|ECR 2013 / C-1555|
|Prevalence of contrast induced nephropaty (CIN) in preemptive living renal donor recipients after enhanced CT with CIN prophylaxis|
Non-dialysis patients with a glomerular filtration rate less than 20 mL/min are the best candidates for kidney transplantation (preemptive transplantation) because graft survival and patient survival are better than in dialysis patients. Therefore, it is necessary to carefully evaluate potential recipients of kidney transplant carefully to determine the feasibility of kidney transplantation and to detect and treat concurrent conditions that may affect graft survival (1).
The best technique to assess the vascular anatomy and concurrent illnesses of a potential candidate is the angio-CT scan. Angio-CT scan is an accurate technique for demonstration of both stenotic and aneurysmal disease, allowing definition of the site, grade, and extent of abnormalities in vascular caliber with substantial interobserver agreement (2). Nonetheless, there is always some fear associated with the use of contrast media in candidates for preemptive kidney transplantation because of the risk of contrast-induced nephropathy (CIN), which might induce acute renal insufficiency and eventually lead to an earlier start of dialysis.
CIN is defined as an acute reduction in renal function secondary to the administration of iodinated contrast material, which results in an increase > 0.5 mg/dl of serum creatinine levels (3).
Several strategies have been studied for the prophylactic prevention of CIN (3). In a large prospective trial, hydration with one-half isotonic (0.45%) saline started in the morning of the contrast procedure and immediately before the procedure proved to reduce the incidence of CIN (4). Tepel et al. were the first to report the protective effect of n-acetylcysteine (NAC) in reducing CIN, and Marenzi et al. demonstrated a dose-dependent effect of NAC (5). Based on this, further studies have demonstrated the effectiveness of NAC in the prevention of CIN (6, 7). Better clinical outcomes have also been reported when combining NAC and NaHCO3 compared with NAC alone (4).
However, a recent randomized trial showed that NAC failed to reduce the incidence of CIN (8), and another study has not provided conclusive evidence about the effective of NAC in preventing CIN (9). To date, no studies have demonstrated a decrease in mortality using NAC.
Despite this evidence, no studies have been conducted to evaluate the preventive effects of hydration, NAC and NaHCO3 in candidates for preemptive kidney transplantation. Recipients of living-donor kidney are the best population to investigate CIN, because transplantation is performed in a short time lapse, avoiding problems of worsening of renal function due to CIN.
The aim of this study is to describe the prevalence of CIN and the need for dialysis in recipients of preemptive living-donor kidney transplants after enhanced computed tomography (CT) with CIN prophylaxis.
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