Monitoring Renal Blood Flow With Contrast Enhanced Ultrasound During Coronary Angiogram
Status:
Unknown status
Trial end date:
1969-12-31
Target enrollment:
Participant gender:
Summary
Contrast induced nephropathy (CN) is a common cause of acute kidney injury and is associated
with increased morbidity and mortality and healthcare cost. Iodinated contrast media (ICM)
induce kidney injury through vasoconstriction and ischemia as well as direct tubular
toxicity. Older subjects, individuals with preexisting kidney disease, diabetes, hypotension,
and those exposed to higher volumes of ICM are at higher risks for CN. Within the last
several years, multiple strategies have been used in clinical studies to reduce the risk of
CN in high risk individuals with inconsistent results. In general, it is agreed that volume
expansion is effective in reducing the risk. However, no study has looked at changes in renal
blood flow (RBF) in response to volume expansion or after exposure to ICM to investigate its
relationship with occurrence of CN.
In this proposal, up to 125 individuals with preexisting kidney disease as evidenced by an
estimated glomerular filtration rate (eGFR) between 30 - 60 ml/min/1.73 m2 and up to 25
individuals with normal renal function (total of up to 150 individuals) who are scheduled for
coronary angiography will be studied. Each individual will have serial measurements of RBF;
at baseline, after volume expansion with normal saline, and after exposure to ICM, using the
novel technique of contrast enhanced ultrasound (CEU). The investigators will investigate the
utility of monitoring RBF with CEU in predicting the occurrence of CN (a rise of > 0.3 mg/dL
or 25% in baseline serum creatinine 48 hours after exposure to ICM) after adjusting for other
known risk factors in the group of subjects with reduced GFR. The investigators will also
examine the correlation between RBF changes and other urinary and serum biomarkers of kidney
injury in this group. Up to 25 individuals with a normal kidney function will be studied in a
separate part of the study in which the accuracy of CEU based measurements of RBF will be
compared to the RBF and blood flow velocity obtained simultaneously using a Doppler flow
probe placed directly inside the main renal artery during coronary angiogram procedure. Total
to enroll = 150.
Phase:
N/A
Details
Lead Sponsor:
University of Virginia
Collaborator:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)