Use of Urinary Cell-Cycle Arrest Biomarkers in Contrast-Associated Nephropathy After Coronary Angiography
- Conditions
- Contrast-induced Nephropathy
- Interventions
- Diagnostic Test: Urinary determination of TIMP-2/ IGFBP7
- Registration Number
- NCT04163250
- Lead Sponsor
- Eva de Miguel Balsa
- Brief Summary
Radiological examinations that require the administration of iodinated contrasts (IC) for diagnostic and therapeutic purposes are essential in current clinical practice, and their use in interventional procedures has been progressively increasing.
IC can cause kidney damage, so there is caution in their use in at-risk populations. This fact may limit its diagnostic use, with data on underutilization of interventional techniques in patients with renal insufficiency, which worsen their prognosis.
In addition, once the use of IC contrasts is decided, preventive measures, such as hyperhydration,are used and can have potential side effects, especially in patients at risk of heart failure (acute coronary syndrome, low left ventricular ejection fraction).
New biomarkers of kidney damage have recently been developed, based on the detection of molecules expressed by the kidney in situations of early damage. The quantitative determination of cell cycle arrest proteins (Tissue Inhibitor of metalloproteinase 2 (TIMP2) and Insulin-Like Growth Factor Binding Protein -7 (IGFBP7)) can be predictive of the development of moderate to severe contrast-associated acute kidney injury.
Urinary determination of \[TIMP-2\] x \[IGFBP7\] in patients with ACS (acute coronary syndromes) before cardiac catheterization would allow early identification of those patients vulnerable to IC-induced toxicity and adjustment of preventive measures.
- Detailed Description
Urinary determination of \[TIMP-2\] x \[IGFBP7\] in patients with ACS undergoing cardiac catheterization would allow early identification of those patients vulnerable to IC-induced toxicity and adjustment of both appropriate preventive measures.
A prospective, descriptive observational study will be carried out to determine sensitivity and specificity of the urinary determination of TIMP2-IGFBP7 and predictive values in the early diagnosis of contrast-associated acute kidney injury (AKI) in patients admitted to the Coronary Care Unit (CCU) in a spanish hospital.
OBJECTIVES
* PRIMARY OBJECTIVE: To determine the operational characteristics (sensitivity, specificity) of the TIMP2-IGFBP7 biomarker in routine clinical practice, in the early diagnosis of contrast-induced AKI (acute renal injury) in patients admitted to the CCU, exposed to iodinated contrasts. The established renal failure is defined as KDIGO (Kidney Disease Improving Global Outcomes) stage ≥ 2 in the 24 to 72 hours after the administration of contrasts.
* SECONDARY OBJECTIVES
Evaluate these parameters according to the patient's initial risk level:
* Estimated renal function upon admission
* Initial severity estimated by GRACE score
* Sex
* Age
* Contrast media type and volume
* Patient weight
* Dose of contrast
* Diabetes
A single determination (10 ml of fresh urine) should be collected in a sterile container and the laboratory should centrifuge them within the time of collection. Neither the attending physicians nor the investigators will know the results, and the treatment will not be influenced.
The result is reported as a single value which is the concentration of TIMP-2 (ng / mL) multiplied by the concentration of IGFBP7 (ng / mL) divided by 1000. The result is reported without any unit or concentrations of individual biomarkers. As previously reported, a value of\> 0.3 identifies patients with a high probability of presenting a moderate to severe AKI (acute kidney injury) in 12 hours, while a value of ≤ 0.3 identifies patients with a low risk of developing a moderate to serious AKI
An aliquot of urine will be stored at -80 ° C in the Clinical Analysis Department
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 194
- Patients older than 21 years exposed to intra-arterial iodinated contrast media for diagnostic / therapeutic purposes and who have signed the Informed Consent document.
- Patients who have been exposed to a previous dose of iodinated contrast within 72 hours prior to recruitment.
- Patients with urgent radiodiagnostic intervention criteria, when it is not possible to obtain a previous urine sample without delaying the diagnosis and / or the intervention.
- Patients in anuria.
- Patients with chronic kidney disease, treated with hemodialysis (HD) or peritoneal dialysis.
- Bilirubinuria: bilirubin concentrations in the urine> 7.2 g / dL interfere with the result.
- Patients in terminal situations, in which diagnostic and therapeutic tests are limited.
- Patients under 21 years.
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Patients with ACS undergoing cardiac catheterization Urinary determination of TIMP-2/ IGFBP7 Adults with moderate / high risk acute coronary syndrome undergoing coronary intervention. The sample will be selected consecutively, including patients admitted to the Cardiac Coronary Unit and who require a radiological test with intra-arterial IC administration, for diagnostic or diagnostic / therapeutic purposes
- Primary Outcome Measures
Name Time Method Contrast-Associated Acute Kidney Injury up to 72 hours of exposure Absolute increase of 0.3 mg / dl in the creatinine value and / or a relative increase greater than 1.5 times the baseline creatinine value, measured at 48 and 72 hours after exposure to contrast.
- Secondary Outcome Measures
Name Time Method Mortality up to 30 days Patients who die during their hospital stay for any reason
Need of renal replacement techniques From exposure to contrasts to three months Hemodialysis, peritoneal dialysis or continuous renal replacement techniques,
Trial Locations
- Locations (1)
Hospital General Universitario de Elche
🇪🇸Elche, Alicante, Spain