Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Mar 25, 2021; 10(2): 8-20
Published online Mar 25, 2021. doi: 10.5527/wjn.v10.i2.8
Low-molecular-weight dextran for optical coherence tomography may not be protective against kidney injury in patients with renal insufficiency
Toru Misawa, Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hoshino, Masao Yamaguchi, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Yumi Yasui, Eisuke Usui, Tetsumin Lee, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta
Toru Misawa, Tomoyo Sugiyama, Yoshihisa Kanaji, Masahiro Hoshino, Masao Yamaguchi, Masahiro Hada, Tatsuhiro Nagamine, Kai Nogami, Yumi Yasui, Eisuke Usui, Tetsumin Lee, Tsunekazu Kakuta, Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
Taishi Yonetsu, Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Tetsuo Sasano, Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Author contributions: Misawa T and Kakuta T contributed to the study conception and design; Misawa T, Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Nagamine T, Nogami K and Yasui Y conducted material preparation and data collection; Misawa T conducted data analysis and wrote the first draft of the manuscript; all authors commented on previous versions of the manuscript, read and approved the final manuscript.
Institutional review board statement: This study was performed in compliance with Institutional Ethics Committee Guidelines of Tsuchiura Kyodo General Hospital, and the study received its approval.
Informed consent statement: All patients provided written informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsunekazu Kakuta, MD, PhD, Doctor, Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Japan. kaz@joy.email.ne.jp
Received: December 29, 2020
Peer-review started: December 30, 2020
First decision: February 15, 2021
Revised: February 22, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: March 25, 2021
ARTICLE HIGHLIGHTS
Research background

Low-molecular-weight dextran (LMWD) is considered a safe alternative to contrast media for blood displacement during optical coherence tomography (OCT) imaging. On the other hand, LMWD-induced acute kidney injury has been repeatedly reported.

Research motivation

The protective role of LMWD against kidney injury remains uncertain in patients with advanced renal insufficiency, particularly regarding the long-term influence.

Research objectives

To investigate whether the use of LMWD for OCT is protective against kidney injury in patients with advanced renal insufficiency.

Research methods

In this retrospective cohort study, we identified 421 patients with advanced renal insufficiency (estimated glomerular filtration rate < 45 mL/min/1.73 m2) who underwent coronary angiography or percutaneous coronary intervention; 79 patients who used additional LMWD for OCT imaging (LMWD group) and 342 patients who used contrast medium exclusively (control group). We evaluated the differences between these two groups and performed a propensity score-matched subgroup comparison.

Research results

Although baseline renal function was not statistically different between these two groups, the LMWD group demonstrated a strong trend toward the progression of renal insufficiency as indicated by the greater change in serum creatinine level during the 1-year follow-up compared with the control group. Patients in the LMWD group experienced worsening renal function more frequently than patients in the control group. Propensity score matching adjusted for total contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up. Delta serum creatinine at 1-year follow-up was significantly greater in the LMWD group than that in the control group [0.06 (-0.06, 0.29) vs -0.04 (-0.23, 0.08) mg/dL, P = 0.001], despite using similar contrast volume.

Research conclusions

Additional use of LMWD for OCT may not be protective against worsening renal function in patients with advanced renal insufficiency.

Research perspectives

Since our study is of hypothesis generating nature, further large, prospective studies are warranted.