Predictive Value of Hyperuricemia in Cardiac Patients with Post-Contrast Acute Kidney Injury (PC-AKI) and Different Basic Renal Functions: A Meta-Analysis
Abstract
Background: Uric acid level has shown a certain relationship with the incidence of post-contrast acute kidney injury (PC-AKI), whereas it remains controversial whether hyperuricemia can function as a predictor of PC-AKI in patients with different basic creatinine serum level. The present meta-analysis aimed to investigate whether hyperuricemia is an independent risk factor for PC-AKI and to explore the relationship between hyperuricemia and basic renal function.
Methods: Relevant studies were retrieved via searching in PubMed, Embase, Cochrane Library, and WAN FANG electronic databases from inception to Jan 2022. Only studies published in English and Chinese languages were selected.
Results: Overall, 11892 patients from 15 studies were included. The results of the pooled analysis revealed that the incidence of PC-AKI was significantly higher in the hyperuricemia group than that in the normouricemic group (20.62% vs. 13.05%). Hyperuricemia was associated with an increased risk of the incidence of PC-AKI (odds ratio (OR): 2.48 [95% confidence interval (CI): 1.77-3.46%]). The pooled ORs for mortality and incidence of undergoing renal replacement therapy were 2.33 (95% CI:1.81-3.00) and 8.69 (95% CI:3.22-23.44%), respectively. Comparatively, the pre-existing renal dysfunction subgroup had a lower relative risk in the hyperuricemia population.
Conclusion: Hyperuricemia was found to be significantly associated with the incidence of PC-AKI. The effect of serum uric acid level on the incidence of PC-AKI was higher in patients with normal renal function, which could lay a foundation for the establishment of individualized schemes to prevent PC-AKI by urate-lowering therapy.
1. Nguyen S, Suranyi P, Ravenel J, et al (2008). Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: effect on kidney function. Radiology, 248:97-105.
2. Morcos S, Thomsen H, Webb J (1999). Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol, 9:1602-13.
3. van der Molen A, Reimer P, Dekkers I, et al (2018). Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol, 28:2845-2855.
4. Mehran R, Nikolsky E (2006). Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int. Suppl. S11-S15. Kidney Int Suppl, (100):S11-5.
5. Abe M, Kimura T, Morimoto T, Furukawa Y, Kita T (2009). Incidence of and risk factors for contrast-induced nephropathy after cardiac catheterization in Japan ese patients. Circ J, 73:1518-22.
6. Barbieri L, Verdoia M, Marino P, et al (2016). Contrast volume to creatinine clearance ratio for the prediction of contrast-induced nephropathy in p atients undergoing coronary angiography or percutaneous intervention. Eur J Prev Cardiol, 23:931-7.
7. Mohammed NMA, Mahfouz A, Achkar K, Rafie IM, Hajar R (2013). Contrast-induced nephropathy. Heart Views, 14:106-116.
8. Kooiman J, Seth M, Nallamothu BK, Heung M, Gurm HS (2015). Association Between Acute Kidney Injury and In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Interventions. Circ Cardiovasc Interv, 8:e002212-.
9. Mitchell A, Kline J, Jones A, Tumlin J (2015). Major Adverse Events One Year After Acute Kidney Injury After Contrast-Enhanced Computed Tomography. Ann Emerg Med, 66:267-274.e4.
10. Mandurino-Mirizzi A, Kajana V, Cornara S, et al (2021). Elevated serum uric acid is a predictor of contrast associated acute kidney injury in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis, 31:2140-2143.
11. Sadineni R, Karthik K, Swarnalatha G, Das U, Taduri G (2017). N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease: A randomized controlled trial. Indian J Nephrol, 27:93-98.
12. Pelliccia F, Pasceri V, Patti G, et al (2018). Uric acid and contrast-induced nephropathy: an updated review and meta-regression analysis. Postepy Kardiol Interwencyjnej, 14(4):399-412.
13. Mirbolouk F, Arami S, Gholipour M, et al (2021). Is there any association between contrast-induced nephropathy and serum uric acid levels? J Cardiovasc Thorac Res, 13:61-67.
14. Liberati A, Altman D, Tetzlaff J, et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 6:e1000100.
15. Stang A (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 25:603-5.
16. Higgins J, Thompson SG, Decks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414):557-60.
17. Colditz GA, Burdick E, Mosteller F (1995). Heterogeneity in meta-analysis of data from epidemiologic studies: a commentary. Am J Epidemiol, 142:371-382.
18. Yong Liu, Ning Tan, Jiyan Chen, et al (2013). The relationship between hyperuricemia and the risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with relatively normal serum creatinine. Clinics (Sao Paulo), 68(1):19-25.
19. Wei G, Yong L, Ji Y, et al (2015). Hyperuricemia Is an Independent Predictor of Contrast-Induced Acute Kidney Injury and Mortality in Patients Undergoing Percutaneous Coronary Intervention. Angiology, 66:721-726.
20. Barbieri L, Verdoia M, Cassetti E, et al (2015). Uric acid levels and the risk of Contrast Induced Nephropathy in patients undergoing coronary angiography or PCI. Nutr Metab Cardiovasc Dis, 25:181-186.
21. Park S, Shin W, Lee E, et al (2011). The impact of hyperuricemia on in-hospital mortality and incidence of acute kidney injury in patients undergoing percutaneous coronary intervention. Circ J, 75:692-7.
22. Shacham Y, Gal-Oz A, Flint N, et al (2016). Serum Uric Acid Levels and Renal Impairment among ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention. Cardiorenal Med, 6:191-7.
23. Toprak O, Cirit M, Esi E, et al (2006). Hyperuricemia as a risk factor for contrast-induced nephropathy in patients with chronic kidney disease. Catheter Cardiovasc Interv, 67:227-35.
24. Mendi M, Afsar B, Oksuz F, et al (2017). Uric Acid is a Useful Tool to Predict Contrast-Induced Nephropathy. Angiology, 68:627-632.
25. Kowalczyk J, Francuz P, Swoboda R, et al (2010). Prognostic significance of hyperuricemia in patients with different types of renal dysfunction and acute myocardial infarction treated with percutaneous coronary intervention. Nephron Clin Pract, 116:c114-22.
26. Okino S, Fukuzawa S, Inagaki M, et al (2010). Hyperuricemia as a risk factor for progressive renal insufficiency after coronary intervention in patients with chronic kidney disease. Cardiovasc Interv Ther, 25:105-11.
27. Xu Z, Chen J, Liu Y, Liu Y, Tan N (2019). The predictive value of the renal resistive index for contrast-induced nephropathy in patients with acute coronary syndrome. BMC Cardiovasc Disord, 19:36.
28. Chen LL CK, FangY. (2011). Association of Hyperuricemia and Contrast Induced Nephropathy. China Academic Journal Electronic Publishing House, 22:261-264.
29. Liu YH TN, Liu Y (2013). The relationship between hyperuricemia and contrast-induced nephropathy in patients with chronic kidney disease undergoing perecutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi, 41:740-743.
30. Nyman U AJ, Aspelin P (2018). Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines. Eur Radiol, 28:5384-5395.
31. Dadi H, Long TE, Solveig H, et al (2018). Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes. J Nephrol, 31(5):721-730.
32. Tian Z, Lu J, Mao S, Liu X, Guo L (2016). Hyperuricemia and contrast-induced acute kidney injury: A systematic review and meta-analysis. Int J Cardiol, 224:286-294.
33. Liu Y, Hong D, Wang AY, et al (2019). Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord, 19:87.
34. Wang Z, Song Y, A G, Li Y (2019). Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention. Int Heart J, 60:1077-1082.
35. Jurado-Román A, Hernández-Hernández F, García-Tejada J, et al (2015). Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention. Am J Cardiol, 115:1174-1178.
36. Wang J, Zhang C, Liu Z, Bai Y (2021). Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospectiv e analysis. J Int Med Res, 49:3000605211005972.
37. Cheng W, Wu X, Liu Q, et al (2020). Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. Eur Radiol, 30:3516-3527.
38. Kashani K, Al-Khafaji A, Ardiles T, et al (2013). Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care, 17:R25.
39. Palevsky PM, Molitoris BA, Okusa MD, et al (2012). Design of Clinical Trials in Acute Kidney Injury: Report from an NIDDK Workshop on Trial Methodology. Clin J Am Soc Nephrol, 7:844-850.
40. Shaw A (2011). Models of Preventable Disease: Contrast-Induced Nephropathy and Cardiac Surgery-Associated Acute Kidney Injury. Contrib Nephrol, 174:156-162.
41. Weisbord SD, Gallagher M, Kaufman J, et al (2013). Prevention of Contrast-Induced AKI: A Review of Published Trials and the Design of the Prevention of Serious Adverse Events following Angiography (PRESERVE) Trial. Clin J Am Soc Nephrol, 8:1618-1631.
42. Ejaz AA, Johnson R, Shimada M, Mohandas R, Dass B (2019). The Role of Uric Acid in Acute Kidney Injury. Nephron, 142:275-283.
43. Shimada M, Dass B, Ejaz AA (2011). Paradigm Shift in the Role of Uric Acid in Acute Kidney Injury. Semin Nephrol, 31:453-458.
2. Morcos S, Thomsen H, Webb J (1999). Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol, 9:1602-13.
3. van der Molen A, Reimer P, Dekkers I, et al (2018). Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol, 28:2845-2855.
4. Mehran R, Nikolsky E (2006). Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int. Suppl. S11-S15. Kidney Int Suppl, (100):S11-5.
5. Abe M, Kimura T, Morimoto T, Furukawa Y, Kita T (2009). Incidence of and risk factors for contrast-induced nephropathy after cardiac catheterization in Japan ese patients. Circ J, 73:1518-22.
6. Barbieri L, Verdoia M, Marino P, et al (2016). Contrast volume to creatinine clearance ratio for the prediction of contrast-induced nephropathy in p atients undergoing coronary angiography or percutaneous intervention. Eur J Prev Cardiol, 23:931-7.
7. Mohammed NMA, Mahfouz A, Achkar K, Rafie IM, Hajar R (2013). Contrast-induced nephropathy. Heart Views, 14:106-116.
8. Kooiman J, Seth M, Nallamothu BK, Heung M, Gurm HS (2015). Association Between Acute Kidney Injury and In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Interventions. Circ Cardiovasc Interv, 8:e002212-.
9. Mitchell A, Kline J, Jones A, Tumlin J (2015). Major Adverse Events One Year After Acute Kidney Injury After Contrast-Enhanced Computed Tomography. Ann Emerg Med, 66:267-274.e4.
10. Mandurino-Mirizzi A, Kajana V, Cornara S, et al (2021). Elevated serum uric acid is a predictor of contrast associated acute kidney injury in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis, 31:2140-2143.
11. Sadineni R, Karthik K, Swarnalatha G, Das U, Taduri G (2017). N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease: A randomized controlled trial. Indian J Nephrol, 27:93-98.
12. Pelliccia F, Pasceri V, Patti G, et al (2018). Uric acid and contrast-induced nephropathy: an updated review and meta-regression analysis. Postepy Kardiol Interwencyjnej, 14(4):399-412.
13. Mirbolouk F, Arami S, Gholipour M, et al (2021). Is there any association between contrast-induced nephropathy and serum uric acid levels? J Cardiovasc Thorac Res, 13:61-67.
14. Liberati A, Altman D, Tetzlaff J, et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 6:e1000100.
15. Stang A (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 25:603-5.
16. Higgins J, Thompson SG, Decks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414):557-60.
17. Colditz GA, Burdick E, Mosteller F (1995). Heterogeneity in meta-analysis of data from epidemiologic studies: a commentary. Am J Epidemiol, 142:371-382.
18. Yong Liu, Ning Tan, Jiyan Chen, et al (2013). The relationship between hyperuricemia and the risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with relatively normal serum creatinine. Clinics (Sao Paulo), 68(1):19-25.
19. Wei G, Yong L, Ji Y, et al (2015). Hyperuricemia Is an Independent Predictor of Contrast-Induced Acute Kidney Injury and Mortality in Patients Undergoing Percutaneous Coronary Intervention. Angiology, 66:721-726.
20. Barbieri L, Verdoia M, Cassetti E, et al (2015). Uric acid levels and the risk of Contrast Induced Nephropathy in patients undergoing coronary angiography or PCI. Nutr Metab Cardiovasc Dis, 25:181-186.
21. Park S, Shin W, Lee E, et al (2011). The impact of hyperuricemia on in-hospital mortality and incidence of acute kidney injury in patients undergoing percutaneous coronary intervention. Circ J, 75:692-7.
22. Shacham Y, Gal-Oz A, Flint N, et al (2016). Serum Uric Acid Levels and Renal Impairment among ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention. Cardiorenal Med, 6:191-7.
23. Toprak O, Cirit M, Esi E, et al (2006). Hyperuricemia as a risk factor for contrast-induced nephropathy in patients with chronic kidney disease. Catheter Cardiovasc Interv, 67:227-35.
24. Mendi M, Afsar B, Oksuz F, et al (2017). Uric Acid is a Useful Tool to Predict Contrast-Induced Nephropathy. Angiology, 68:627-632.
25. Kowalczyk J, Francuz P, Swoboda R, et al (2010). Prognostic significance of hyperuricemia in patients with different types of renal dysfunction and acute myocardial infarction treated with percutaneous coronary intervention. Nephron Clin Pract, 116:c114-22.
26. Okino S, Fukuzawa S, Inagaki M, et al (2010). Hyperuricemia as a risk factor for progressive renal insufficiency after coronary intervention in patients with chronic kidney disease. Cardiovasc Interv Ther, 25:105-11.
27. Xu Z, Chen J, Liu Y, Liu Y, Tan N (2019). The predictive value of the renal resistive index for contrast-induced nephropathy in patients with acute coronary syndrome. BMC Cardiovasc Disord, 19:36.
28. Chen LL CK, FangY. (2011). Association of Hyperuricemia and Contrast Induced Nephropathy. China Academic Journal Electronic Publishing House, 22:261-264.
29. Liu YH TN, Liu Y (2013). The relationship between hyperuricemia and contrast-induced nephropathy in patients with chronic kidney disease undergoing perecutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi, 41:740-743.
30. Nyman U AJ, Aspelin P (2018). Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines. Eur Radiol, 28:5384-5395.
31. Dadi H, Long TE, Solveig H, et al (2018). Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes. J Nephrol, 31(5):721-730.
32. Tian Z, Lu J, Mao S, Liu X, Guo L (2016). Hyperuricemia and contrast-induced acute kidney injury: A systematic review and meta-analysis. Int J Cardiol, 224:286-294.
33. Liu Y, Hong D, Wang AY, et al (2019). Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord, 19:87.
34. Wang Z, Song Y, A G, Li Y (2019). Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention. Int Heart J, 60:1077-1082.
35. Jurado-Román A, Hernández-Hernández F, García-Tejada J, et al (2015). Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention. Am J Cardiol, 115:1174-1178.
36. Wang J, Zhang C, Liu Z, Bai Y (2021). Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospectiv e analysis. J Int Med Res, 49:3000605211005972.
37. Cheng W, Wu X, Liu Q, et al (2020). Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. Eur Radiol, 30:3516-3527.
38. Kashani K, Al-Khafaji A, Ardiles T, et al (2013). Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care, 17:R25.
39. Palevsky PM, Molitoris BA, Okusa MD, et al (2012). Design of Clinical Trials in Acute Kidney Injury: Report from an NIDDK Workshop on Trial Methodology. Clin J Am Soc Nephrol, 7:844-850.
40. Shaw A (2011). Models of Preventable Disease: Contrast-Induced Nephropathy and Cardiac Surgery-Associated Acute Kidney Injury. Contrib Nephrol, 174:156-162.
41. Weisbord SD, Gallagher M, Kaufman J, et al (2013). Prevention of Contrast-Induced AKI: A Review of Published Trials and the Design of the Prevention of Serious Adverse Events following Angiography (PRESERVE) Trial. Clin J Am Soc Nephrol, 8:1618-1631.
42. Ejaz AA, Johnson R, Shimada M, Mohandas R, Dass B (2019). The Role of Uric Acid in Acute Kidney Injury. Nephron, 142:275-283.
43. Shimada M, Dass B, Ejaz AA (2011). Paradigm Shift in the Role of Uric Acid in Acute Kidney Injury. Semin Nephrol, 31:453-458.
| Files | ||
| Issue | Vol 51 No 12 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i12.11455 | |
| Keywords | ||
| Hyperuricemia Post-contrast acute kidney injury Creatinine serum | ||
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How to Cite
1.
Cai A, Zhou T. Predictive Value of Hyperuricemia in Cardiac Patients with Post-Contrast Acute Kidney Injury (PC-AKI) and Different Basic Renal Functions: A Meta-Analysis. Iran J Public Health. 2022;51(12):2641-2653.
