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Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam

      Of the several agents that have been studied in the prevention of radiographic contrast nephropathy (RCN), saline hydration, use of nonionic dye, and N-acetylcysteine have been promising.
      • McCullough P.
      • Wolyn R.
      • Rocher L.
      • Levin R.
      • O’Neill W.
      Acute renal failure after coronary intervention incidence, risk factors, and relationship to mortality.
      ,
      • Gruberg L.
      • Mintz G.
      • Mehran R.
      • Dangas G.
      • Lansky A.
      • Kent K.
      • Pichard A.
      • Satler L.
      • Leon M.
      The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency.
      ,
      • Rudnick M.
      • Goldfarb S.
      • Wexler L.
      • Ludbrook P.
      • Murphy M.
      • Halpern E.
      • Hill J.
      • Winniford M.
      • Cohen M.
      • VanFossen D.
      The EPIC InvestigatorsIohexol Cooperative Study
      Nephrotoxicity of ionic and nonionic contrast media in 1196 patients a randomized trial.
      ,
      • Solomon R.
      • Werner C.
      • Mann D., D.’
      • Elia J.
      • Silva P.
      Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents.
      ,
      • Deray G.
      • Jacobs C.
      Radiocontrast nephrotoxicity a review.
      ,
      • Weisberg L.
      • Kurnik P.
      • Kurnik B.
      Risk of radiocontrast nephropathy in patients with and without diabetes mellitus.
      ,
      • Stevens M.
      • McCullough P.
      • Tobin K.
      • Speck J.
      • Westveer D.
      • Guido-Allen D.
      • Timmis G.
      • O’Neill W.
      A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy results of the PRINCE study.
      ,
      • Taliercio C.
      • Vlietstra R.
      • Ilstrup D.
      • Burnett J.
      • Menke K.
      • Stensrud S.
      • Holmes D.
      A randomized comparison of the nephrotoxicity of Iopamidol and Diatrizoate in high risk patients undergoing cardiac angiography.
      ,
      • Gare M.
      • Haviv Y.
      • Ben-Yehuda A.
      • Rubinger D.
      • Bdolah-Abram T.
      • Fuchs S.
      • Gat O.
      • Popovtzer M.
      • Gotsman M.
      • Mosseri M.
      The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography.
      ,
      • Abizaid A.
      • Clark C.
      • Mintz G.
      • Dosa S.
      • Popma J.
      • Pichard A.
      • Satler L.
      • Harvey M.
      • Kent K.
      • Leon M.
      Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency.
      ,
      • Tepel M.
      • van der Giet M.
      • Schwarzfeld C.
      • Laufer U.
      • Liermann D.
      • Zidek W.
      Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine.
      No agent, however, has been shown to be effective in diabetics, especially those with baseline serum creatinine ≥2.0 mg/dl. Bakris et al
      • Bakris G.
      • Lass N.
      • Glock D.
      Renal hemodynamics in radiocontrast medium-induced renal dysfunction a role for dopamine-1 receptors.
      showed that selective dopamine-1 receptor agonist fenoldopam protects against contrast-mediated reduction in renal blood flow compared with Schering 23390, a dopamine-1 receptor antagonist. Although fenoldopam has been shown to be a “reno-protective” agent in the setting of renal ischemic injury during percutaneous coronary intervention (PCI),
      • Kini A.
      • Mitre C.
      • Kim M.
      • Kamran M.
      • Reich D.
      • Sharma S.
      A protocol for prevention of radiographic contrast nephropathy during percutaneous coronary intervention effect of selective dopamine receptor agonist fenoldopam.
      its role in high-risk patients with diabetes mellitus and chronic renal insufficiency has not been studied. The present study evaluates the incidence and predictors of RCN after PCI with use of fenoldopam in high-risk patients.
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