Correction to: National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort
Claudio ParcoMaximilian BrockmeyerLucin KosejianJulia QuadeJennifer TröstlerSelina BaderYingfeng LinAlexander SokolowskiAlexander HossYvonne HeinenVolker SchulzeAndrea IcksChristian JungMalte KelmGeorg Wolff
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Contrast-Induced Nephropathy
Nephrology
Nephrology
Renal replacement therapy
Dialysis Therapy
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<i>Background:</i> Some patients who reach end-stage renal disease refuse to start dialysis at the time suggested by their nephrologist and delay it. Whether this delay may affect health-related quality of life (HRQoL), clinical and biological parameters at dialysis onset, and then survival and hospitalization during dialysis is unknown. <i>Methods:</i> We considered all adult patients who began dialysis in Lorraine (France) in 2005–2006 having previously been followed by a nephrologist. Clinical and biological characteristics at dialysis onset were collected from medical records, and nephrologists were interviewed about compliance with the recommended starting date. HRQoL was measured using the French version of the ‘Kidney Disease Quality of Life’ V36 questionnaire. Mortality and total duration of hospitalization during the first year of dialysis were recorded as part of the end-stage renal disease French registry. The effects of delaying dialysis on survival and on duration of hospitalization were determined using log-rank test and polychotomous logistic regression, respectively. <i>Results:</i> Of 541 patients, 88 (16.3%) declined to initiate dialysis at the time recommended by the nephrologist and delayed it. Compared with patients who were compliant with the advice, noncompliers had more comorbidities, poorer clinical and biological profiles at dialysis start, and a higher risk of beginning dialysis in emergency circumstances with greater decline in the ‘burden of kidney disease’ dimension of HRQoL. However, there were no differences in survival or duration of hospitalization during dialysis. <i>Conclusion:</i> Despite a negative effect on clinical and biological parameters at initiation, delaying dialysis did not impact on survival during treatment.
Nephrology
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Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis. This is in contrast to the nephrology professionals' opinion about the best dialysis therapy and their potential choice in the hypothetical situation of choosing a dialysis modality for themselves. Pre-dialysis education changes the distribution of dialysis modality significantly, as 50% of informed patients choose home dialysis. Close collaboration among nephrology professionals, patients and providers is required to make home therapy a reality for any interested patient.
Nephrology
Home dialysis
Renal replacement therapy
Home hemodialysis
Treatment modality
Modalities
Modality (human–computer interaction)
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Background and Objectives:Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality in coronary angiography. Although the mechanism is unclear, N-acetylcysteine (NAC) is known to protect against CIN. Preliminary studies with NAC have found conflicting results for the prevention of CIN in patients undergoing coronary angiography. This study was designed to evaluate the efficacy and safety of NAC for the prevention of CIN in patients undergoing coronary angiography. Subjects and Methods:48 patients with chronic renal insufficiency (mean (±SD) serum creatinine concentration, 2.06±0.56 mg/dL), who were undergoing coronary angiography with a nonionic, low-osmolar contrast agent, were prospectively studied. Pa- tients were randomly assigned to receive either the antioxidant, NAC (600 mg orally twice daily), and 0.45% saline intravenously (n=25), before and after administration of contrast agents, or saline only (n=23). The renal function parameters were assessed 48 hour before and after radiocontrast media administration. Results:14 of the 48 patients (29%) showed an increase in the 0.5 mg/dL serum creatinine concentration after 48 hours of contrast media administration: 4 of the 25 patients in the NAC group (16%) and 10 of the 23 in the control group (43%; p=0.036; relative risk, 0.37; 95% confidence interval, 1.04 to 7.79). In the NAC group, the mean serum creatinine concentration insignificantly increased (p=0.54), from 2.2±0.8 to 2.3±0.9 mg/dL, after 48 hours of contrast media administration; whereas, in the control group, the mean serum creatinine concentration significantly increased (p=0.011), from 1.9±0.4 to 2.2±0.8 mg/dL. The absolute change in serum creatinine concentration was significantly greater in the control than the NAC group (p=0.044). Conclusion:Prophylac- tic oral administration of the antioxidant NAC, along with hydration, prevents the decrease in the renal func- tion induced by a nonionic, low-osmolality contrast agent in patients with chronic renal insufficiency. (Korean Circulation J 2005;35:696-701)
Contrast-Induced Nephropathy
Nephrotoxicity
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Nephrology
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Nephrology
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Objective:To determine whether hydration with reduced glutathione is superior to hydration for the prevention of contrast-induced nephropathy(CIN)in elderly patients undergoing coronary angiography in our prospective randomized controlled clinical study. Methods:505 patients aged ≥75 years were randomly divided into treatment group receiving hydration with reduced glutathione(n=262)and control group with hydration(n=243).Serum creatinine was measured prior to the procedure and 48 h after coronary angiography.The primary endpoint was occurrence of CIN defined as25 % above baseline or 44.2μmol/L in serum creatinine 48 h after the procedure. Results:The overall incidence of CIN was 6.49 % in treatment group versus 7.41 % in control group(P=0.68).In the subgroup analysis by percutaneous coronary intervention(PCI),no statistically significant differences were found between the two groups. Conclusion:Reduced glutathione added to optimal hydration does not seem to further reduce the risk of CIN in elderly patients undergoing coronary angiography.
Contrast-Induced Nephropathy
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Contrast-Induced Nephropathy
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STARRT recently demonstrated that many patients experience suboptimal dialysis starts (defined as initiation as an inpatient and/or with a central venous catheter), even when followed by a nephrologist for >12 months (NDT 2011). However, STARRT did not identify the factors associated with suboptimal initiation of dialysis. The objectives of this study were to extend the results of STARRT by ascertaining the factors leading to suboptimal initiation of dialysis in patients who were referred at least 12 months prior to commencement of dialysis. At each of the three Toronto centers, charts of consecutive incident RRT patients were identified from 1 January 2009 to 31 December 2010, with predetermined data extracted. A total of 436 incident RRT patients were studied; 52.4% were followed by a nephrologist for >12 months prior to the initiation of dialysis. Suboptimal starts occurred in 56.4% of these patients. No attempt at arteriovenous fistula (AVF) or arteriovenous graft (AVG) prior to initiation was made in 65% of these starts. Factors contributing to suboptimal starts despite early referral included patient-related delays (31.25%), acute-on-chronic kidney disease (31.25%), surgical delays (16.41%), late decision-making (8.59%) and others (12.50%). The percentage of optimal starts with early referral among 14 nephrologists ranged from 33 to 72%. Most patients started dialysis in a suboptimal manner, despite an extended period of pre-dialysis care. Nephrologists should take responsibility for suboptimal initiation of dialysis despite early referral and test methods that attempt to prevent this.
Nephrology
Central venous catheter
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Contrast-Induced Nephropathy
Acute tubular necrosis
Neutrophil gelatinase-associated lipocalin
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