Systemic and renal hemodynamic effects of intra-arterial radiocontrast

Intensive Care Medicine Experimental - 2014
Paolo Calzavacca1, Ken Ishikawa2, Michael Bailey3, Clive N. May2, Rinaldo Bellomo4
1Department of Anaesthesia and Intensive Care, Uboldo Hospital, Vi aUboldo 21, Milano, 20063, Cernusco sul Naviglio, Italy
2The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, 156 Grattan St, Melbourne, 3010, Parkville, Australia
3Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
4Department of Intensive Care and Department of Medicine, Austin Hospital and The University of Melbourne, 145 Studley Rd, Heidelberg, 3084, Melbourne, Australia

Tóm tắt

Abstract Background Decreased renal blood flow (RBF) and vasoconstriction are considered major mechanisms of contrast-induced acute kidney injury (CIAKI). To understand the severity and duration of such putative effects, we measured systemic and renal hemodynamics after intra-arterial radiocontrast administration. The subjects were six Merino ewes. The setting was a university-affiliated research institute. This is a randomized cross-over experimental study. Methods Transit-time flow probes were implanted on the pulmonary and left renal arteries 2 weeks before experimentation. We simulated percutaneous coronary intervention by administering five intra-arterial boluses of 0.5 mL/kg saline (control) or radiocontrast (iodixanol) to a total of 2.5 mL/kg over 1 h. Cardiac output (CO), heart rate, mean arterial pressure (MAP), RBF, renal vascular conductance (RVC), urine output (UO), creatinine clearance (CrCl), and fractional excretion of sodium (FENa) were measured. Results In the first 8 h after intra-arterial administration of radiocontrast, CO, total peripheral conductance (TPC), and heart rate (HR) increased compared with those after normal saline administration. Thereafter, CO and TPC were similar between the two groups, but HR remained higher with radiocontrast (p < 0.001). After a short (30 min) period of renal vasoconstriction with preserved RBF secondary to an associated increase in MAP, RBF and RVC showed an earlier and greater increase (vasodilatation) with radiocontrast (p < 0.001) and remained higher during the first 2 days. Radiocontrast initially increased urine output (p < 0.001) and FENa (p = 0.003). However, the overall daily urine output decreased in the radiocontrast-treated animals at 2 days (p < 0.001) and 3 days (p = 0.006). Creatinine clearance was not affected. Conclusions In healthy animals, intra-arterial radiocontrast increased RBF, induced renal vasodilatation, and caused a delayed period of oliguria. Our findings suggest that sustained reduction in RBF and renal vasoconstriction may not occur in normal large mammals after intra-arterial radiocontrast administration.

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Tài liệu tham khảo

Barrett BJ, Parfrey PS, Vavasour HM, McDonald J, Kent G, Hefferton D, O'Dea F, Stone E, Reddy R, McManamon PJ: Contrast nephropathy in patients with impaired renal function: high versus low osmolar media. Kidney Int 1992, 41: 1274–1279. 10.1038/ki.1992.189

Briguori C, Tavano D, Colombo A: Contrast agent–associated nephrotoxicity. Prog Cardiovasc Dis 2003, 45: 493–503. 10.1053/pcad.2003.YPCAD16

McCullough PA, Soman SS: Contrast-induced nephropathy. Crit Care Clin 2005, 21: 261–280. 10.1016/j.ccc.2004.12.003

Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, Hill JA, Winniford M, Cohen MB, VanFossen DB: Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int 1995, 47: 254–261. 10.1038/ki.1995.32

Solomon R: Contrast-medium-induced acute renal failure. Kidney Int 1998, 53: 230–242. 10.1038/sj.ki.4495510

Solomon R, Werner C, Mann D, D'Elia J, Silva P: Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994, 331: 1416–1420. 10.1056/NEJM199411243312104

Taliercio CP, Vlietstra RE, Ilstrup DM, Burnett JC, Menke KK, Stensrud SL, Holmes DR Jr: A randomized comparison of the nephrotoxicity of iopamidol and diatrizoate in high risk patients undergoing cardiac angiography. J Am Coll Cardiol 1991, 17: 384–390. 10.1016/S0735-1097(10)80103-2

Haller C, Hizoh I: The cytotoxicity of iodinated radiocontrast agents on renal cells in vitro. Invest Radiol 2004, 39: 149–154. 10.1097/01.rli.0000113776.87762.49

Hizoh I, Haller C: Radiocontrast-induced renal tubular cell apoptosis: hypertonic versus oxidative stress. Invest Radiol 2002, 37: 428–434. 10.1097/00004424-200208000-00003

Moreau JF, Droz D, Noel LH, Leibowitch J, Jungers P, Michel JR: Tubular nephrotoxicity of water-soluble iodinated contrast media. Invest Radiol 1980, 15: S54-S60. 10.1097/00004424-198011001-00014

Deray G, Bagnis C, Jacquiaud C, Dubois M, Adabra Y, Jaudon C: Renal effects of low and isoosmolar contrast media on renal hemodynamic in a normal and ischemic dog kidney. Invest Radiol 1999, 34: 1–4. 10.1097/00004424-199901000-00001

Hetzel GR, May P, Hollenbeck M, Voiculescu A, Modder U, Grabensee B: Assessment of radiocontrast media induced renal vasoconstriction by color coded duplex sonography. Ren Fail 2001, 23: 77–83. 10.1081/JDI-100001286

Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L: Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure. J Am Soc Nephrol 1995, 6: 1451–1458.

Tumlin JA, Wang A, Murray PT, Mathur VS: Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: a pilot trial in the prevention of contrast nephropathy. Am Heart J 2002, 143: 894–903. 10.1067/mhj.2002.122118

Langenberg C, Wan L, Bagshaw SM, Egi M, May CN, Bellomo R: Urinary biochemistry in experimental septic acute renal failure. Nephrol Dial Transplant 2006, 21: 3389–3397. 10.1093/ndt/gfl541

Langenberg C, Wan L, Egi M, May CN, Bellomo R: Renal blood flow in experimental septic acute renal failure. Kidney Int 2006, 69: 1996–2002. 10.1038/sj.ki.5000440

Langenberg C, Wan L, Egi M, May CN, Bellomo R: Renal blood flow and function during recovery from experimental septic acute kidney injury. Intensive Care Med 2007, 33: 1614–1618. 10.1007/s00134-007-0734-8

Saotome T, Langenberg C, Wan L, Ramchandra R, May CN, Bellomo R, Bailey M, Bagshaw SM: Early and sustained systemic and renal hemodynamic effects of intravenous radiocontrast. Blood Purif 2010, 29: 339–346. 10.1159/000302721

Wan L, Langenberg C, Bellomo R, May CN (2009) Angiotensin II in experimental hyperdynamic sepsis. Crit Care 13:R190

Edwards RM, Trizna W, Kinter LB: Renal microvascular effects of vasopressin and vasopressin antagonists. Am J Physiol 1989, 256: F274-F278.

Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P: Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005, 365: 1231–1238. 10.1016/S0140-6736(05)74811-X

Martensson J, Martling CR, Bell M: Novel biomarkers of acute kidney injury and failure: clinical applicability. Br J Anaesth 2012, 109: 843–850. 10.1093/bja/aes357

Martensson J, Xu S, Bell M, Martling CR, Venge P: Immunoassays distinguishing between HNL/NGAL released in urine from kidney epithelial cells and neutrophils. Clin Chim Acta 2012, 413: 1661–1667. 10.1016/j.cca.2012.05.010

Prasad PV, Priatna A, Spokes K, Epstein FH: Changes in intrarenal oxygenation as evaluated by BOLD MRI in a rat kidney model for radiocontrast nephropathy. J Magn Reson Imaging 2001, 13: 744–747. 10.1002/jmri.1103

Haneder S, Aufgustin J, Jost G, Pietsch H, Lengsfeld P, Krämer BK, Schoenberg SO, Meyer M, Attenberger UI, Michaely HJ: Impact of iso- and low-osmolar iodinated contrast agents on BOLD and diffusion MRI in swine kidneys. Invest Radiol 2012, 47: 299–305. 10.1097/RLI.0b013e318240a8ac

Li P, Thacker J, Lu J, Franklin T, Zhou Y, Papadopoulou MV, Solomon R, Prasad PV: Efficacy of preventive interventions for iodinated contrast-induced acute kidney injury evaluated by intrarenal oxygenation as an early marker. Invest Radiol 2014, 49: 647–652. 10.1097/RLI.0000000000000065

Hofmann L, Simon-Zoula S, Nowak A, Giger A, Vock P, Boesch C, Frey FJ, Vogt B: BOLD-MRI for the assessment of renal oxygenation in humans: acute effect of nephrotoxic xenobiotics. Kidney Int 2006, 70: 144–150. 10.1038/sj.ki.5000418

Rosenberger C, Rosen S, Shina A, Bernhardt W, Wiesener MS, Frei U, Eckardt KU, Heyman S: Hypoxia-inducible factors and tubular cell survival in isolated perfused kidneys. Kidney Int 2006, 70: 60–70. 10.1038/sj.ki.5000395

Khamaisi M, Raz I, Shile V, Shina A, Rosenberger C, Dahan R, Abassi Z, Meidan R, Lecht S, Heyman SN: Diabetes and radiocontrast media increase endothelin converting enzyme-1 in the kidney. Kidney Int 2008, 74: 91–100. 10.1038/ki.2008.112

Liu ZZ, Schmerbach K, Lu Y, Perlewitz A, Nikitina T, Cantow K, Seeliger E, Persson PB, Patzak A, Liu R, Sendeski MM: Iodinated contrast media cause direct tubular cell damage, leading to oxidative stress, low nitric oxide, and impairment of tubuloglomerular feedback. Am J Physiol Renal Physiol 2014, 306: F864-F872. 10.1152/ajprenal.00302.2013

Liss P, Nygren A, Erikson U, Ulfendahl HR: Injection of low and iso-osmolar contrast medium decreases oxygen tension in the renal medulla. Kidney Int 1998, 53: 698–702. 10.1046/j.1523-1755.1998.00811.x

Liss P, Nygrean A, Olsson U, Ulfendahl HR, Erikson U: Effects of contrast media and mannitol on renal medullary blood flow and red cell aggregation in the rat kidney. Kidney Int 1996, 49: 1268–1275. 10.1038/ki.1996.181

Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH 3rd, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Devarajan P: NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol 2007, 22: 2089–2095. 10.1007/s00467-007-0601-4

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