Contrast-Induced Acute Kidney Injury: The At-Risk Patient and Protective Measures
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Contrast-induced acute kidney injury (CI-AKI) is a major complication following radiocontrast procedures. In this review, we characterize the recent literature on CI-AKI, risk factors, prevention, biomarkers, and new technologies. The premise of CI-AKI prophylaxis should focus on implementing mandatory standing orders before and after cardiac catheterization for hydration with normal saline or sodium bicarbonate and use of high-dose (1200-mg) N-acetylcysteine. Contrast agents may play a role in preventing CI-AKI. Implement catheter-laboratory technology and awareness to limit the amount of contrast dye used for any patient.
- DeFrances CJ, Hall MJ: 2005 National Hospital Discharge Survey. Adv Data 2007, (385):1–19.
- National Center for Health Statistics: Health, United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD: National Center for Health Statistics; 2010.
- Bagshaw SM, Ghali WA: Acetylcysteine for prevention of contrast-induced nephropathy after intravascular angiography: a systematic review and meta-analysis. BMC Med 2004, 2:38. CrossRef
- Tumlin J, Stacul F, Adam A, et al.: Pathophysiology of contrast-induced nephropathy. Am J Cardiol 2006, 98:14K–20K. CrossRef
- • Romano G, Briguori C, Quintavalle C, et al.: Contrast agents and renal cell apoptosis. Eur Heart J 2008, 29:2569–2576. This paper demonstrates the association between contrast dye and renal cell death. CrossRef
- • Brown JR, Malenka DJ, DeVries JT, et al.: Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: insights from the Dartmouth Dynamic Registry. Catheter Cardiovasc Interv 2008, 72:347–354. This paper demonstrates the poor survival associated with both transient and persistent CI-AKI. CrossRef
- Taliercio CP, Vlietstra RE, Fisher LD, Burnett JC: Risks for renal dysfunction with cardiac angiography. Ann Intern Med 1986, 104:501–504.
- Mehran R, Aymong ED, Nikolsky E, et al.: A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004, 44:1393–1399.
- • Brown JR, DeVries JT, Piper WD, et al.: Serious renal dysfunction after percutaneous coronary interventions can be predicted. Am Heart J 2008, 155:260–266. This is a paper for predicting CI-AKI prior to PCI. CrossRef
- • Stolker JM, McCullough PA, Rao S, et al.: Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing coronary angiography. J Am Coll Cardiol 2010, 55:1433–1440. This paper suggests baseline hyperglycemia is a risk factor for CI-AKI. CrossRef
- • Brown JR, Block CA, Malenka DJ, et al.: Sodium bicarbonate plus N-acetylcysteine prophylaxis: a meta-analysis. JACC Cardiovasc Interv 2009, 2:1116–1124. This is a meta-analysis for the combination therapy of sodium bicarbonate plus N-acetylcysteine. CrossRef
- • Zoungas S, Ninomiya T, Huxley R, et al.: Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med 2009, 151:631–638. This paper and the papers by Meier et al.  and Kanbay et al.  are recent systematic reviews and meta-analyses of sodium bicarbonate and CI-AKI.
- Meier P, Ko DT, Tamura A, et al.: Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis. BMC Med 2009, 7:23. CrossRef
- Kanbay M, Covic A, Coca SG, et al.: Sodium bicarbonate for the prevention of contrast-induced nephropathy: a meta-analysis of 17 randomized trials. Int Urol Nephrol 2009, 41:617–627. CrossRef
- Chertow GM, Burdick E, Honour M, et al.: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005, 16:3365–3370. CrossRef
- Tamura A, Goto Y, Miyamoto K, et al.: Efficacy of single-bolus administration of sodium bicarbonate to prevent contrast-induced nephropathy in patients with mild renal insufficiency undergoing an elective coronary procedure. Am J Cardiol 2009, 104:921–925. CrossRef
- • Meier PP, Gurm HS: Is simpler also better? Brief sodium bicarbonate infusion to prevent contrast-induced nephropathy. Am J Cardiol 2010, 105:1042–1043. This paper demonstrates the usefulness of a short infusion protocol for sodium bicarbonate that might be useful for patients with ST-segment elevation myocardial infarction. CrossRef
- Trivedi H, Daram S, Szabo A, et al.: High-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Am J Med 2009, 122:874e9–874e15. CrossRef
- Marenzi G, Assanelli E, Marana I, et al.: N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 2006, 354:2773–2782. CrossRef
- Baskurt M, Okcun B, Abaci O, et al.: N-acetylcysteine versus N-acetylcysteine+theophylline for the prevention of contrast nephropathy. Eur J Clin Invest 2009, 39:793–799. CrossRef
- Malhis M, Al-Bitar S, Al-Deen Zaiat K: The role of theophylline in prevention of radiocontrast media-induced nephropathy. Saudi J Kidney Dis Transpl 2010, 21:276–283.
- Cigarroa RG, Lange RA, Williams RH, Hillis LD: Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989, 86:649–652. CrossRef
- • Marenzi G, Assanelli E, Campodonico J, et al.: Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality. Ann Intern Med 2009, 150:170–177. This paper evaluates the role of contrast volume and CI-AKI.
- • Brown JR, Robb JF, Block CA, Schoolwerth AC, Kaplan AV, O’Connor GT, Solomon RJ, Malenka DJ: Does “safe” dosing of iodinated contrast prevent contrast-induced acute kidney injury? Circ Cardiovasc Interv 2010, 3:1–5.
- • Reed M, Meier P, Tamhane UU, et al.: The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv 2009, 2:645–654. This study is a systematic review of the clinical utility of iodixanol (iso-osmolar contrast agent) compared with low-osmolar agents. CrossRef
- Wessely R, Koppara T, Bradaric C, et al.: Choice of contrast medium in patients with impaired renal function undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2009, 2:430–437. CrossRef
- Alexopoulos E, Spargias K, Kyrzopoulos S, et al.: Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media. Am J Med Sci 2010, 339:25–30. CrossRef
- Laskey W, Aspelin P, Davidson C, et al.: Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures. Am Heart J 2009, 158:822–828.e3. CrossRef
- Solomon R: Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures. Am Heart J 2010, 159:7; author reply e9. CrossRef
- Hernandez F, Mora L, Garcia-Tejada J, et al.: Comparison of iodixanol and ioversol for the prevention of contrast-induced nephropathy in diabetic patients after coronary angiography or angioplasty. Rev Esp Cardiol 2009, 62:1373–1380. CrossRef
- Bolognese L, Falsini G, Grotti S, et al.: The contrast media and nephrotoxicity following coronary revascularization by primary angioplasty for acute myocardial infarction study: design and rationale of the CONTRAST-AMI study. J Cardiovasc Med (Hagerstown) 2010, 11:199–206.
- Maioli M, Toso A, Leoncini M, et al.: Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol 2008, 52:599–604. CrossRef
- Xinwei J, Xianghua F, Jing Z, et al.: Comparison of usefulness of simvastatin 20mg versus 80mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol 2009, 104:519–524. CrossRef
- • Weisz G, Filby SJ, Cohen MG, et al.: Safety and performance of targeted renal therapy: the Be-RITe! Registry. J Endovasc Ther 2009, 16:1–12. This paper demonstrates the use of the Benephit System Renal Infusion Therapy (Be-RITe!). CrossRef
- Chen HH, Cataliotti A, Schirger JA, et al.: Local renal delivery of a natriuretic peptide a renal-enhancing strategy for B-type natriuretic peptide in overt experimental heart failure. J Am Coll Cardiol 2009, 53:1302–1308. CrossRef
- Teirstein PS, Price MJ, Mathur VS, et al.: Differential effects between intravenous and targeted renal delivery of fenoldopam on renal function and blood pressure in patients undergoing cardiac catheterization. Am J Cardiol 2006, 97:1076–1081. CrossRef
- Grube E, Baim D, Burkhoff D, et al.: Local intra-renal fenoldopam infusion causes greater increases in renal artery flow velocity than systemic intravenous fenoldopam infusion: a pilot study. EuroIntervention 2005, 1:305–308.
- • Smith EJ, Reitan O, Keeble T, et al.: A first-in-man study of the Reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention. Catheter Cardiovasc Interv 2009, 73:859–865. This paper demonstrates the use of the Reitan catheter pump. CrossRef
- • Haase M, Bellomo R, Devarajan P, et al.: Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009, 54:1012–1024. This paper systematically reviews the evidence for supporting NGAL as an early biomarker for AKI. CrossRef
- Contrast-Induced Acute Kidney Injury: The At-Risk Patient and Protective Measures
Current Cardiology Reports
Volume 12, Issue 5 , pp 440-445
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- Kidney injury
- Cardiac catheterization
- Risk factors
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- Author Affiliations
- 2. The Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology, Dartmouth Medical School, Hanover, NH, USA
- 1. Invasive Cardiology and Vascular Medicine, Yale University School of Medicine, PO Box 208017, 333 Cedar Street, Fitkin 3, New Haven, CT, 06520-8017, USA