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Effect of contrast medium versus low-molecular-weight dextran for intracoronary optical coherence tomography in renal insufficiency

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Abstract

Low-molecular-weight dextran (LMWD) is considered a safe alternative to contrast media to displace blood during optical coherence tomography (OCT) imaging, but concerns remain. The purpose of this study was to investigate whether using LMWD for OCT protects against kidney injury in patients with renal insufficiency compared with contrast media. We retrospectively identified 474 patients with renal insufficiency (estimated glomerular filtration rate < 60 ml/min/1.73 m2) who underwent OCT during coronary angiography or percutaneous coronary intervention; 110 patients with LMWD plus contrast medium (LMWD group) and 364 patients with contrast medium exclusively (Contrast group). We evaluated differences between the two groups and performed propensity score-matched subgroup comparisons. Compared with the Contrast group, the LMWD group had worse baseline renal function, higher prevalence of diabetes mellitus and percutaneous coronary intervention history, higher C-reactive protein and N-terminal pro B-type natriuretic peptide levels, lower hemoglobin levels, and lower left ventricular ejection fraction. The median total volume of contrast medium in the Contrast group was 230.0 ml vs. 61.8 ml of LMWD in addition to 164.0 ml of contrast medium in the LMWD group. Renal function was consistently impaired in the LMWD group within 5 days, at 1-month, and 1-year follow-up (P < 0.001). Two propensity score-matched analyses adjusted for either total volume used or contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up. No protective benefit for renal function from using LMWD instead of contrast media for OCT was observed in patients with renal insufficiency.

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Data availability

The data is available and permission might be sought per reasonable request.

Abbreviations

ACS:

Acute coronary syndrome

AKI:

Acute kidney injury

CAD:

Coronary artery disease

eGFR:

Estimated glomerular filtration rate

LMWD:

Low-molecular-weight dextran

OCT:

Optical coherence tomography

PCI:

Percutaneous coronary intervention

References

  1. Gruberg L, Mintz GS, Mehran R, Gangas G, Lansky AJ, Kent KM et al (2000) The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol 36:1542–1548

    Article  CAS  Google Scholar 

  2. Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ et al (2002) Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 105:2259–2264

    Article  Google Scholar 

  3. Mehran R, Dangas GD, Weisbord SD (2019) Contrast-associated acute kidney injury. N Engl J Med 380:2146–2155

    Article  CAS  Google Scholar 

  4. Wang F, Peng C, Zhang G, Zhao Q, Xuan C, Wei M et al (2016) Delayed kidney injury following coronary angiography. Exp Ther Med 12:530–534

    Article  CAS  Google Scholar 

  5. Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK et al (2010) Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 31:401–415

    Article  Google Scholar 

  6. Prati F, Guagliumi G, Mintz GS, Costa M, Regar E, Akasaka T et al (2012) Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Eur Heart J 33:2513–2520

    Article  Google Scholar 

  7. Meneveau N, Souteyrand G, Motreff P, Caussin C, Amabile N, Ohlmann P et al (2016) Optical coherence tomography to optimize results of percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome: results of the multicenter, randomized DOCTORS study (Does Optical Coherence Tomography Optimize Results of Stenting). Circulation 134:906–917

    Article  Google Scholar 

  8. Kubo T, Shinke T, Okamura T, Hibi K, Nakazawa G, Morino Y, et al. Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results. Eur Heart J. 2017;38:3139–47.

  9. Brezinski M, Saunders K, Jesser C, Li X, Fujimoto J (2001) Index matching to improve optical coherence tomography imaging through blood. Circulation 103:1999–2003

    Article  CAS  Google Scholar 

  10. Ozaki Y, Kitabata H, Tsujioka H, Hosokawa S, Kashiwagi M, Ishibashi K et al (2012) Comparison of contrast media and low-molecular-weight dextran for frequency-domain optical coherence tomography. Circ J 76:922–927

    Article  Google Scholar 

  11. Frick K, Michael TT, Alomar M, Mohammed A, Rangan BV, Abdullah S et al (2014) Low molecular weight dextran provides similar optical coherence tomography coronary imaging compared to radiographic contrast media. Catheter Cardiovasc Interv 84:727–731

    Article  Google Scholar 

  12. Feest TG (1976) Low molecular weight dextran: a continuing cause of acute renal failure. Br Med J 2:1300

    Article  CAS  Google Scholar 

  13. Moran M, Kapsner C (1987) Acute renal failure associated with elevated plasma oncotic pressure. N Engl J Med 317:150–153

    Article  CAS  Google Scholar 

  14. Zwaveling JH, Meulenbelt J, van Xanten NH, Hene RJ (1989) Renal failure associated with the use of dextran-40. Neth J Med 35:321–326

    CAS  PubMed  Google Scholar 

  15. Dickenmann M, Oettl T, Mihatsch MJ (2008) Osmotic nephrosis: acute kidney injury with accumulation of proximal tubular lysosomes due to administration of exogenous solutes. Am J Kidney Dis 51:491–503

    Article  Google Scholar 

  16. Terada N, Kuramochi T, Sugiyama T, Kanaji Y, Hoshino M, Usui E et al (2020) Ventricular fibrillation during optical coherence tomography/optical frequency domain imaging - a large single-center experience. Circ J 84:178–185

    Article  CAS  Google Scholar 

  17. Clinical practice guidebook for diagnosis and treatment of chronic kidney disease 2012: Tokyo Igakusha; 2012.

  18. KDIGO (2012) Clinical practice guideline for the evaluation and management of chronic kidney disease. Elsevier, New York

    Google Scholar 

  19. Mehran R, Faggioni M, Chandrasekhar J, Angiolillo DJ, Bertolet B, Jobe RL et al (2018) Effect of a contrast modulation system on contrast media use and the rate of acute kidney injury after coronary angiography. J Am Coll Cardiol Intv 11:1601–1610

    Article  Google Scholar 

  20. Bleyer AJ, Shemanski LR, Burke GL, Hansen KJ, Appel RG (2000) Tobacco, hypertension, and vascular disease: risk factors for renal functional decline in an older population. Kidney Int 57:2072–2079

    Article  CAS  Google Scholar 

  21. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M et al (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399

    PubMed  Google Scholar 

  22. Balemans CE, Reichert LJ, van Schelven BI, van den Brand JA, Wetzels JF (2012) Epidemiology of contrast material-induced nephropathy in the era of hydration. Radiology 263:706–713

    Article  Google Scholar 

  23. Karimi Galougahi K, Zalewski A, Leon MB, Karmpaliotis D, Ali ZA (2016) Optical coherence tomography-guided percutaneous coronary intervention in pre-terminal chronic kidney disease with no radio-contrast administration. Eur Heart J 37:1059

    Article  Google Scholar 

  24. Ferraboli R, Malheiro PS, Abdulkader RC, Yu L, Sabbaga E, Burdmann EA (1997) Anuric acute renal failure caused by dextran 40 administration. Ren Fail 19:303–306

    Article  CAS  Google Scholar 

  25. Klotz U, Kroemer H (1987) Clinical pharmacokinetic considerations in the use of plasma expanders. Clin Pharmacokinet 12:123–135

    Article  CAS  Google Scholar 

  26. Nearman HS, Herman ML (1991) Toxic effects of colloids in the intensive care unit. Crit Care Clin 7:713–723

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all subjects for their participation and other colleagues for their support.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan

    Toru Misawa, Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hoshino, Masao Yamaguchi, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Yumi Yasui, Eisuke Usui, Tetsumin Lee & Tsunekazu Kakuta

  2. Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan

    Noriko Terada & Tatsuhiko Kuramochi

  3. Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan

    Taishi Yonetsu

  4. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Tetsuo Sasano

Authors
  1. Toru Misawa
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  2. Tomoyo Sugiyama
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  3. Yoshihisa Kanaji
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  4. Masahiro Hoshino
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  11. Tatsuhiko Kuramochi
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  13. Tetsumin Lee
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  14. Taishi Yonetsu
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  15. Tetsuo Sasano
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  16. Tsunekazu Kakuta
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TM, TS, YK, MH, MY, MH, TN, KN, YY, NT and TK. The first draft of the manuscript was written by Toru Misawa and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tsunekazu Kakuta.

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The authors have no conflict of interest.

Ethical approval

This observational study was performed in compliance with our institutional ethics committee guidelines, and the study received its approval.

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All patients provided written informed consent prior to participation in the study.

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Misawa, T., Sugiyama, T., Kanaji, Y. et al. Effect of contrast medium versus low-molecular-weight dextran for intracoronary optical coherence tomography in renal insufficiency. Int J Cardiovasc Imaging 37, 2603–2615 (2021). https://doi.org/10.1007/s10554-021-02245-9

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  • DOI: https://doi.org/10.1007/s10554-021-02245-9

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