Effect of no prehydration vs sodium bicarbonate prehydration prior to contrast-enhanced computed tomography in the prevention of postcontrast acute kidney injury in adults with chronic kidney disease the Kompas randomized clinical trial

Importance Prevention of postcontrast acute kidney injury in patients with stage 3 chronic kidney disease (CKD) by means of prehydration has been standard care for years. However, evidence for the need for prehydration in this group is limited. Objective To assess the renal safety of omitting prophylactic prehydration prior to iodine-based contrast media administration in patients with stage 3 CKD. Design, Setting, and Participants The Kompas trial was a multicenter, noninferiority, randomized clinical trial conducted at 6 hospitals in the Netherlands in which 523 patients with stage 3 CKD were randomized in a 1:1 ratio to receive no prehydration or prehydration with 250 mL of 1.4% sodium bicarbonate administered in a 1-hour infusion before undergoing elective contrast-enhanced computed tomography from April 2013 through September 2016. Final follow-up was completed in September 2017. Data were analyzed from January 2018 to June 2019. Interventions In total, 262 patients were allocated to the no prehydration group and 261 were allocated to receive prehydration. Analysis on the primary end point was available in 505 patients (96.6%). Main Outcomes and Measures The primary end point was the mean relative increase in serum creatinine level 2 to 5 days after contrast administration compared with baseline (noninferiority margin of less than 10% increase in serum creatinine level). Secondary outcomes included the incidence of postcontrast acute kidney injury 2 to 5 days after contrast administration, mean relative increase in creatinine level 7 to 14 days after contrast administration, incidences of acute heart failure and renal failure requiring dialysis, and health care costs. Results Of 554 patients randomized, 523 were included in the intention-to-treat analysis. The median (interquartile range) age was 74 (67-79) years; 336 (64.2%) were men and 187 (35.8%) were women. The mean (SD) relative increase in creatinine level 2 to 5 days after contrast administration compared with baseline was 3.0% (10.5) in the no prehydration group vs 3.5% (10.3) in the prehydration group (mean difference, 0.5; 95% CI, -1.3 to 2.3; P < .001 for noninferiority). Postcontrast acute kidney injury occurred in 11 patients (2.1%), including 7 of 262 (2.7%) in the no prehydration group and 4 of 261 (1.5%) in the prehydration group, which resulted in a relative risk of 1.7 (95% CI, 0.5-5.9; P = .36). None of the patients required dialysis or developed acute heart failure. Subgroup analyses showed no evidence of statistical interactions between treatment arms and predefined subgroups. Mean hydration costs were euro119 (US $143.94) per patient in the prehydration group compared with euro0 (US$0) in the no prehydration group (P < .001). Other health care costs were similar. Conclusions and Relevance Among patients with stage 3 CKD undergoing contrast-enhanced computed tomography, withholding prehydration did not compromise patient safety. The findings of this study support the option of not giving prehydration as a safe and cost-efficient measure.Cardiolog

Pharmacokinetics and Pharmacodynamics of Dabigatran 75 mg b.i.d. in Patients With Severe Chronic Kidney Disease

Thrombosis and Hemostasi

Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography

Pathogenesis and treatment of chronic pulmonary disease

Hydration Prior to CT-Pulmonary Angiography is Not Required for Prevention of Contrast Induced-Acute Kidney Injury: The Randomized Nefros Trial

Cardiovascular Aspects of Radiolog

Cultivar affects browning susceptibility of freshly cut star fruit slices

Consumption of freshly-cut horticultural products has increased in the last few years. The principal restraint to using freshly-cut carambola is its susceptibility to tissue-browning, due to polyphenol oxidase-mediated oxidation of phenolic compounds present in the tissue. The current study investigated the susceptibility to browning of star fruit slices (Averrhoa carambola L.) of seven genotypes (Hart, Golden Star, Taen-ma, Nota-10, Malásia, Arkin, and Fwang Tung). Cultivar susceptibility to browning as measured by luminosity (L*) varied significantly among genotypes. Without catechol 0.05 M, little changes occurred on cut surface of any cultivars during 6 hour at 25° C, 67% RH. Addition of catechol led to rapid browning, which was more intense in cvs. Taen-ma, Fwang Tung, and Golden Star, with reduction in L* value of 28.60%, 27.68%, and 23.29%, respectively. Browning was more intense in the center of the slices, particularly when treated with catechol, indicating highest polyphenol oxidase (PPO) concentration. Epidermal browning, even in absence of catechol, is a limitation to visual acceptability and indicates a necessity for its control during carambola processing. Care must be given to appropriate selection of cultivars for fresh-cut processing, since cultivar varied in browning susceptibility in the presence of catechol

Search for the chiral magnetic wave using anisotropic flow of identified particles at energies available at the BNL Relativistic Heavy Ion Collider

The chiral magnetic wave (CMW) has been theorized to propagate in the deconfined nuclear medium formed in high-energy heavy-ion collisions and to cause a difference in elliptic flow (v2) between negatively and positively charged hadrons. Experimental data consistent with the CMW have been reported by the STAR Collaboration at the Relativistic Heavy Ion Collider (RHIC), based on the charge asymmetry dependence of the pion v2 from Au+Au collisions at sNN=27 to 200 GeV. In this comprehensive study, we present the STAR measurements of elliptic flow and triangular flow of charged pions, along with the v2 of charged kaons and protons, as a function of charge asymmetry in Au+Au collisions at sNN=27, 39, 62.4, and 200 GeV. The slope parameters extracted from the linear dependence of the v2 difference on charge asymmetry for different particle species are reported and compared in different centrality intervals. In addition, the slopes of v2 for charged pions in small systems, i.e., p+Au and d+Au at sNN=200 GeV, are also presented and compared with those in large systems, i.e., Au+Au at sNN=200 GeV and U+U at 193 GeV. Our results provide new insights for the possible existence of the CMW and further constrain the background contributions in heavy-ion collisions at RHIC energies.The chiral magnetic wave (CMW) has been theorized to propagate in the deconfined nuclear medium formed in high-energy heavy-ion collisions, and to cause a difference in elliptic flow ($v_{2}$) between negatively and positively charged hadrons. Experimental data consistent with the CMW have been reported by the STAR Collaboration at the Relativistic Heavy Ion Collider (RHIC), based on the charge asymmetry dependence of the pion $v_{2}$ from Au+Au collisions at $\sqrt{s_{\rm NN}}$ = 27 to 200 GeV. In this comprehensive study, we present the STAR measurements of elliptic flow and triangular flow of charged pions, along with the $v_{2}$ of charged kaons and protons, as a function of charge asymmetry in Au+Au collisions at $\sqrt{s_{\rm NN}}$ = 27, 39, 62.4 and 200 GeV. The slope parameters extracted from the linear dependence of the $v_2$ difference on charge asymmetry for different particle species are reported and compared in different centrality intervals. In addition, the slopes of $v_{2}$ for charged pions in small systems, \textit{i.e.}, $p$+Au and $d$+Au at $\sqrt{s_{\rm NN}}$ = 200 GeV, are also presented and compared with those in large systems, \textit{i.e.}, Au+Au at $\sqrt{s_{\rm NN}}$ = 200 GeV and U+U at 193 GeV. Our results provide new insights for the possible existence of the CMW, and further constrain the background contributions in heavy-ion collisions at RHIC energies