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Contrast-Induced Acute Kidney Injury: Epidemiology, Risk Stratification, and Prognosis

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Kidney Disease in the Cardiac Catheterization Laboratory

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Abstract

Contrast-induced acute kidney injury (CI-AKI) risk is generally higher with the use of coronary angiography, with an average incidence of CI-AKI of 13.7% and a range between 4.4% and 28%. Long-term effects of acute kidney injury following nephrotoxic exposure include CKD progression and all-cause mortality. Baseline CKD status is the most predictive risk factor for CI-AKI, with increased risk in eGFR <30 mL/min/1.73 m. Prophylactic measures, including avoidance of high-osmolar contrast media (HOCM), use of lowest volume of contrast media (CM), and volume optimization with isotonic fluids, are useful for the prevention of CI-AKI. Innovative measures for targeting the latter two strategies are being investigated. Other prophylactic measures, including extracorporeal removal of CM with dialysis methods and administration of N-acetyl cysteine, have not been consistently shown to prevent CI-AKI. Although long-term outcomes following CI-AKI are present, it remains crucial to consider the risks and benefits of use vs nonuse of angiographic procedures.

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Authors and Affiliations

  1. Penn Presbyterian Medical Center, Philadelphia, PA, USA

    Jehan Zahid Bahrainwala

  2. Renal Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Philadelphia, PA, USA

    Amanda K. Leonberg-Yoo

  3. Perelman School of Medicine of the University of Pennsylvania, Department of Nephrology, Penn Presbyterian Medical Center, Philadelphia, PA, USA

    Michael R. Rudnick

Authors
  1. Jehan Zahid Bahrainwala
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  2. Amanda K. Leonberg-Yoo
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  3. Michael R. Rudnick
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Correspondence to Amanda K. Leonberg-Yoo .

Editor information

Editors and Affiliations

  1. Einstein Medical Center/Thomas Jefferson University, Department of Medicine/Nephrology, Philadelphia, PA, USA

    Janani Rangaswami

  2. UIC/Advocate Christ Medical Center, Department of Medicine, Chicago, Il, USA

    Edgar V. Lerma

  3. Baylor University Medical Center, Baylor Heart and Vascular Hospital, Department of Internal Medicine, Texas A & M College of Medicine, Division of Cardiology, Dallas, TX, USA

    Peter A. McCullough

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Bahrainwala, J.Z., Leonberg-Yoo, A.K., Rudnick, M.R. (2020). Contrast-Induced Acute Kidney Injury: Epidemiology, Risk Stratification, and Prognosis. In: Rangaswami, J., Lerma, E., McCullough, P. (eds) Kidney Disease in the Cardiac Catheterization Laboratory . Springer, Cham. https://doi.org/10.1007/978-3-030-45414-2_11

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