Effects of Carperitide on Contrast-Induced Acute Kidney Injury with a Minimum Volume of Contrast in Chronic Kidney Disease Patients

Background/Aims: Although contrast-induced acute kidney injury (CIAKI) is a major complication associated with angiography, the prophylaxis is not well established. Use of a low dose of carperitide for preventing CIAKI remains controversial. We examined the protective effect of carperitide on CIAKI after coronary angiography with a small contrast volume in chronic kidney disease (CKD) patients with coronary artery disease. Methods: We randomly assigned 112 consecutive patients to a carperitide or a control group. The contrast volume was kept under 150 ml. The primary endpoint was the incidence of CIAKI defined by a serum creatinine of ≥25% or a serum creatinine of ≥0.5 mg/dl from baseline within 48 h. The secondary endpoint was a change in renal function at 1 week after the procedure. Results: The baseline characteristics and contrast volumes (carperitide group: 67.4 ± 38.2 ml vs. control group: 64.8 ± 20.5 ml, p = 0.661) were comparable in the two groups. The incidence of CIAKI was similar in the two groups (carperitide group: 8.5% vs. control group: 5.7%, p = 0.564). A multivariate analysis revealed that a hypotension ≥20 mm Hg was a significant predictor of developing CIAKI in the carperitide group (p = 0.015). The incidence of CIAKI in the carperitide group without hypotension was rare, but not significantly different (carperitide group: 2.4% vs. control group: 5.7%, p = 0.432). Conclusions: This study indicated that the use of a small contrast volume suppressed the incidence of CIAKI and that carperitide had no prophylactic effect against CIAKI. Our results also revealed the impact of hypotension on the development of CIAKI in the carperitide group

Recovery of flow-mediated vasodilatation after repetitive measurements is involved in early vascular impairment: comparison with indices of vascular tone.

In repetitive measurements of flow-mediated dilatation (FMD), the duration of the interval between measurements remains controversial. In this pilot study, we conducted three sequential measurements of low-flow-mediated constriction (L-FMC), FMD and flow-mediated total dilation (FMTD; L-FMC+ FMD) at baseline and intervals of 15 and 60 min in 30 healthy males. FMD15, L-FMC15, and FMTD15 were significantly lower than the respective first measurements, but all indices showed full recovery at 60 min in all subjects. The baseline diameter was slightly increased at 15 min and restored at 60 min, but the maximum diameter, and the baseline and reactive flow velocity unchanged. We examined the relationship between recovery rate of FMTD at 15 min (FMTD-R) and cardio-ankle vascular index (CAVI). Univariate analysis showed moderate correlation between FMTD-R, and CAVI and L-FMC0. Patients were divided according to FMTD-R value; the low-FMTD-R group [below the median value (-26.2%)] included a significantly higher proportion of smokers and higher CAVI values than the high-FMTD-R group. The reproducibility of FMTD and FMTD-R was evaluated in another group of 25 healthy subjects. The range of variation across measurements was 1.1% for FMTD and 4.6% for FMTD-R; with intraclass correlation coefficients of 0.93 and 0.95, respectively. The present study demonstrated blunted recovery of FMD within 15 min, suggesting the need for selection of a more adequate interval between measurements to avoid underestimation of FMD in subsequent measurements. The findings demonstrated the reproducibility of FMTD-R and FMTD measurements, and that FMTD-R might be involved in arterial stiffness and early vascular impairment in the healthy subjects

Correlation between FMTD-R and other FMD-related indices.

<p>Although a significant correlation between FMTD-R and L-FMC was confirmed (A), no relationship was found between FMTD-R and FMD (B) or FMTD (C). Notably, FMTD-R correlated significantly with CAVI (D).</p

Brachial artery characteristics.

<p>Values are mean ± SD.</p><p>p<0.01, compared with the respective baseline measurement.</p

Clinical characteristics of the patient population divided according to FMTD-R.

<p>Values are mean ± SD or percentage of patients.</p><p>*p<0.004, compared with the good FMTD-R group (Fisher's exact probability test).</p

Values of FMD-related indices and CAVI in the healthy subjects divided into the poor and good recovery groups based on the median FMTD-R value (-26.2%).

<p>No significant difference was observed in FMD (A), FMTD (B), and L-FMC (C) values between the two groups. CAVI values were significantly higher in the poor recovery group.</p

FMTD and FMTD-R measurements in consecutive FMD procedures in healthy volunteers.

<p>Correlation analysis for FMTD (A) and FMTD-R (B) (p<0.01, respectively.). Bland-Altman Plots for FMTD (C) and FMTD-R (D). The dotted lines represent 1.96 ± SD.</p