Preventive Effects of Nicorandil Against Contrast-Induced Nephropathy in Patients With Moderate Renal Insufficiency Undergoing Percutaneous Coronary Intervention.

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group (P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: -19.996 to -0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.

Preventive Effects of Alprostadil Against Contrast-Induced Nephropathy Inpatients With Renal Insufficiency Undergoing Percutaneous Coronary Intervention.

We investigated the preventive effect of alprostadil on contrast-induced nephropathy (CIN) in patients with renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 300 patients with creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to alprostadil or a control group. The primary end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or≥ 25% after administration of the contrast media within 72 hours. The secondary end points were (1) changes in Scr and crCl within 72 hours and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 2.7% (4/150) in the alprostadil group, and 8.7% (13/150) in the control group (χ2 = 5.05, P = .043).There was no difference regarding the incidence of major adverse events during hospitalization between the alprostadil group and control groups (2.7% vs 4.0%, P = .750). Multivariate logistic regression analysis showed that alprostadil was an independent protective factor for CIN (odds ratio = 0.136, 95% confidence interval: 0.020-0.944, P = .044). Prophylactic administration of alprostadil may prevent CIN in patients with renal insufficiency undergoing PCI.

A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention.

OBJECTIVE: To develop a simple scoring system based on preprocedural clinical features that is capable of predicting contrast-induced acute kidney injury (CI-AKI) before percutaneous coronary intervention (PCI). BACKGROUND: CI-AKI is associated with increased in-hospital morbidity and mortality, prolonged hospitalization, and long-term renal impairment. Although several scoring methods have been developed to determine risk of CI-AKI, no simple scoring method based on PCI preprocedural clinical features yet exists for Chinese patients. METHODS: A total of 2,500 Chinese patients were randomly and retrospectively assigned in a 3:2 manner to create a training and validation dataset, respectively. CI-AKI was defined as an increase of ≥25% or ≥0.5 mg/dL serum creatinine within 5 days after PCI. Preprocedural clinical variables showing independent correlation to CI-AKI were used to derive the risk score from the training dataset and then subsequently tested in the validation dataset. The odds ratios from multivariate logistic regression were used to assign a weighted integer to age ≥70 years = 4, history of myocardial infarction = 5, diabetes mellitus = 4, hypotension = 6, left ventricular ejection fraction ≤45% = 4, anemia = 3, creatinine clearance rate <60 mL/min = 7, decreased high-density lipoprotein <1 mmol/L= 3, and urgent PCI = 3. Summation of the integers represented the total risk score. RESULTS: The overall incidence of CI-AKI in the training dataset was 16.4% [246/1500; 5.4% for low (≤7) and 61.3% for very high (≥17) risk scores]. The rates of CI-AKI, 1-year dialysis, and 1-year mortality increased significantly with each group (Cochran-Armitage test of trend, P < 0.001). The risk score facilitated appropriate classification of patients with low and high risk for CI-AKI after PCI in the validation dataset (c-statistic = 0.82). CONCLUSION: Risk classification based on the most significantly correlated parameters is useful for predicting CI-AKI before contrast exposure. The simple preprocedural score showed excellent predictive ability for identifying patients at high risk of nephropathy and those with deteriorative prognosis after PCI.

[Risk factors and scoring system in the prediction of contrast induced nephropathy in patients undergoing percutaneous coronary intervention].

OBJECTIVE: To develop a simplified risk scoring system of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI). METHODS: A retrospective study was performed on 1500 patients in the development set undergoing PCI from January 2008 to December 2009. And 1000 patients treated from January 2010 to May 2011 were selected for the validation set. Logistic regression analysis was applied to identify the risk factors of CIN. Based on the odds ratio, the sum of integers was a total risk score for each patient. RESULTS: (1) Among them, CIN occurred in 246 patients with an overall incidence of 16.4%. (2) Eleven identified variables were identified as the risk factors of CIN (with weighted integer): diabetes (3 scores), hypotension (3 scores), left ventricular ejection fraction (LVEF ≤ 45%) (3 scores), eGFR < 60 [ml×min(-1)·(1.73 m(2))(-1)] (3 scores), age >70 years (2 scores), myocardial infarction (2 scores), emergency PCI (2 scores), anemia (2 scores), decreased high-density lipoprotein (HDL) concentration (< 1 mmol/L) (2 scores), contrast agent dose > 200 ml (2 scores) and low permeability contrast agent (1 score). (3) The sum of integers was a total risk score for each patient. The incidence of CIN was 5.2% in the low-risk group (≤ 4), 13.6% in the moderate-risk group (5 - 10), 32.3% in the high-risk group (11 - 14) and 59.0% in the very-high-risk group (≥ 15). (4) Good discriminative power was found in the validation population. And the risk score was strongly correlated with CIN (c-statistic = 0.82). CONCLUSION: This scoring system provides a good estimate of the risk of CIN after PCI. It may be used for the prevention and treatment of CIN.

Preparation and characterization of camptothecin solid lipid nanoparticles.

Camptothecin (CA), an antitumor drug, was incorporated into solid lipid nanoparticles (SLNs) prepared by high-pressure homogenization. A Taguchi orthogonal experimental design was used to study the influence of four different variables, with each variable having three value levels on nanoparticle size. Analysis of variance (ANOVA) has been used to evaluate the preparation of CA-SLNs and perform product optimization. The optimized CA-SLNs suspension was lyophilized using mannitol and glucose as cryoprotectants. The physicochemical characteristics of CA-SLNs were evaluated using transmission electron microscopy (TEM), electrophoresis, and differential scanning calorimetry (DSC). The release of camptothecin from CA-SLNs in various media was evaluated using a high-performance liquid chromatography (HPLC) method. The results showed that the concentration of emulsifier and the homogenization pressure had a significant influence on the particle size. The optimized CA-SLNs had an average diameter of about 200 nm, exhibited monodispersity with Dw/Dn of 1.06, and carried a negative charge. The optimal cryoprotectants consisted of 10% mannitol and 5% glucose in nanoparticle suspension. Lyophilized product was reconstituted in distilled water within 0.5 min without change of nanoparticle size. Camptothecin might exist in an amorphous state in SLNs. In vitro results showed that drug release was achieved for up to one week, and the released camptothecin quickly changed to open carboxylate form in the biological pH phosphate buffer. The results indicate that SLNs might be good potential sustained-release delivery vehicles for camptothecin or other lipophilic drugs.