Contrast-induced Nephropathy Clinical Trial
Official title:
Using Preprocedural Urine NMR-Based Metabolomics Analysis to Prediction the Risk of Contrast Induced Nephropathy Following Elective Coronary Angiography
The use of coronary intervention has increased over the last decade. Contrast induced
nephropathy (CIN) that develops as a result of procedures using intravenous or intra arterial
contrast enhancement, or other diagnostic procedures, has been reported to be the third
leading cause of acute renal failure in hospitalized patients. It has been hypothesized that
this occurs as a result of direct toxicity, oxidative stress, and ischemic injury. Numerous
studies have evaluated the incidence of CIN in patients undergoing angiography. There are
limited studies in the acute care setting. Therefore, a tool that could identify early risk
factors for CIN would be valuable for patient care.
Metabolomic profiling is the identification of small molecule metabolites that are altered in
response to injury. We hypothetize that urine metabolomic profiles may differ in patients
before and after contrast administration coronary intervention.We hypothesized that
metabolomic profiles will differ between those patients who develop CIN and those who do not
after contrast administration. In addition we believe that metabolomics profiles prior to
angiography may identify subjects who will go on to develop CIN and are therefore at higher
risk.
The specific aim of this pilot study is to determine if metabolomics profiles differ in
patients who develop CIN after contrast administration for coronary angiography versus those
who do not. Additionally, our goal was to identify specific urinary metabolites that warrant
further investigation.This is a pilot study of prospectively identified patients undergoing a
coronary intervention with intraarterial contrast during their evaluation. The study was
approved by the University of Shahid Beheshti, Medical institutional review boards.
100 number of patients were enrolled. To be eligible for the study, patients had to be >18
years old, undergoing coronary angiography and have at least 1 of the following high risk
features for CIN: diabetes, coronary artery disease, congestive heart failure. Past medical
history was confirmed by chart review if available, or patient report.
Patients were excluded from the study if they had an estimated glomerular filtration rate <15
mL/min/1.73 m2, a history of organ transplantation, were currently on immunosuppressive
medications, were septic or on antibiotic therapy, had a history of or were currently
receiving dialysis of any type, had an exposure to iodinated contrast within 3 days prior to
the study, or had multiple doses of contrast given.
Patients were managed according to the treating provider recommendations. No intervention was
requested as part of this study. There was no institutional standard for mandatory fluid
administration or use of N-acetylcysteine prior to elective coronary angiography.All patients
received approximately 60 mili Liter of intravenous iodinated contrast material that was
administered via computer-controlled automated power injector at 4 mL per second.
data were collected prospectively after patients were identified as fulfilling inclusion and
exclusion criteria, and informed consent was obtained. Data collection included ,
demographics, dietary history, medical history, physical examination, and electrocardiogram
findings, as documented by the treating emergency physician. Medical history was confirmed
through patient self-report and review of the medical record when available. Medications
administered before arrival were also recorded. No additional laboratory tests were mandated
as a part of the trial study and the treating physician ordered all tests, except urinary
metabolomics analysis, according to their clinical judgment. Urine samples were collected as
a midstream sample or via a foley bag prior to angiography and 12 hours post imaging. Samples
were aliquoted into 2 mL samples and frozen at -80˚C.
Serum creatinine levels were recorded at presentation, and at 24 and 72 hours. The outcome
measure was the presence CIN, which was defined as an increase in serum creatinine level of
≥0.5 mg/dL above baseline within 72 hours after contrast administration.
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