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Contrast-induced acute kidney injury

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Abstract

Although major advancements in the field of cardiology have allowed for an increasing number of patients to undergo minimally invasive imaging and interventional procedures, contrast-induced acute kidney injury (CI-AKI) continues to be a dreaded complication among patients receiving intravascular contrast media. CI-AKI is characterized by progressive decline in kidney function within a few days of contrast medium administration. Physiological changes resulting from the direct nephrotoxic effect of contrast media on tubular epithelial cells and release of vasoactive molecules have been implicated in creating a state of increased oxidative stress and subsequent ischemic renal cell injury. Over the last several years, preventive strategies involving intravenous hydration, pharmaceutical agents and renal replacement therapies have resulted in lower rates of CI-AKI. However, due to the evolving paradigm of diagnostic and therapeutic interventions, several unanswered questions remain. This review highlights the epidemiology, pathogenesis and preventive strategies of CI-AKI.

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Fig. 1

Adapted from Mehran et al. [14]

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  1. Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA

    Rishi Chandiramani, Davide Cao, Johny Nicolas & Roxana Mehran

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Dr. Mehran reports receiving consulting fees from Abbott Vascular, Boston Scientific, Medscape/WebMD, Siemens Medical Solutions, Phillips/Volcano/Spectranetics, Roviant Sciences, Sanofi Italy, Bracco Group, Janssen, and AstraZeneca, grant support, paid to her institution, from Bayer, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Osprey Medical, PLC/RenalGuard, and Abbott Vascular, grant support and advisory board fees, paid to her institution, from BMS, fees for serving on a data and safety monitoring board from Watermark Research Funding, advisory fees and lecture fees from Medintelligence (Janssen), and lecture fees from Bayer. All other authors report no conflicts of interest.

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Chandiramani, R., Cao, D., Nicolas, J. et al. Contrast-induced acute kidney injury. Cardiovasc Interv and Ther 35, 209–217 (2020). https://doi.org/10.1007/s12928-020-00660-8

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