KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Kidney International, Journal Year: 2024, Volume and Issue: 105(4), P. S117 - S314

Published: March 13, 2024

This article is published as part of a supplement sponsored by Kidney Disease: Improving Global Outcomes (KDIGO). The opinions or views expressed in this are those the authors and do not necessarily reflect recommendations International Society Nephrology Elsevier. Dosages, indications, methods use for products that referred to may their clinical experience be derived from professional literature other sources.

Language: Английский

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Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation

Radiology, Journal Year: 2020, Volume and Issue: 294(3), P. 660 - 668

Published: Jan. 21, 2020

Intravenous iodinated contrast media are commonly used with CT to evaluate disease and determine treatment response. The risk of acute kidney injury (AKI) developing in patients reduced function following exposure intravenous has been overstated. This is due primarily historic lack control groups sufficient separate contrast-induced AKI (CI-AKI; ie, caused by administration) from contrast-associated (CA-AKI; coincident administration). Although the true CI-AKI remains uncertain for severe disease, prophylaxis normal saline indicated who have or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 not undergoing maintenance dialysis. In individual high-risk circumstances, may be considered 30–44 at discretion ordering clinician. article a simultaneous joint publication Radiology Kidney Medicine. articles identical except stylistic changes keeping each journal’s style. Either version citing this article. © 2020 RSNA National Foundation published Elsevier Inc. open access under CC BY NC-ND license.

Language: Английский

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Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association

Circulation, Journal Year: 2022, Volume and Issue: 146(21)

Published: Oct. 17, 2022

Coronary heart disease is an important source of mortality and morbidity among kidney transplantation liver candidates recipients driven by traditional nontraditional risk factors related to end-stage organ disease. In this scientific statement, we review evidence from the past decade coronary screening management for candidates. in asymptomatic has not been demonstrated improve outcomes but common practice. Risk stratification algorithms based on presence or absence clinical physical performance have proposed, a high proportion still meet criteria tests. We suggest new approaches pretransplantation evaluation grounded known cardiac symptoms emphasize multidisciplinary engagement, including involvement dedicated cardiologist. Noninvasive functional methods such as stress echocardiography myocardial perfusion scintigraphy limited accuracy, newer noninvasive modalities, especially computed tomography-based tests, are promising alternatives. Emerging results 2020 International Study Comparative Health Effectiveness With Medical Invasive Approaches-Chronic Kidney Disease trial emphasizes vital importance guideline-directed medical therapy managing diagnosed further questions value revascularization Optimizing strategies disseminate implement best practices broader population should be prioritized cardiovascular these populations.

Language: Английский

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Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group

Nature Reviews Cardiology, Journal Year: 2023, Volume and Issue: 20(10), P. 696 - 714

Published: June 5, 2023

Language: Английский

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EASL Clinical Practice Guidelines on liver transplantation

Journal of Hepatology, Journal Year: 2024, Volume and Issue: 81(6), P. 1040 - 1086

Published: Oct. 31, 2024

Language: Английский

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Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease

Kidney Medicine, Journal Year: 2020, Volume and Issue: 2(1), P. 85 - 93

Published: Jan. 1, 2020

The putative risk of administering modern intravenous iodinated contrast media in patients with reduced kidney function has been overstated. This is primarily because the conflation contrast-associated acute injury (CA-AKI) contrast-induced (CI-AKI) uncontrolled studies. Although true CI-AKI remains unknown, prophylaxis normal saline indicated for without contraindication (eg, heart failure) who have (AKI) or an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 are not undergoing maintenance dialysis. In individual high-risk circumstances, may be considered eGFR 30–44 at discretion ordering clinician. presence a solitary should independently influence decision making regarding CI-AKI. Ad hoc lowering dose below known diagnostic threshold avoided due to accuracy. When feasible, nephrotoxic medications withheld by referring clinician high risk. However, renal replacement therapy initiated altered solely based on administration. Prospective controlled data needed adult and pediatric populations clarify A summary these recommendations comparison existing guidelines provided Table 1.Table 1Summary Major ACR-NKF Consensus Statements Use Intravenous Iodinated Contrast Media Patients With Kidney Disease, Comparison ACR (2018) KDIGO (2012) Guidelines CI-AKISummary1.The terms CA-AKI PC-AKI recommended use clinical practice large proportion AKI events correlated but necessarily caused administration.a.ACR: Similar recommendation distinguish generic from CI-AKIb.KDIGO: No terminology, although it acknowledged that other things2.CI-AKI only feasible diagnose context well-matched study.a.ACR: Not specifically addressedb.KDIGO: addressed3.KDIGO criteria diagnosis AKI, CKD CKD.a.ACR: AKIN recommendedb.KDIGO: recommended4.The lower previously thought. Necessary material–enhanced CT suitable alternative basis risk.a.ACR: recommendationb.KDIGO: recommendation5.CI-AKI determined using stage AKI. include those recent m2, including nonanuric dialysis.a.ACR: recommendation, 45 instead m26.Kidney screening identify Personal history disease (CKD, remote surgery ablation) strongest factor indicating need assessment.a.ACR: also includes age, diabetes mellitus, hypertension as potential factors indicate assessmentb.KDIGO: hypertension, multiple myeloma, gout, proteinuria assessment7.Radiologist-clinician discussions about risks benefits contrast-enhanced imaging can helpful CI-AKI.a.ACR: addressed8.There no clinically relevant differences between iso-osmolality low-osmolality media.a.ACR: recommendation9.Prophylaxis dialysis clinician.a.ACR: Prophylaxis m2; exception factorsb.KDIGO: sodium bicarbonate N-acetylcysteine10.Prophylaxis stable greater equal m2.a.ACR: m2b.KDIGO: Necessity ambiguous 45–59 m211.Kidney schedule adjusted recommendation12.The addressed13.In CI-AKI, ad avoided. Rather, minimum routine used.a.ACR: reduction recommended14.When recommendation15.Data extrapolated patients. Pediatric-specific research this area major unmet need.a.ACR: addressedAbbreviations: ACR, American College Radiology; injury; AKIN, Acute Injury Network; CA-AKI, AKI; CKD, chronic disease; eGFR, rate; KDIGO, Disease Improving Global Outcomes; NKF, National Foundation; PC-AKI, postcontrast Source.—References 15, 17, 21. Open table new tab

Language: Английский

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Use of Intravenous Gadolinium-Based Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation

Kidney Medicine, Journal Year: 2020, Volume and Issue: 3(1), P. 142 - 150

Published: Nov. 10, 2020

These joint consensus statements by the American College of Radiology and National Kidney Foundation are intended to improve standardize care patients with decreased kidney function who have indication(s) receive intravenous gadolinium-based contrast media (GBCM). The risk nephrogenic systemic fibrosis (NSF) or nephrotoxicity following administration a standard dose (0.1 mmol/kg) group II GBCM is extremely low. estimate NSF for in stage 5 5D chronic disease based on data from 2,581 individuals. It possible that may rarely occur this population. harms delaying withholding clinically indicated MRI patient acute injury estimated glomerular filtration rate less than 30 mL/min per 1.73 m2 outweigh NSF, regardless dialysis status. safety margin should be considered potential harm delayed diagnosis misdiagnosis. Further study investigating clinical benefits common indications can risk-benefit decision making. screening prior optional. not necessary initiate alter an established schedule III administration. recommendations also apply receiving nephrotoxic medications, chemotherapy, contrast-enhanced CT.

Language: Английский

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Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial

Circulation, Journal Year: 2023, Volume and Issue: 148(18), P. 1371 - 1380

Published: Sept. 29, 2023

BACKGROUND: Patients with previous coronary artery bypass grafting often require invasive angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac (CTCA) may facilitate ICA in this group, but not been tested randomized controlled trial. METHODS: This study was single-center, open-label trial assessing benefit adjunctive CTCA patients referred ICA. were 1:1 to undergo before or alone. The co–primary end points procedural duration (defined as interval between local anesthesia administration obtaining vascular access removal last catheter), patient satisfaction after using validated questionnaire, incidence contrast-induced nephropathy. Linear regression used score; nephropathy analyzed logistic regression. We applied Bonferroni correction, P <0.017 considered significant 98.33% CIs presented. Secondary included complications 1-year major adverse events. RESULTS: Over 3 years, 688 median follow-up 1.0 years. mean age 69.8±10.4 108 (15.7%) women, 402 (58.4%) White, there high burden comorbidity (85.3% hypertension 53.8% diabetes). time from 12.0 (interquartile range, 2 3) grafts per participant. Procedure significantly shorter CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus alone, 39.5±16.9 [98.33% CI, −23.5 −18.4]; <0.001), alongside improved scores (1=very good 5=very poor; −1.1 difference −1.2 −0.9]; reduced (3.4% 27.9%; odds ratio, 0.09 0.04–0.2]; <0.001). Procedural (2.3% 10.8%; 0.2 [95% 0.1–0.4]; <0.001) events (16.0% 29.4%; hazard 0.4 0.3–0.6]; also lower group. CONCLUSIONS: For grafting, leads reductions nephropathy, satisfaction. should be patients. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03736018.

Language: Английский

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Novel Insights into Diabetic Kidney Disease

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(18), P. 10222 - 10222

Published: Sept. 23, 2024

Diabetic kidney disease (DKD) is a major complication of diabetes mellitus (DM), affecting over one-third type 1 and nearly half 2 patients. As the leading cause end-stage renal (ESRD) globally, DKD develops through complex interplay chronic hyperglycemia, oxidative stress, inflammation. Early detection crucial, with diagnosis based on persistent albuminuria reduced estimated glomerular filtration rate (eGFR). Treatment strategies emphasize comprehensive management, including glycemic control, blood pressure regulation, use nephroprotective agents such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), sodium-glucose cotransporter-2 (SGLT2) glucagon-like peptide-1 (GLP-1) agonists. Ongoing research explores novel therapies targeting molecular pathways non-coding RNAs. Preventive measures focus rigorous control hyperglycemia hypertension, aiming to mitigate progression. Despite therapeutic advances, remains ESRD, highlighting need for continued identify new biomarkers innovative treatments.

Language: Английский

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Competence of radiologists in cardiac CT and MR imaging in Europe: insights from the ESCR Registry

European Radiology, Journal Year: 2024, Volume and Issue: 34(9), P. 5666 - 5677

Published: Feb. 28, 2024

Abstract Rationale To provide an overview of the current status cardiac multimodality imaging practices in Europe and radiologist involvement using data from European Society Cardiovascular Radiology (ESCR) MRCT-registry. Materials methods Numbers on CT MRI examinations were extracted MRCT-registry ESCR, entered between January 2011 October 2023 ( n = 432,265). Data collection included total/annual numbers examinations, indications, complications, reporting habits. Results Thirty-two countries contributed to MRCT-registry, including 29 countries. Between 2022, there was a 4.5-fold increase annually submitted 3368 15,267, 3.8-fold 3445 13,183. The main indications for suspected coronary artery disease (CAD) (59%) transcatheter aortic valve replacement planning (21%). number patients with intermediate pretest probability who underwent CAD showed 61% 2012 82% 2022. myocarditis (26%), (21%), cardiomyopathy (19%). Adverse event rates very low (0.3%) (0.7%) examinations. Reporting performed mainly by radiologists (respectively 76% 71%) and, lesser degree, consensus non-radiologists (19% 27%, respectively). remaining (4.9% 1.7% MRI) reported non-radiological specialties or separate readings non-radiologists. Conclusions Real-life largest available demonstrate considerable over past years, vast majority which are read radiologists. These findings indicate that contribute meeting increasing demands competent effective care relevant extent. Clinical relevance statement has risen these studies as recorded Key Points • is constantly . Radiologists play central role providing MR services large volume Cardiac show good safety profile Graphical

Language: Английский

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