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Title:Kontrastna nefropatija po koronarni arteriografiji ali angioplastiki - incidenca in vpliv askorbinske kisline na zmanjšanje incidence.
Authors:ID Dvoršak, Benjamin (Author)
ID Hojs, Radovan (Mentor) More about this mentor... New window
Files:.pdf DR_Dvorsak_Benjamin_2014.pdf (12,27 MB)
MD5: 5C1243C96E5F744862415A96E4C951AD
 
Language:Slovenian
Work type:Dissertation
Organization:MF - Faculty of Medicine
Abstract:Uvod Za kontrastno nefropatijo je značilna akutna ledvična odpoved ali poslabšanje kronične ledvične odpovedi po vnosu jodiranih rentgenskih kontrastnih sredstev v kri. Kontrastna nefropatija je tretji najpogostejši vzrok akutne ledvične odpovedi nastale v bolnišnici, povezana je z večjo intrahospitalno in dolgoročno obolevnostjo in umrljivostjo ter s podaljšanjem trajanja hospitalizacije. Raziskave so pokazale, da je za zmanjšanje tveganja za nastanek kontrastne nefropatije učinkovita intravenska hidracija pred radiokontrastno preiskavo s fiziološko raztopino ali raztopino natrijevega bikarbonata. Za dodatno zmanjšanje tveganja so raziskovali vpliv vazodilatatorjev in antioksidantov. Raziskave o vplivu antioksidanta N-acetilcisteina na incidenco kontrastne nefropatije so dale precej neenotne rezultate. Malo pa je raziskav o vplivu askorbinske kisline, vitamina z antioksidantnim delovanjem. Bolniki in metode Opravili smo randomizirano, s placebom kontrolirano, prospektivno raziskavo o incidenci kontrastne nefropatije in o vplivu askorbinske kisline na incidenco kontrastne nefropatije po koronarni arteriografiji ali angioplastiki pri bolnikih z zmanjšanim ledvičnim delovanjem. Dodatno smo ugotavljali prevalenco zmanjšanega ledvičnega delovanja pri bolnikih pred opravljeno koronarno arteriografijo ali angioplastiko (serumska koncentracija kreatinina nad 107 mol/l). Vključili smo 81 bolnikov s serumsko koncentracijo kreatinina pred preiskavo nad 107 mol/l, ki so imeli opravljeno koronarno arteriografijo ali angioplastiko. Po randomizaciji je 40 bolnikov prejelo 3 grame askorbinske kisline oralno vsaj 2 uri pred preiskavo, 2 grama askorbinske kisline zvečer po preiskavi in 2 grama askorbinske kisline naslednje jutro. Placebo je prejelo 41 bolnikov. Vsi bolniki so prejemali intravensko infuzijo fiziološke raztopine 50 do 100 ml/uro vsaj 2 uri pred preiskavo in vsaj 6 ur po preiskavi. Kriterij za kontrastno nefropatijo je bil porast serumskega kreatinina 3. do 4. dan po preiskavi za vsaj 25 % ali porast serumske koncentracije cistatina C za vsaj 25 % nad vrednost pred preiskavo. Rezultati Pri bolnikih, ki so imeli v obdobju raziskave opravljeno koronarno arteriografijo ali angioplastiko je znašala prevalenca zmanjšanega ledvičnega delovanja pred preiskavo 24,7 %. Kontrastna nefropatija je bila prisotna pri 5/81 bolnikov (6,2 %). Incidenca kontrastne nefropatije je bila 3 % v skupini, ki je prejela askorbinsko kislino in 7,3 % v kontrolni skupini. Razlika ni bila statistično pomembna (p= 0,512). Če je bil kriterij za kontrastno nefropatijo porast serumskega cistatina C po preiskavi za vsaj 25 %, je bila le-ta prisotna pri ravno tako 5 bolnikih. Bolnike smo razdelili še v skupini z zvišanjem ali znižanjem serumske koncentracije kreatinina po preiskavi glede na vrednost pred preiskavo. Zvišanje serumske koncentracije kreatinina je bilo prisotno pri 10/81 (12,3 %) bolnikov, ki so prejeli askorbinsko kislino in pri 19/81 (23,4 %) bolnikov v kontrolni skupini. Razlika je bila statistično značilna (p= 0,038). Bolniki s kontrastno nefropatijo so bili, v primerjavi z bolniki brez kontrastne nefropatije, pogosteje moški, imeli so večjo povprečno telesno težo, bili so starejši, pred preiskavo so imeli v povprečju višji serumski kreatinin, cistatin C in nižjo ocenjeno glomerulno filtracijo, med preiskavo so v povprečju prejeli več kontrastnega sredstva. Vendar razlika med skupinama glede teh parametrov ni bila statistično pomembna. Nobeden od bolnikov s kontrastno nefropatijo ni potreboval nadomestnega dializnega zdravljenja. Zaključki Z raziskavo nismo ugotovili statistično pomembnega vpliva askorbinske kisline na zmanjšanje incidence kontrastne nefropatije po koronarni arteriografiji pri bolnikih z zmanjšanim ledvičnim delovanjem. Nakazuje pa se zaščitni vpliv askorbinske kisline, ki se kaže z manjšo incidenco poslabšanja ledvičnega delovanja po preiskavi v zdravljeni skupini bolnikov.
Keywords:rentgenska kontrastna sredstva, kontrastna nefropatija, akutna ledvična odpoved, koronarna angiografija, askorbinska kislina
Place of publishing:Maribor
Year of publishing:2014
PID:20.500.12556/DKUM-43512 New window
COBISS.SI-ID:512369208 New window
NUK URN:URN:SI:UM:DK:FKT50GXG
Publication date in DKUM:11.02.2014
Views:2814
Downloads:160
Metadata:XML RDF-CHPDL DC-XML DC-RDF
Categories:MF
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Secondary language

Language:English
Title:Contrast-induced nephropathy after coronary angiography or angioplasty – incidence and impact of ascorbic acid on reduction of incidence.
Abstract:Introduction Contrast-induced nephropathy is characterized by reduction of renal function after intravascular aplication of radiographic contrast media. Contrast-induced nephropathy is the third most common cause of hospital-acquired renal failure, it is associated with prolonged hospital stay, increased morbidity and mortality. It is well documented that periprocedural hydration with intravenous infusion of normal saline or sodium bicarbonate is effective in prevention of contrast-induced nephropathy. For further risk reduction action of vasodilating and antioxidant agents have been investigated. There is conflicting evidence suggesting that antioxidant N-acetylcysteine is effective in prevention of contrast-induced nephropathy. Little data exist on effectiveness of ascorbic acid, a vitamin with antioxidative action. Patients and methods We conducted a randomized, double-blind, placebo-controlled prospective trial on incidence of contrast-induced nephropathy and impact of ascorbic acid on incidence of contrast-induced nephropathy in patients with renal dysfunction after coronary arteriography or angioplasty. 81 patients with stable serum creatinine level >107 mol/l were randomized to receive either ascorbic acid or placebo in 500 mg capsules 3 g orally before the procedure and 2 g after the procedure in the evening and the next morning. There were 40 patients in the ascobic acid group and 41 patients in the placebo group. All the patients received intravenous volume expansion with normal saline 50 to 100 ml/h for 2 hours before the procedure and for at least 6 hours afterward. Contrast-induced nephropathy was defined as an increase of serum creatinine >25 % from baseline or increase of serum cistatin C >25 % from baseline measured 3 to 4 days after the procedure. Results Contrast-induced nephropathy occurred totally in 5/81 patients (6,2 %); in 2 patients (3 %) in the ascorbic acid group and in 3 patients (7,3 %) in the placebo group. There was no statistically significant difference between the groups. Contrast-induced nephropathy occurred in 5/81 patients as well when defined as an increase of serum cistatin C >25 %. Postprocedural worsening of renal function (postprocedural increase of serum creatinine level) was present in 10/81 patients (12,3 %) in the ascorbic acid group and in 19/81 patients (23,4 %) in the placebo group. Difference was statistically significant (p= 0,038). Patients with contrast-induced nephropathy were more often men, they were older, heavier, they had higher preprocedural serum creatinine, cistatin C and lower estimated glomerular filtration rate and they received higher amount of contrast media compared with patients without contrast-induced nephropathy. Difference between the groups regarding those parameters was not statistically significant. No patient required dialysis treatment. Conclusions We found no statistically significant impact of ascorbic acid on incidence of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary arteriography or angioplasty. Ascorbic acid may has some protective role in contrast-induced nephropathy reflected in lower incidence of worsening of renal function in treated group.
Keywords:contrast media, contrast-induced nephropathy, renal insufficiency, coronary angiography, ascorbic acid


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