Journal Club 2017/05/30 Tomohiro Matsumoto PGY-2
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1 Journal Club 2017/05/30 Tomohiro Matsumoto PGY-2
2 本 の論 March 21,
3 Introduc)on 3
4 : (CIN) 3 25% 44µmol/L(0.5mg/dL) CIN 4 European Society of Urogenital Radiology. ESUR guidelines on contrast media, version 9.0. September hkp:// esur-guidelines/
5 Pathogenesis of CI-AKI. (Modified from Brown JR, McCullough PA: Contrast nephropathy and kidney injury. In Thompson CA [ed]: Textbook of Cardiovascular Intervention. New York, Springer, )
6 - CI-AKI J Am Coll Cardiol Apr 15;51(15):
7 egfr 7 J Am Coll Cardiol Apr 15;51(15):
8 egfr<60ml/ /1.73m2 egfr<45ml/ /1.73m2 (NYHA III IV ) LVEF (< 24 ) >70 European Society of Urogenital Radiology. ESUR guidelines on contrast media, version September hkp:// esur-guidelines/
9 2 3 European Society of Urogenital Radiology. ESUR guidelines on contrast media, version 9.0. September hkp:// esur-guidelines/ 9
10 % James MT, Samuel SM, Manning MA, et al. Contrast-induced acute kidney injury and risk of adverse clinical outcomes a_er coronary angiography: a systema`c review and metaanalysis. Circ Cardiovasc Interv 2013; 6:
11 CKD 4 CKD 5 (GFR< 30mL/ ) CKD 3(GFR 30 60mL/ )
12 / 12
13 13
14 mL/kg/ (154mEq/L 5% ) 1 3mL/kg/h 6 1mL/kg/h European Society of Urogenital Radiology. ESUR guidelines on contrast media, version 9.0. September hkp:// esur-guidelines/ 14
15 8 24h 7500 CKD 8-16%
16 16
17 17
18 P STEMI PCI n=408 I C O 25%, 0.5 mg/dl Result 11% VS 21% (p = 0.016) Jurado-Román A et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol 2015; 115:
19 P STEMI PCI n=216 I n=108 C n=108 O 25%, 0.5 mg/ dl Result 20.4%(22/108) VS 35.2% (38/108) (p = 0.015) 19 Luo Y et al. Intern Med 2014; 53:
20 P PE n=138 I n=67 C n=71 O 48-96h 25%, 0.5 mg/dl Result 0.14% (15.1% -12.0%) VS 0.32% (9.7% -10.1%) (difference 0.19%, 95%, CI -5.88% to 6.25%, P-value non-inferiority < 0.001) 20 Kooiman J. et al. J Thromb Haem 2014; 12:
21 STEMI PCI CT 21
22 本 の論 March 21,
23 AMACING PCI 23
24 Methods
25 2014/6/ /7/
26 PICO P egfr30 59 CKD3 I C O 2 6 Cr 25% 0.5mg/dl 26
27 EVIDENCE 1 LaBounty TM, etal. Within-hospital and 30-day outcomes in patients undergoing invasive coronary angiography with different low-osmolar iodinated contrast media. Am J Cardiol 2012; 109: Katzberg Rwet al. Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe? Radiology 2010; 256: James MT, Samuel SM, Manning MA, et al. Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis. Circ Cardiovasc Interv 2013; 6:
28 Primary endpoint /dl Secondary endpoint egfr <15mL /m/ eGFR 30mL / /
29 Inclusion criteria egfr 30 45mL / /1.73m² (CKD G3b) MM MUGS egfr 45 59mL / /1.73m²(CKD G3a) 2 > 75 NSAIDs 29
30 Exclusion criteria egfr<30ml/min/1.73m 2 CKD G4 ICU IC 30
31 0.9% NaCl 3 4 ml/kg /h 4 0.9% NaCl 1 ml/kg / h 12 31
32 Randomisation and masking H+ group H- Group ALEA screening and enrolment applica`on so_ware egfr (<45 vs 45 ml per min/ 1 73 m²), vs VS 32
33 Randomisation and masking 2.4% 2.1% power80% one-sided alpha5% /332 92% 296/328 90% ITT per-protocol 33
34 34
35 Results 35
36 egfr<60ml/m/1.73m IC egfr>60ml/m/1.73m inclusion criteria 460 IC
37 37
38
39 35 ICU
40 10% 40
41 Primary outcome 25 44μmol/ L mg H + 8/ H- 8/ (no hydration vs hydration) absolute difference 0 10% (one-sided 95% CI 2 25 to 2 06; onetailed p=0 4710). 41
42 Secondary outocome 42
43 egfr 10 4% 43
44 44
45 45
46
47 egfr 30 60mL / /
48 Discussion 48
49 CONSORT Title Background and objec`ves Par`cipants Interven`ons: Outcome Outcome Sample size: Sta`s`cal methods: 2side confiden`al approrch 1 sidide Outcome and es`ma`on: Interpreta`on: 49
50
51 Jurado-Román A et al. Role of hydra`on in contrast-induced nephropathy in pa`ents who underwent primary percutaneous coronary interven`on. Am J Cardiol 2015; 115: Luo Y et al. Remedial hydra`on reduces the incidence of contrast-induced nephropathy and short-term adverse events in pa`ents with ST-segment eleva`on myocardial infarc`on: a single-center, randomized trial. Intern Med 2014; 53:
52 9 AMACING AMACING
53 2 1 53
54 /dl
55 55
56 LIMITATION 95 CI 2.1% 56
57 CKD1-3 PCI angio 57
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