{
  "abstract": "Background: Contrast-associated acute kidney injury (CA-AKI) remains a controversial clinical entity, partly because incidence estimates vary according to the diagnostic criteria and biomarkers used. Serum creatinine-based definitions may underestimate early functional renal impairment after contrast exposure, whereas cystatin C has emerged as a more sensitive early biomarker of glomerular filtration changes. This study aimed to evaluate how biomarker selection influences CA-AKI detection and interpretation of preventive strategies after intra-arterial contrast procedures.\n\nMethods: This prospective, randomized, single-blind exploratory trial included 76 patients with peripheral arterial disease undergoing elective intra-arterial contrast-enhanced vascular procedures, most of which were diagnostic angiographic examinations. Participants were stratified according to baseline renal function and randomized to receive either standardized hydration alone or hydration plus high-dose atorvastatin and N-acetylcysteine. CA-AKI was assessed using two predefined definitions: historical creatinine-based criteria (≥ 25% or ≥ 0.5 mg/dL increase within 72 h) and cystatin C–based criteria (≥ 10% increase within 24 h). Diagnostic concordance and biomarker-dependent differences in event ascertainment were evaluated.\n\nResults: Substantial diagnostic discordance was observed between creatinine- and cystatin C–defined CA-AKI, with no overlapping cases and poor agreement between biomarkers (κ = 0.07). Creatinine-based criteria identified 4 CA-AKI events, whereas cystatin C identified 7 additional early functional injury cases. Biomarker-dependent differences in event detection varied across renal function strata, particularly among patients with preserved baseline renal function. Low event rates using creatinine-based criteria limited definitive assessment of preventive efficacy. Exploratory analyses suggested that biomarker selection influenced the apparent magnitude and direction of treatment-effect estimates.\n\nConclusions: CA-AKI ascertainment after intra-arterial contrast exposure is strongly biomarker-dependent. Historical creatinine-based definitions may underestimate early functional renal impairment and influence interpretation of preventive strategies. These findings highlight the importance of endpoint selection in CA-AKI clinical trials and support further investigation of sensitive functional biomarkers in larger prospective studies.\n\nTrial registration: Brazilian Registry of Clinical Trials (ReBEC), RBR3h2gv8r (Universal Trial Number U1111-1277-3145), registered on 31 March 2023 retrospectively registered.",
  "abstract_shown": true,
  "affiliations": [
    "Hospital Geral de Goiânia Dr. Alberto Rassi (HGG), Goiânia, Brazil",
    "São Paulo State University (UNESP), Botucatu, Brazil"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Daniel Cesar Magalhaes Fernandes",
      "orcid": "0000-0002-4034-0523"
    },
    {
      "affs": [
        0
      ],
      "name": "Roberto Gomide"
    },
    {
      "affs": [
        0
      ],
      "name": "Thais Rodrigues Magalhaes"
    },
    {
      "affs": [
        0
      ],
      "name": "Rosa Tanmyris de Sousa Lima"
    },
    {
      "affs": [
        0
      ],
      "name": "Romulo Mendes Silva"
    },
    {
      "affs": [
        0
      ],
      "name": "Paulo Ricardo Alves Moreira"
    },
    {
      "affs": [
        0
      ],
      "name": "Alef Ribeiro Souza"
    },
    {
      "affs": [
        0
      ],
      "name": "Delvo Vasquez Netto"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Luiza Amaral"
    },
    {
      "affs": [
        0
      ],
      "name": "Lorrayne Silva Pequeno"
    },
    {
      "affs": [
        1
      ],
      "name": "Matheus Bertanha"
    },
    {
      "affs": [
        1
      ],
      "name": "Marcone Lima Sobreira"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a7p4zws7x8p6g.bib",
  "cited_by": 0,
  "doi": "10.1186/s12882-026-05342-w",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13737526/",
  "id": "a7p4zws7x8p6g",
  "issns": [
    "1471-2369"
  ],
  "landing_url": "https://doi.org/10.1186/s12882-026-05342-w",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2727|Acute Kidney Injury Research"
    ]
  ],
  "openalex": "W7214174545",
  "pdf_url": null,
  "pmcid": "PMC13737526",
  "pmid": "42983348",
  "published": "2026-09-24",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/a7p4zws7x8p6g.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:22:41Z",
      "native_id": "PMC13737526",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12882-026-05342-w"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Acute Kidney Injury Research",
      "subfield": "general"
    }
  ],
  "title": "Biomarker−dependent detection of contrast−associated acute kidney injury after intra−arterial contrast procedures: an exploratory randomized trial",
  "title_text": "Biomarker−dependent detection of contrast−associated acute kidney injury after intra−arterial contrast procedures: an exploratory randomized trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:22:41Z",
  "url": "https://research.draconitic.com/paper/a7p4zws7x8p6g",
  "venue": "BMC Nephrology",
  "versions": []
}