative to angiography with intravascular <PERSOON> dose of iodine-containing contrast medium should be minimized without compromising the diagnostic aspect of the study/procedure, taking into consideration the indication and the patientâs body weight In angiography / interventional procedures the amount of contrast medium used is highly variable There must always be a commitment to use the lowest possible dose of contrast medium With the development of new generations of CT scanners and angiography equipment, and improved contrast media injection systems, the total volume of contrast medium used for most contrast-enhanced CT /angiography studies has dropped Also, lower tube voltages allow for lower volumes of CM as lower tube Multiple procedures with intravascular iodine-containing contrast medium within ## hours should be avoided.
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Startpagina - Richtlijn diagnostiek en beleid bij volwassenen met chronische nierschade (CNS) Medicamenteuze behandeling van Cardiovasculaire en renale risicofactoren bij chronische nierschade (CNS) Medicamenteuze behandeling van secundaire metabole gevolgen van chronische nierschade (CNS) Startpagina - Richtlijn diagnostiek en beleid bij volwassenen met chronische Deze richtlijn geeft aanbevelingen voor diagnostiek en beleid bij volwassenen met chronische nierschade (CNS) De richtlijn is gericht op professionals in zowel de eerste als de tweede lijn De volgende onderwerpen komen in medicamenteuze behandeling van cardiovasculaire en renale risicofactoren (hypertensie, diabetes mellitus, dislipidemie, secundaire preventie hart- en vaatziekten met trombocytenaggregatieremmers), influenzaen pneumococcenvaccinatie, voorkomen additionele nierschade (aanpassing medicatie op grond van nierfunctie, bepaling nierfunctie bij ouderen bij wie geen actuele nierfunctie bekend is, polyfarmacie), Specifiek voor de # e lijn is een aanvullend aantal aanbevelingen geformuleerd over de volgende onderwerpen De doelgroep van deze richtlijn zijn professionals die zich bezig houden met de zorg voor patiënten met CNS laboratoriumspecialisten klinische chemie en diëtisten Ook andere professionals, zoals andere medisch specialisten, verpleegkundigen en maatschappelijk werkenden, kunnen hun voordeel doen met deze richtlijn Deze richtlijn gaat over diagnostiek en behandeling die wordt aanbevolen voor patiënten met chronische nierschade Dokters en andere zorgverleners hebben daarbij ook afspraken gemaakt over hoe zij met elkaar Het initiatief voor de ontwikkeling van deze richtlijn lag bij het Nederlands Huisartsen Genootschap en de Nederlandse Internisten Vereniging De richtlijn is ontwikkeld door een multidisciplinaire richtlijnwerkgroep Vereniging, de Koninklijke Nederlandse Maatschappij ter Bevordering der Pharmacie, de Nederlandse Vereniging van Diëtisten, de Nederlandse Vereniging van Ziekenhuisapothekers en de Nederlandse Vereniging voor Klinische Chemie en Laboratoriumgeneeskunde Het patiëntenperspectief werd gewaarborgd door participatie door de Nierpatiënten Vereniging <LOCATIE> De werkgroep werd methodologisch en procedureel ondersteund Aanvullend aan de multidisciplinaire modules is een aantal modules specifiek voor de tweede lijn ontwikkeld Deze zijn ontwikkeld door een werkgroep van drie internist-nefrologen, tevens met ondersteuning van PROVA Het wordt aanbevolen de diagnose chronische nierschade te stellen bij patiënten met afwijkingen in de ACR albumine/creatinine ratio; AER albumin excretion rate, albumine excretie snelheid te meten door De richtlijnwerkgroep acht de KDIGO aanbeveling âmet consequenties voor de gezondheidâ moeilijk te De LTA definieert CNS als ⥠# maanden persisterende verminderde nierfunctie en/of persisterende (micro-) albuminurie (â matig verhoogd of ernstig verhoogd albumine in de urine) en/of persisterende en specifieke sprake moet zijn van afwijkingen in de nierstructuur of -functie, gedurende meer dan # maanden, met consequenties voor de gezondheid [KDIGO, ###] De NICE richtlijn ten slotte hanteert dezelfde definitie als de Om een antwoord te krijgen op deze uitgangsvraag is gebruik gemaakt van bestaande richtlijnen op het gebied van CNS en is op basis van consensus een aanbeveling geformuleerd door de richtlijnwerkgroep [LTA-CNS, Grauw WJC de, Kaasjager HAH, Bilo HJG, <PERSOON>, et al Landelijke transmurale afspraak Kidney Disease Improving Global Outcomes (KDIGO) KDIGO ### clinical practice guideline for the evaluation and National Institute for Health and Care Excellence (NICE) Chronic kidney disease Early identification and management of.
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Ziekenhuisapothekers en de Nederlandse Vereniging voor Klinische Chemie en Laboratoriumgeneeskunde Het patiëntenperspectief werd gewaarborgd door participatie door de Nierpatiënten Vereniging <LOCATIE> De werkgroep werd methodologisch en procedureel ondersteund Aanvullend aan de multidisciplinaire modules is een aantal modules specifiek voor de tweede lijn ontwikkeld Deze zijn ontwikkeld door een werkgroep van drie internist-nefrologen, tevens met ondersteuning van PROVA Het wordt aanbevolen de diagnose chronische nierschade te stellen bij patiënten met afwijkingen in de ACR albumine/creatinine ratio; AER albumin excretion rate, albumine excretie snelheid te meten door De richtlijnwerkgroep acht de KDIGO aanbeveling âmet consequenties voor de gezondheidâ moeilijk te De LTA definieert CNS als ⥠# maanden persisterende verminderde nierfunctie en/of persisterende (micro-) albuminurie (â matig verhoogd of ernstig verhoogd albumine in de urine) en/of persisterende en specifieke sprake moet zijn van afwijkingen in de nierstructuur of -functie, gedurende meer dan # maanden, met consequenties voor de gezondheid [KDIGO, ###] De NICE richtlijn ten slotte hanteert dezelfde definitie als de Om een antwoord te krijgen op deze uitgangsvraag is gebruik gemaakt van bestaande richtlijnen op het gebied van CNS en is op basis van consensus een aanbeveling geformuleerd door de richtlijnwerkgroep [LTA-CNS, Grauw WJC de, Kaasjager HAH, Bilo HJG, <PERSOON>, et al Landelijke transmurale afspraak Kidney Disease Improving Global Outcomes (KDIGO) KDIGO ### clinical practice guideline for the evaluation and National Institute for Health and Care Excellence (NICE) Chronic kidney disease Early identification and management of NICE, ### Welke grenzen voor nierfunctie en albuminurie worden aanbevolen om chronische nierschade te definiëren? Voor classificatie van albuminurie wordt een indeling in normaal (A#), matig verhoogd (A#) en ernstig verhoogd Voor nierfunctiebepaling wordt schatting middels de CKD-EPI formule aanbevolen, waarbij creatinine selectief Een eGFR ( ## ml/min/#,## m# wordt voor patiënten van alle leeftijden beschouwd als afwijkend Bij patiënten met een eerder bekende nierfunctie dient een gevonden afwijkende nierfunctie na # maanden bevestigd te worden Bij een persisterend afwijkende nierfunctie is er sprake van chronische nierschade Bij patiënten bij wie nooit eerder een nierfunctiebepaling werd gedaan, of bij wie de waarde duidelijk afwijkt van eerder laboratoriumonderzoek, wordt een herhalingstest binnen één week aanbevolen om acute nierschade tijdig op te Bij patiënten met een geschatte eGFR tussen ## en ## ml/min/#,## m# zonder andere tekenen van chronische nierschade of risicofactoren voor chronische nierschade, kan aanvullende diagnostiek naar de nierfunctie overwogen worden Een schatting van de nierfunctie op basis van cystatine C (of creatinine én cystatine C) heeft hierbij de voorkeur, indien dit beschikbaar is Alternatieven zijn bepaling van de creatinineklaring in ##-uurs urine Op basis van de lage analytische en biologische variabiliteit is de serum of plasma creatinine test geschikt om minimale veranderingen te detecteren Een betekenisvol oftewel âkritischâ verschil wordt met ##% zekerheid een geconfirmeerde daling van de eGFR van ##% ten opzichte van de eerste meting in de afgelopen vijf daling van de eGFR van ten minste # ml/min/#,## m# /jaar, vastgesteld met ten minste # metingen in één.
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grenzen voor nierfunctie en albuminurie worden aanbevolen om chronische nierschade te definiëren? Voor classificatie van albuminurie wordt een indeling in normaal (A#), matig verhoogd (A#) en ernstig verhoogd Voor nierfunctiebepaling wordt schatting middels de CKD-EPI formule aanbevolen, waarbij creatinine selectief Een eGFR ( ## ml/min/#,## m# wordt voor patiënten van alle leeftijden beschouwd als afwijkend Bij patiënten met een eerder bekende nierfunctie dient een gevonden afwijkende nierfunctie na # maanden bevestigd te worden Bij een persisterend afwijkende nierfunctie is er sprake van chronische nierschade Bij patiënten bij wie nooit eerder een nierfunctiebepaling werd gedaan, of bij wie de waarde duidelijk afwijkt van eerder laboratoriumonderzoek, wordt een herhalingstest binnen één week aanbevolen om acute nierschade tijdig op te Bij patiënten met een geschatte eGFR tussen ## en ## ml/min/#,## m# zonder andere tekenen van chronische nierschade of risicofactoren voor chronische nierschade, kan aanvullende diagnostiek naar de nierfunctie overwogen worden Een schatting van de nierfunctie op basis van cystatine C (of creatinine én cystatine C) heeft hierbij de voorkeur, indien dit beschikbaar is Alternatieven zijn bepaling van de creatinineklaring in ##-uurs urine Op basis van de lage analytische en biologische variabiliteit is de serum of plasma creatinine test geschikt om minimale veranderingen te detecteren Een betekenisvol oftewel âkritischâ verschil wordt met ##% zekerheid een geconfirmeerde daling van de eGFR van ##% ten opzichte van de eerste meting in de afgelopen vijf daling van de eGFR van ten minste # ml/min/#,## m# /jaar, vastgesteld met ten minste # metingen in één overstappen naar andere terminologie inspanningen op het gebied van implementatie vereisen De termen normaal, matig verhoogd en ernstig verhoogd sluiten echter meer aan bij de internationale literatuur De Het bepalen van de nierfunctie kent een bepaalde mate van onzekerheid, afhankelijk van bijvoorbeeld spiermassa in het geval van creatinine, maar ook intrinsiek in iedere bepaling Bij grote afwijkingen van de die relevant kan zijn voor bijvoorbeeld dosering van medicatie Bij patiënten met te weinig spiermassa, of amputatie, wordt de eGFR overschat Bij patiënten met spierhypertrofie (bijvoorbeeld bij bodybuilders) wordt Serum of plasma creatinine is de eerste keuze voor het evalueren van de nierfunctie in ieder klinisch-chemisch niveau, ligt de inter-laboratorium variabiliteit in <LOCATIE> ver onder de ##% Belangrijke verbetering in de creatinine assay was destijds de IDMS standaardisatie [Levey, ###] Als resultaat van voortdurende verbeteringen in de creatinine assays, zijn nu methoden beschikbaar waarmee selectief creatinine kan worden gemeten, met een hoge reproduceerbaarheid en kleine variatie De richtlijnwerkgroep beveelt hierbij het gebruik aan van de selectieve (veelal enzymatische) bepaling Enzymatische bepaling van creatinine is analytisch beter De CKD-EPI formule is een meer accurate methode om de GFR te schatten dan de MDRD formule De GFRschatting op basis van CKD-EPI kent desondanks een foutmarge De werkgroep vindt confirmatie van een afwijkende nierfunctie essentieel voor het stellen van de diagnose CNS Van CNS is sprake als er gedurende ten minste # maanden sprake is van een verminderde nierfunctie; de nierfunctie kan dan dus als afwijkend bevestigd worden.
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andere terminologie inspanningen op het gebied van implementatie vereisen De termen normaal, matig verhoogd en ernstig verhoogd sluiten echter meer aan bij de internationale literatuur De Het bepalen van de nierfunctie kent een bepaalde mate van onzekerheid, afhankelijk van bijvoorbeeld spiermassa in het geval van creatinine, maar ook intrinsiek in iedere bepaling Bij grote afwijkingen van de die relevant kan zijn voor bijvoorbeeld dosering van medicatie Bij patiënten met te weinig spiermassa, of amputatie, wordt de eGFR overschat Bij patiënten met spierhypertrofie (bijvoorbeeld bij bodybuilders) wordt Serum of plasma creatinine is de eerste keuze voor het evalueren van de nierfunctie in ieder klinisch-chemisch niveau, ligt de inter-laboratorium variabiliteit in <LOCATIE> ver onder de ##% Belangrijke verbetering in de creatinine assay was destijds de IDMS standaardisatie [Levey, ###] Als resultaat van voortdurende verbeteringen in de creatinine assays, zijn nu methoden beschikbaar waarmee selectief creatinine kan worden gemeten, met een hoge reproduceerbaarheid en kleine variatie De richtlijnwerkgroep beveelt hierbij het gebruik aan van de selectieve (veelal enzymatische) bepaling Enzymatische bepaling van creatinine is analytisch beter De CKD-EPI formule is een meer accurate methode om de GFR te schatten dan de MDRD formule De GFRschatting op basis van CKD-EPI kent desondanks een foutmarge De werkgroep vindt confirmatie van een afwijkende nierfunctie essentieel voor het stellen van de diagnose CNS Van CNS is sprake als er gedurende ten minste # maanden sprake is van een verminderde nierfunctie; de nierfunctie kan dan dus als afwijkend bevestigd worden in het kader van cardiovasculair risicomanagement of diabetes mellitus, zodat een vergelijking met de eerdere nierfunctie mogelijk is Bij een deel van de patiënten is er geen eerdere nierfunctie voorhanden De richtlijnwerkgroep vindt een tussenpoze van # maanden te lang voor het bevestigen van een nieuwe afwijkende nierfunctie omdat hierdoor acute nierschade gemist kan worden Bij deze groep patiënten adviseren we de nierfunctie binnen een week opnieuw te bepalen om acute nierschade tijdig op te sporen Bij patiënten met een eGFR tussen ## en ## ml/min/#,## m# , zonder additionele tekenen van en risicofactoren voor CNS, kan mogelijk sprake zijn van misclassificatie van verhoogd cardiovasculair risico door CNS, door onderschatting van de nierfunctie met de eGFR meting Bij deze groep patiënten zou aanvullende diagnostiek zinvol zijn In een dergelijk geval kan de nierfunctie op basis van cystatine C bepaald worden Echter momenteel is de bepaling in <LOCATIE> nog zeer beperkt beschikbaar en relatief duur en bovendien is er nog geen serum cystatine als nierfunctie marker is hiermee nog niet volledig uitgekristalliseerd Een alternatief is de ##uurs creatinineklaring, hoewel deze tijdrovend en vaak lastig uitvoerbaar is, en een overschatting van de nierfunctie geeft op basis van tubulaire secretie van creatinine Een tweede alternatief is consultatie van de Op basis van de lage analytische en biologische variabiliteit (totale analytische variatiecoëfficiënt ( #% en biologische variatie = <DATUM> ), is de serum of plasma creatinine test op zichzelf geschikt om minimale veranderingen te detecteren [Fraser, ###].
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kader van cardiovasculair risicomanagement of diabetes mellitus, zodat een vergelijking met de eerdere nierfunctie mogelijk is Bij een deel van de patiënten is er geen eerdere nierfunctie voorhanden De richtlijnwerkgroep vindt een tussenpoze van # maanden te lang voor het bevestigen van een nieuwe afwijkende nierfunctie omdat hierdoor acute nierschade gemist kan worden Bij deze groep patiënten adviseren we de nierfunctie binnen een week opnieuw te bepalen om acute nierschade tijdig op te sporen Bij patiënten met een eGFR tussen ## en ## ml/min/#,## m# , zonder additionele tekenen van en risicofactoren voor CNS, kan mogelijk sprake zijn van misclassificatie van verhoogd cardiovasculair risico door CNS, door onderschatting van de nierfunctie met de eGFR meting Bij deze groep patiënten zou aanvullende diagnostiek zinvol zijn In een dergelijk geval kan de nierfunctie op basis van cystatine C bepaald worden Echter momenteel is de bepaling in <LOCATIE> nog zeer beperkt beschikbaar en relatief duur en bovendien is er nog geen serum cystatine als nierfunctie marker is hiermee nog niet volledig uitgekristalliseerd Een alternatief is de ##uurs creatinineklaring, hoewel deze tijdrovend en vaak lastig uitvoerbaar is, en een overschatting van de nierfunctie geeft op basis van tubulaire secretie van creatinine Een tweede alternatief is consultatie van de Op basis van de lage analytische en biologische variabiliteit (totale analytische variatiecoëfficiënt ( #% en biologische variatie = <DATUM> ), is de serum of plasma creatinine test op zichzelf geschikt om minimale veranderingen te detecteren [Fraser, ###] respectievelijk #% en #%, wordt een betekenisvol oftewel âkritischâ verschil met ##% zekerheid gedetecteerd als de twee opeenvolgende creatinine metingen minimaal ##% verschillen, bijvoorbeeld als een uitslag van ### µmol/l tot minstens ### µmol/l toeneemt of een uitslag van ### µmol/l tot minstens ### µmol/l Bij een eGFR tot maximaal ## ml/min/#,## m# kan ook voor de eGFR (CKD-EPI m b v creatinine) in principe een kritisch verschil Leeftijd van de patiënt is gecorreleerd aan de nierfunctie en is ook van prognostische waarde De werkgroep beschouwt een eGFR ( ## ml/min/#,## m# als afwijkend voor patiënten van alle leeftijden De levensverwachting van de patiënt is wel een belangrijke factor voor het bepalen van het beleid bij een afwijkende Het is belangrijk om de mate van progressie in kaart te brengen, omdat de interventies die later besproken worden er op gericht zijn progressie af te remmen Dan moet dus duidelijk zijn wat normale progressie is en wanneer we spreken van te sterke progressie Daarbij dient men zich te realiseren dat er een bepaalde variatie bloedmonster is afgenomen (meer of minder gehydreerd) invloed heeft op de uitkomst Het vaststellen van progressie vereist daarom in feite meerdere metingen van de eGFR en bij voorkeur ook over een langere tijdsperiode In de algemene bevolking is vanaf het ## e levensjaar de achteruitgang in eGFR ongeveer #,# tot In een analyse van het <PERSOON>) van bijna ### ### mensen met minimaal #.
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oftewel âkritischâ verschil met ##% zekerheid gedetecteerd als de twee opeenvolgende creatinine metingen minimaal ##% verschillen, bijvoorbeeld als een uitslag van ### µmol/l tot minstens ### µmol/l toeneemt of een uitslag van ### µmol/l tot minstens ### µmol/l Bij een eGFR tot maximaal ## ml/min/#,## m# kan ook voor de eGFR (CKD-EPI m b v creatinine) in principe een kritisch verschil Leeftijd van de patiënt is gecorreleerd aan de nierfunctie en is ook van prognostische waarde De werkgroep beschouwt een eGFR ( ## ml/min/#,## m# als afwijkend voor patiënten van alle leeftijden De levensverwachting van de patiënt is wel een belangrijke factor voor het bepalen van het beleid bij een afwijkende Het is belangrijk om de mate van progressie in kaart te brengen, omdat de interventies die later besproken worden er op gericht zijn progressie af te remmen Dan moet dus duidelijk zijn wat normale progressie is en wanneer we spreken van te sterke progressie Daarbij dient men zich te realiseren dat er een bepaalde variatie bloedmonster is afgenomen (meer of minder gehydreerd) invloed heeft op de uitkomst Het vaststellen van progressie vereist daarom in feite meerdere metingen van de eGFR en bij voorkeur ook over een langere tijdsperiode In de algemene bevolking is vanaf het ## e levensjaar de achteruitgang in eGFR ongeveer #,# tot In een analyse van het <PERSOON>) van bijna ### ### mensen met minimaal # eGFR categorie plus een ##% achteruitgang van eGFR [Hemmelgarn, ###] De individuen met een zodanig overlijden en een #,## (#,#<DATUM> ##)-voudig verhoogd risico op noodzaak voor dialyse of transplantatie [Turin, ###a,b] In een daaropvolgende studie van het Chronic Kidney Disease Prognosis Consortium (CKD-PC) werd aangetoond dat een ##% achteruitgang in eGFR over een periode van <LEEFTIJD> jaar gepaard ging met een #,#-voudig (##% BI #,<DATUM> #) verhoogd risico op noodzaak voor dialyse of transplantatie en met een #,#-voudig (#,<DATUM> #) verhoogd risico om te overlijden [Coresh, ###] Het risico van een ##% daling van de eGFR was vergelijkbaar met het risico van het hebben van een eGFR achteruitgang van ) -# ml/min/# ##m# per jaar Een dergelijke respectievelijk de noodzaak voor dialyse of transplantatie en op overlijden Op grond van deze gegevens wordt voorgesteld een abnormale progressie te definiëren als een ##% afname van de eGFR plus categorie In de LTA chronische nierschade (###) werd uitgegaan van de termen micro-albuminurie en macroalbuminurie, terwijl de KDIGO richtlijn uitgaat van een indeling in normaal, matig verhoogd en ernstig verhoogd In de dagelijkse praktijk wordt met âde nierfunctieâ meestal de glomerulaire filtratiesnelheid (GFR) bedoeld, als maat voor de hoeveelheid functionerend nierweefsel Deze kan onder meer m b v formules worden geschat op basis van de plasma of serum creatinine concentratie, waarmee de âestimated GFRâ (eGFR) wordt verkregen Als afkappunt voor een verminderde nierfunctie wordt veelal een eGFR van ( ## ml/min/#,## m# gekozen Bij gezonde personen begint de GFR al af te nemen bij een leeftijd vanaf ca <LEEFTIJD> jaar Bij een belangrijk percentage.
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een zodanig overlijden en een #,## (#,#<DATUM> ##)-voudig verhoogd risico op noodzaak voor dialyse of transplantatie [Turin, ###a,b] In een daaropvolgende studie van het Chronic Kidney Disease Prognosis Consortium (CKD-PC) werd aangetoond dat een ##% achteruitgang in eGFR over een periode van <LEEFTIJD> jaar gepaard ging met een #,#-voudig (##% BI #,<DATUM> #) verhoogd risico op noodzaak voor dialyse of transplantatie en met een #,#-voudig (#,<DATUM> #) verhoogd risico om te overlijden [Coresh, ###] Het risico van een ##% daling van de eGFR was vergelijkbaar met het risico van het hebben van een eGFR achteruitgang van ) -# ml/min/# ##m# per jaar Een dergelijke respectievelijk de noodzaak voor dialyse of transplantatie en op overlijden Op grond van deze gegevens wordt voorgesteld een abnormale progressie te definiëren als een ##% afname van de eGFR plus categorie In de LTA chronische nierschade (###) werd uitgegaan van de termen micro-albuminurie en macroalbuminurie, terwijl de KDIGO richtlijn uitgaat van een indeling in normaal, matig verhoogd en ernstig verhoogd In de dagelijkse praktijk wordt met âde nierfunctieâ meestal de glomerulaire filtratiesnelheid (GFR) bedoeld, als maat voor de hoeveelheid functionerend nierweefsel Deze kan onder meer m b v formules worden geschat op basis van de plasma of serum creatinine concentratie, waarmee de âestimated GFRâ (eGFR) wordt verkregen Als afkappunt voor een verminderde nierfunctie wordt veelal een eGFR van ( ## ml/min/#,## m# gekozen Bij gezonde personen begint de GFR al af te nemen bij een leeftijd vanaf ca <LEEFTIJD> jaar Bij een belangrijk percentage gevonden Biopsie studies bij gezonde nierdonoren hebben aangetoond dat bij een belangrijk deel van deze patiënten nefrosclerose wordt gevonden, waarvan de ernst geassocieerd is met de mate van nierfunctieverlies [Rule, ###] CNS draagt bij aan een verhoging van het cardiovasculaire risico, waarbij is aangetoond dat het relatieve risico op cardiovasculaire mortaliteit bij ouderen minder sterk toeneemt bij lagere nierfunctie dan bij jongeren, maar dat het absolute risico in de oudere leeftijdsgroep juist sterker toeneemt [Hallan, ###] De LTA vermeldt nog dat de eGFR geschat dient te worden met gebruikmaking van de MDRD formule [Grauw, ###] De nadien gepubliceerde CKD-EPI formule is nauwkeuriger dan de MDRD formule om de GFR te schatten [Levey, ###] en is sterker geassocieerd met renale en cardiovasculaire uitkomsten dan de oudere MDRD formule [Matsushita, ###] Internationale richtlijnen adviseren daarom ook het gebruik van de CKD-EPI formule om de GFR te schatten Sinds ### hebben veel van de Nederlandse klinisch-chemische laboratoria de <PERSOON> CW Prime time for enzymatic creatinine methods in pediatrics <PERSOON> TC, Matsushita K et al Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of <PERSOON> JP, Delanghe JR Calibration and precision of serum creatinine and plasma cystatin C measurement impact on the estimation of glomerular filtration rate <PERSOON> AH et al Macroalbuminuria is a better risk marker than low estimated GFR to identify.
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Biopsie studies bij gezonde nierdonoren hebben aangetoond dat bij een belangrijk deel van deze patiënten nefrosclerose wordt gevonden, waarvan de ernst geassocieerd is met de mate van nierfunctieverlies [Rule, ###] CNS draagt bij aan een verhoging van het cardiovasculaire risico, waarbij is aangetoond dat het relatieve risico op cardiovasculaire mortaliteit bij ouderen minder sterk toeneemt bij lagere nierfunctie dan bij jongeren, maar dat het absolute risico in de oudere leeftijdsgroep juist sterker toeneemt [Hallan, ###] De LTA vermeldt nog dat de eGFR geschat dient te worden met gebruikmaking van de MDRD formule [Grauw, ###] De nadien gepubliceerde CKD-EPI formule is nauwkeuriger dan de MDRD formule om de GFR te schatten [Levey, ###] en is sterker geassocieerd met renale en cardiovasculaire uitkomsten dan de oudere MDRD formule [Matsushita, ###] Internationale richtlijnen adviseren daarom ook het gebruik van de CKD-EPI formule om de GFR te schatten Sinds ### hebben veel van de Nederlandse klinisch-chemische laboratoria de <PERSOON> CW Prime time for enzymatic creatinine methods in pediatrics <PERSOON> TC, Matsushita K et al Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of <PERSOON> JP, Delanghe JR Calibration and precision of serum creatinine and plasma cystatin C measurement impact on the estimation of glomerular filtration rate <PERSOON> AH et al Macroalbuminuria is a better risk marker than low estimated GFR to identify <PERSOON> Y, et al , Chronic Kidney Disease Prognosis Consortium <PERSOON> and association of kidney Hemmelgarn BR, <PERSOON> BJ et al Overview of the <PERSOON> K et al Slower decline of glomerular filtration rate in the Japanese general population a study equation for estimating glomerular filtration rate <PERSOON> LA, Schmid CH, et al , CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) A new equation to <PERSOON-##> RD, Tobin JD, Shock NW Association between blood pressure and the rate of decline in renal function with age <PERSOON-##> BK, Woodward M, et al for the CKD Prognosis Consortium Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate <PERSOON-##> LD et al Change in estimated GFR associates with coronary heart disease and mortality <PERSOON-##> JW, <PERSOON-##> JD et al <PERSOON-##> effect of age on creatinine clearance in men a crosssectional and longitudinal Rule AD, <PERSOON-##> LD, et al <PERSOON-##> association between age and nephrosclerosis on renal biopsy among healthy Slack TK, <PERSOON-##> DM Normal renal function CIN and CPAH in healthy donors before and after nephrectomy.
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<PERSOON> Y, et al , Chronic Kidney Disease Prognosis Consortium <PERSOON> and association of kidney Hemmelgarn BR, <PERSOON> BJ et al Overview of the <PERSOON> K et al Slower decline of glomerular filtration rate in the Japanese general population a study equation for estimating glomerular filtration rate <PERSOON> LA, Schmid CH, et al , CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) A new equation to <PERSOON> RD, Tobin JD, Shock NW Association between blood pressure and the rate of decline in renal function with age <PERSOON> BK, Woodward M, et al for the CKD Prognosis Consortium Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate <PERSOON> LD et al Change in estimated GFR associates with coronary heart disease and mortality <PERSOON> JW, <PERSOON-##> JD et al <PERSOON-##> effect of age on creatinine clearance in men a crosssectional and longitudinal Rule AD, <PERSOON-##> LD, et al <PERSOON-##> association between age and nephrosclerosis on renal biopsy among healthy Slack TK, <PERSOON-##> DM Normal renal function CIN and CPAH in healthy donors before and after nephrectomy Welke stadiumindeling wordt aanbevolen voor het indelen van chronische nierschade? Voor het stadiëren van chronische nierschade en het bepalen van het risico op cardiovasculaire schade, progressie van nierschade en mortaliteit wordt aanbevolen de onderstaande tabel (tabel #) te gebruiken De kleurcodering in deze tabel is gebaseerd op het relatieve risico op overlijden, cardiovasculaire eindpunten, het optreden van acute nierschade en eindstadium nierfalen De percentages in de legenda bij de kleurcoderingen geven de prevalentie in de algemene bevolking weer (zoals gevonden in het PREVEND Tabel # Stadiëring van chronische nierschade op basis van eGFR en albumine/creatinine ratio en De werkgroep is van mening dat de indeling zoals die aanbevolen wordt in de KDIGO richtlijn de voorkeur geniet, zodat de behandeling gericht kan worden op het verlagen van het risico op cardiovasculaire (en renale) De kans op cardiovasculair lijden en het ontstaan van eindstadium nierfalen is (sterk) verhoogd bij mensen met CNS ten opzichte van mensen zonder CNS Voor het relatief risico op cardiovasculair overlijden is dit een factor #,#â#,# in geval van mild verhoogd risico (geel), een factor #,<DATUM> in geval van een matig verhoogd risico (oranje) en een factor ) # in geval van een sterk verhoogd risico (rood) Voor het risico op het optreden van eindstadium nierfalen is dit een factor #-## in geval van mild verhoogd risico (geel), een factor ##-## in geval van een matig verhoogd risico (oranje) en een factor ) ## in geval van een sterk verhoogd risico (rood).
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stadiumindeling wordt aanbevolen voor het indelen van chronische nierschade? Voor het stadiëren van chronische nierschade en het bepalen van het risico op cardiovasculaire schade, progressie van nierschade en mortaliteit wordt aanbevolen de onderstaande tabel (tabel #) te gebruiken De kleurcodering in deze tabel is gebaseerd op het relatieve risico op overlijden, cardiovasculaire eindpunten, het optreden van acute nierschade en eindstadium nierfalen De percentages in de legenda bij de kleurcoderingen geven de prevalentie in de algemene bevolking weer (zoals gevonden in het PREVEND Tabel # Stadiëring van chronische nierschade op basis van eGFR en albumine/creatinine ratio en De werkgroep is van mening dat de indeling zoals die aanbevolen wordt in de KDIGO richtlijn de voorkeur geniet, zodat de behandeling gericht kan worden op het verlagen van het risico op cardiovasculaire (en renale) De kans op cardiovasculair lijden en het ontstaan van eindstadium nierfalen is (sterk) verhoogd bij mensen met CNS ten opzichte van mensen zonder CNS Voor het relatief risico op cardiovasculair overlijden is dit een factor #,#â#,# in geval van mild verhoogd risico (geel), een factor #,<DATUM> in geval van een matig verhoogd risico (oranje) en een factor ) # in geval van een sterk verhoogd risico (rood) Voor het risico op het optreden van eindstadium nierfalen is dit een factor #-## in geval van mild verhoogd risico (geel), een factor ##-## in geval van een matig verhoogd risico (oranje) en een factor ) ## in geval van een sterk verhoogd risico (rood) De NICE richtlijn en KDIGO richtlijn gaan uit van een indeling op basis van cardiovasculair risico welke is gebaseerd op nierfunctie (ingedeeld in # stadia) en nog een uitzonderingspositie aan voor jongvolwassenen, in tegenstelling tot de KDIGO richtlijn Welke factoren worden betrokken in de evaluatie van de oorzaak van chronische nierschade en welke groepen Om een oorzaak van chronische nierschade aan te tonen dient, naast de reguliere beoordeling van anamnese en naar specifieke ziekten, echografie van de nieren en/of een nierbiopsie te worden overwogen Jaarlijkse screening op chronische nierschade wordt aanbevolen in geval van diabetes mellitus, hypertensie, CNS met mild tot matig verhoogd risico leidt meestal niet tot klachten en wordt dus meestal niet opgespoord, tenzij er bewust op wordt gescreend Omdat er ook bij mensen met beginnende CNS vaak wel noodzaak voor behandeling bestaat is het gewenst eventuele CNS tijdig op te sporen Die diagnostiek is met name gewenst bij mensen met risicofactoren op CNS Dit geldt met name voor mensen met diabetes mellitus, mensen met hypertensie en mensen met een positieve cardiovasculaire familiegeschiedenis Het advies om deze mensen jaarlijks te screenen op CNS is ook opgenomen in de NHG Standaard Cardiovasculair risicomanagement en de Het is ook gewenst andere patiënten met een verhoogd risico op het ontstaan van CNS te screenen op aanwezigheid van CNS, zoals patiënten met systeemziekten zoals SLE, patiënten met urologische problematiek zoals recidiverende pyelonefritis, of een status na anti-reflux operaties of nefrectomie, en patiënten met een Of naast deze reeds geaccepteerd hoogrisicogroepen nog andere hoogrisicogroepen gedefinieerd moeten.
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gaan uit van een indeling op basis van cardiovasculair risico welke is gebaseerd op nierfunctie (ingedeeld in # stadia) en nog een uitzonderingspositie aan voor jongvolwassenen, in tegenstelling tot de KDIGO richtlijn Welke factoren worden betrokken in de evaluatie van de oorzaak van chronische nierschade en welke groepen Om een oorzaak van chronische nierschade aan te tonen dient, naast de reguliere beoordeling van anamnese en naar specifieke ziekten, echografie van de nieren en/of een nierbiopsie te worden overwogen Jaarlijkse screening op chronische nierschade wordt aanbevolen in geval van diabetes mellitus, hypertensie, CNS met mild tot matig verhoogd risico leidt meestal niet tot klachten en wordt dus meestal niet opgespoord, tenzij er bewust op wordt gescreend Omdat er ook bij mensen met beginnende CNS vaak wel noodzaak voor behandeling bestaat is het gewenst eventuele CNS tijdig op te sporen Die diagnostiek is met name gewenst bij mensen met risicofactoren op CNS Dit geldt met name voor mensen met diabetes mellitus, mensen met hypertensie en mensen met een positieve cardiovasculaire familiegeschiedenis Het advies om deze mensen jaarlijks te screenen op CNS is ook opgenomen in de NHG Standaard Cardiovasculair risicomanagement en de Het is ook gewenst andere patiënten met een verhoogd risico op het ontstaan van CNS te screenen op aanwezigheid van CNS, zoals patiënten met systeemziekten zoals SLE, patiënten met urologische problematiek zoals recidiverende pyelonefritis, of een status na anti-reflux operaties of nefrectomie, en patiënten met een Of naast deze reeds geaccepteerd hoogrisicogroepen nog andere hoogrisicogroepen gedefinieerd moeten De aanwezigheid van CNS is over het algemeen gebaseerd op een verlaagde eGFR en/of een verhoogde albuminurie Deze # parameters zeggen niets over de oorzaak van de chronische nierschade Omdat de prognose van chronische nierschade mede afhankelijk is van de oorzaak, is vaak nadere diagnostiek gewenst Dat onderzoek begint met een anamnese, inclusief een familieanamnese, en vragen over eventueel gebruikte medicatie Bij het aanvullend laboratoriumonderzoek heeft onderzoek op erythrocyturie een belangrijke plaats Kwalitatieve urineteststroken kunnen een indicatie geven of er sprake is van erythrocyturie In deze gevallen dient het bestaan van hematurie te worden bevestigd door microscopisch onderzoek van het urinesediment [<PERSOON>, ###] Het sediment dient daarbij âversâ te zijn, dat wil zeggen bij voorkeur niet ouder dan twee uur Middels herhaling bestaande hematurie kan op urologische en/of nefrologische problemen wijzen Als er in geval van hematurie sprake is van monomorfe erytrocyturie dienen patiënten verwezen te worden naar de uroloog Bij dysmorfe erytrocyturie ()##% dysmorfe erytrocyten bij ten minste ## erytrocyten/µl) en/of aanwezigheid van erytrocyten cilinders, zeker in combinatie met eiwitverlies in de urine en/of hypertensie, is verwijzing naar de Glomerulaire hematurie is een onafhankelijke risicofactor voor het optreden van eindstadium nierinsufficiëntie [<PERSOON>, ###] Echter, een daling van de GFR wordt in het algemeen alleen gezien bij patiënten met hematurie en reeds bestaande nierschade of bij patiënten die tijdens follow-up proteïnurie ontwikkelen [<PERSOON>, ###; <PERSOON>, ###] Bij patiënten bij wie glomerulaire hematurie wordt gevonden, moet daarom nader onderzoek.
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CNS is over het algemeen gebaseerd op een verlaagde eGFR en/of een verhoogde albuminurie Deze # parameters zeggen niets over de oorzaak van de chronische nierschade Omdat de prognose van chronische nierschade mede afhankelijk is van de oorzaak, is vaak nadere diagnostiek gewenst Dat onderzoek begint met een anamnese, inclusief een familieanamnese, en vragen over eventueel gebruikte medicatie Bij het aanvullend laboratoriumonderzoek heeft onderzoek op erythrocyturie een belangrijke plaats Kwalitatieve urineteststroken kunnen een indicatie geven of er sprake is van erythrocyturie In deze gevallen dient het bestaan van hematurie te worden bevestigd door microscopisch onderzoek van het urinesediment [<PERSOON>, ###] Het sediment dient daarbij âversâ te zijn, dat wil zeggen bij voorkeur niet ouder dan twee uur Middels herhaling bestaande hematurie kan op urologische en/of nefrologische problemen wijzen Als er in geval van hematurie sprake is van monomorfe erytrocyturie dienen patiënten verwezen te worden naar de uroloog Bij dysmorfe erytrocyturie ()##% dysmorfe erytrocyten bij ten minste ## erytrocyten/µl) en/of aanwezigheid van erytrocyten cilinders, zeker in combinatie met eiwitverlies in de urine en/of hypertensie, is verwijzing naar de Glomerulaire hematurie is een onafhankelijke risicofactor voor het optreden van eindstadium nierinsufficiëntie [<PERSOON>, ###] Echter, een daling van de GFR wordt in het algemeen alleen gezien bij patiënten met hematurie en reeds bestaande nierschade of bij patiënten die tijdens follow-up proteïnurie ontwikkelen [<PERSOON>, ###; <PERSOON>, ###] Bij patiënten bij wie glomerulaire hematurie wordt gevonden, moet daarom nader onderzoek nierfunctie) plaatsvinden Patiënten met hematurie en verhoogde albuminurie of verminderde nierfunctie dienen Om een antwoord te krijgen op deze uitgangsvraag is gebruik gemaakt van de KDIGO-richtlijn en is op basis van consensus een aanbeveling geformuleerd door de werkgroep [<PERSOON> RS Clinical practice Microscopic hematuria <PERSOON> JF Glomerular haematuria not so benign? Neth J Med ###; ## #<DATUM> Hoe moeten patiënten worden voorgelicht over chronische nierschade en gevolgen daarvan met betrekking tot medicatie (nieuwe medicatie en medicijnen die nierschade veroorzaken met speciale aandacht voor medicijnen die vrij verkrijgbaar zijn (zoals NSAIDâs), en wanneer dosisaanpassing nodig is (bijvoorbeeld bij wettelijke verplichting van doorgeven van de nierfunctie door de arts aan de apotheker en de rol die de patiënt zelf heeft om ervoor te zorgen dat zijn zorgverleners op de hoogte zijn van de nierfunctie van de De werkgroep vindt het belangrijk dat patiënten de juiste informatie krijgen over nieuwe medicatie en medicatie die nierschade veroorzaakt Voorlichtingsmateriaal moet goed op elkaar afgestemd zijn Voorlichtingsmateriaal Het is wettelijk verplicht dat de zorgverlener die een recept uitschrijft bij een patiënt met CNS op het recept een Voor de beantwoording van deze uitgangsvraag heeft de werkgroep zich gebaseerd op eigen ervaringen en groepsdiscussie, gericht op consensus Hierbij is gebruik gemaakt van reeds bestaand voorlichtingsmateriaal Op welke wijze kan zelfmanagement bij patiënten met chronische nierschade worden gestimuleerd? De werkgroep adviseert bij patiënten met chronische nierschade gebruik te maken van de Zorgmodule.
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