Cystatin C as an Early Marker of Contrast-Medium Nephropathy in Cardiac Catheterization Patients

NCT ID: NCT00467311

Last Updated: 2008-05-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

66 participants

Study Classification

OBSERVATIONAL

Study Start Date

2006-12-31

Study Completion Date

2008-04-30

Brief Summary

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Hypothesis:

Cystatin C compared with creatinine is a better and earlier marker of contrast-induced nephropathy in high and intermedium risk cardiac catheterization patients.

Primary Objective:

Establish if Cystatin C is superior detecting contrast-induced nephropathy than creatinine in high and intermedium risk cardiac catheterization patients.

Detailed Description

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Contrast induced-nephropathy is a complication that is underestimated in clinical practice after cardiac catheterization. During the last 30 years, because of the increasing use of contrast medium for diagnostic and therapeutic procedures, this has become the third in-hospital cause of acute renal failure (12%). That's why, it is necessary to establish an earlier marker of renal dysfunction that can help us in the diagnosis and allow us to initiate the appropriate therapeutics, because depending on the severity of the renal damage, it can increase the cardiovascular risk and morbidity.

The risk of contrast medium nephropathy is still present even with the use of low osmolarity contrast media, and many patients increase their in-hospital days, costs and hemodialysis requirement.

Cystatin C is a non glucosylated protein produced in nucleated cells in a constant rate, and because of its low molecular weight it's filtered through the glomerular membrane without restriction and it's fully reabsorbed in the proximal tubule, that's why it's considered an excellent marker evaluating the glomerular filtration rate in patients with acute renal failure during the first 24-48 hours.

We propose that Cystatin C can be useful as an earlier and superior marker of contrast-induced nephropathy in high and intermedium cardiac catheterization patients.

Conditions

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Contrast Induced Nephropathy Acute Renal Failure

Keywords

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Contrast-induced nephropathy Cystatin C Contrast media Creatinine Cardiac Catheterization

Study Design

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Study Time Perspective

CROSS_SECTIONAL

Eligibility Criteria

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Inclusion Criteria

* Age over 20 years old
* Indication for coronariography and/or percutaneous coronary intervention
* Voluntary written consent for the realization of coronariography and/or percutaneous intervention and for the participation in this clinical trial
* A MEHRAN contrast-induced nephropathy score from six to fifteen.

Exclusion Criteria

* N-Acetylcystein and Fenoldopam pre-medication
* Low risk patients according MEHRAN classification
* Cardiogenic and septic shock
* Acute renal failure by any other cause
* Patients with chronic kidney failure requiring any kind of dialysis
* Patients unable to complete follow-up
* Exposure to contrast media 48 hours prior to study
* Patients unable to give consent
* Receiving contrast media other than non-ionic
Minimum Eligible Age

20 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart Institute, Mexico

OTHER_GOV

Sponsor Role lead

Principal Investigators

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Jhonathan L Uribe-González, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Ignacio Chávez National Institute of Cardiology

Jorge G Hernández, MD, FSCAI

Role: STUDY_CHAIR

Ignacio Chávez National Institute of Cardiology

Marco A Martínez-Rios

Role: STUDY_DIRECTOR

Ignacio Chávez National Institute of Cardiology

Marco A Peña-Duque, MD

Role: PRINCIPAL_INVESTIGATOR

Ignacio Chávez National Institute of Cardiology

Locations

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Ignacio Chávez National Institute of Cardiology

Mexico City, Mexico City, Mexico

Site Status

Countries

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Mexico

References

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Goldenberg I, Matetzky S. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ. 2005 May 24;172(11):1461-71. doi: 10.1503/cmaj.1040847.

Reference Type BACKGROUND
PMID: 15911862 (View on PubMed)

Rickli H, Benou K, Ammann P, Fehr T, Brunner-La Rocca HP, Petridis H, Riesen W, Wuthrich RP. Time course of serial cystatin C levels in comparison with serum creatinine after application of radiocontrast media. Clin Nephrol. 2004 Feb;61(2):98-102. doi: 10.5414/cnp61098.

Reference Type BACKGROUND
PMID: 14989628 (View on PubMed)

Schuck O, Teplan V, Jabor A, Stollova M, Skibova J. Glomerular filtration rate estimation in patients with advanced chronic renal insufficiency based on serum cystatin C levels. Nephron Clin Pract. 2003;93(4):c146-51. doi: 10.1159/000070234.

Reference Type BACKGROUND
PMID: 12759583 (View on PubMed)

Han WK, Bonventre JV. Biologic markers for the early detection of acute kidney injury. Curr Opin Crit Care. 2004 Dec;10(6):476-82. doi: 10.1097/01.ccx.0000145095.90327.f2.

Reference Type BACKGROUND
PMID: 15616389 (View on PubMed)

Villa P, Jimenez M, Soriano MC, Manzanares J, Casasnovas P. Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients. Crit Care. 2005 Apr;9(2):R139-43. doi: 10.1186/cc3044. Epub 2005 Feb 7.

Reference Type BACKGROUND
PMID: 15774046 (View on PubMed)

Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med. 2005 May 19;352(20):2049-60. doi: 10.1056/NEJMoa043161.

Reference Type BACKGROUND
PMID: 15901858 (View on PubMed)

Lameire N, Hoste E. Reflections on the definition, classification, and diagnostic evaluation of acute renal failure. Curr Opin Crit Care. 2004 Dec;10(6):468-75. doi: 10.1097/01.ccx.0000144939.24897.71. No abstract available.

Reference Type BACKGROUND
PMID: 15616388 (View on PubMed)

Loew M, Hoffmann MM, Koenig W, Brenner H, Rothenbacher D. Genotype and plasma concentration of cystatin C in patients with coronary heart disease and risk for secondary cardiovascular events. Arterioscler Thromb Vasc Biol. 2005 Jul;25(7):1470-4. doi: 10.1161/01.ATV.0000168416.74206.62. Epub 2005 Apr 28.

Reference Type BACKGROUND
PMID: 15860739 (View on PubMed)

Mares J, Stejskal D, Vavrouskova J, Urbanek K, Herzig R, Hlustik P. Use of cystatin C determination in clinical diagnostics. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2003 Dec;147(2):177-80.

Reference Type BACKGROUND
PMID: 15037900 (View on PubMed)

Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant. 2003 Oct;18(10):2024-31. doi: 10.1093/ndt/gfg349.

Reference Type BACKGROUND
PMID: 13679476 (View on PubMed)

Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C--a new marker of glomerular filtration rate in children independent of age and height. Pediatrics. 1998 May;101(5):875-81. doi: 10.1542/peds.101.5.875.

Reference Type BACKGROUND
PMID: 9565418 (View on PubMed)

Herget-Rosenthal S, Marggraf G, Husing J, Goring F, Pietruck F, Janssen O, Philipp T, Kribben A. Early detection of acute renal failure by serum cystatin C. Kidney Int. 2004 Sep;66(3):1115-22. doi: 10.1111/j.1523-1755.2004.00861.x.

Reference Type BACKGROUND
PMID: 15327406 (View on PubMed)

Coll E, Botey A, Alvarez L, Poch E, Quinto L, Saurina A, Vera M, Piera C, Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis. 2000 Jul;36(1):29-34. doi: 10.1053/ajkd.2000.8237.

Reference Type BACKGROUND
PMID: 10873868 (View on PubMed)

O'Riordan SE, Webb MC, Stowe HJ, Simpson DE, Kandarpa M, Coakley AJ, Newman DJ, Saunders JA, Lamb EJ. Cystatin C improves the detection of mild renal dysfunction in older patients. Ann Clin Biochem. 2003 Nov;40(Pt 6):648-55. doi: 10.1258/000456303770367243.

Reference Type BACKGROUND
PMID: 14629803 (View on PubMed)

Related Links

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http://www.cardiologia.org.mx

National Institute of Cardiology

Other Identifiers

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07552

Identifier Type: -

Identifier Source: org_study_id