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Current Evidence of Contrast Medium-Induced Nephropathy (CIN) After Administration of Low-Osmolarity Iodine-Based Contrast Agents

  • Urogenital Imaging (M Bertolotto, Section Editor)
  • Published:
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Abstract

Purpose of review

Contrast medium-induced nephropathy (CIN) may occur after intravascular administration of low-osmolarity iodine-based contrast media. The goal of this review is to provide an updated overview of the current knowledge of CIN. Questions to be investigated are as follows: What are risk factors of CIN? How should the risk factors be assessed? Have any preventive measures proven effective?

Recent findings

The main risk factor of CIN is decreased renal function prior to contrast-enhanced imaging. A variety of other factors have been described, but these are not significant in controlled studies. Before contrast medium-enhanced imaging it is advisable to assess renal function with estimation of glomerular filtration rate (eGFR). Preventive strategies must be used in patients with eGFR < 45 ml/min/1.73 m2. The most effective preventive strategy is proper hydration.

Summary

To reduce the risk of CIN, risk factors must be assessed before contrast-enhanced imaging. The most effective, preventive strategy is hydration.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Stacul F, van der Molen AJ, Reimer P, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011;21(12):2527–41.

    Article  PubMed  Google Scholar 

  2. • Wilhelm-Leen E, Montez-Rath ME, Chertow G. Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol. 2017;28(2):653–659. CIN may have been overestimated in previous reports.

  3. Rao QA, Newhouse JH. Risk of nephropathy after intravenous administration of contrast material: a critical literature analysis. Radiology. 2006;239(2):392–7.

    Article  PubMed  Google Scholar 

  4. Azzouz M, Rømsing J, Thomsen HS. Fluctuations in eGFR in relation to unenhanced and enhanced MRI and CT outpatients. Eur J Radiol. 2014;83(6):886–92.

    Article  PubMed  Google Scholar 

  5. McDonald JS, McDonald RJ, Comin J, et al. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 2013;267(1):119–28.

    Article  PubMed  Google Scholar 

  6. Thomsen HS, Webb JA. Control groups in studies of contrast media adverse events. Acta Radiol. 2016;57(8):903–5.

    Article  PubMed  Google Scholar 

  7. Karlsberg RP, Dohad SY, Sheng R. Iodixanol Peripheral Computed Tomographic Angiography Study Investigator Panel. Contrast medium-induced acute kidney injury: comparison of intravenous and intraarterial administration of iodinated contrast medium. J Vasc Interv Radiol. 2011;22(8):1159–65.

    Article  PubMed  Google Scholar 

  8. Kooiman J, Le Haen PA, Gezgin G, et al. Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration: risk comparison adjusted for patient characteristics by design. Am Heart J. 2013;165(5):793–9.

    Article  PubMed  Google Scholar 

  9. • McDonald JS, Leake CB, McDonald RJ, et al. Acute kidney injury after intravenous versus intra-arterial contrast material administration in a paired cohort. Invest Radiol. 2016;51(12): 804–809. Study comparing CIN after intravenous and intra-arterial contrast administration.

  10. • Tong GE, Kumar S, Chong KC, et al. Risk of contrast-induced nephropathy for patients receiving intravenous vs. intra-arterial iodixanol administration. Abdom Radiol. 2016;41(1): 91–99. Study comparing CIN after intravenous and intra-arterial contrast administration.

  11. Moos SI, van Vemde DNH, Stoker J, Bipat S. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis. Eur J Radiol. 2013;82(9):e387–99.

    Article  PubMed  Google Scholar 

  12. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993;188(1):171–8.

    Article  CAS  PubMed  Google Scholar 

  13. Eng J, Wilson RF, Subramaniam RM, et al. Comparative effect of contrast media type on the incidence of contrast-induced nephropathy. Ann Intern Med. 2016;164(6):417.

    Article  PubMed  Google Scholar 

  14. Heinrich MC, Häberle L, Müller V, Bautz W, Uder M. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. Radiology. 2009;250(1):68–86.

    Article  PubMed  Google Scholar 

  15. Nyman U. Contrast dose, estimated GFR, and techniques to reduce contrast dose in PCI—time to consider some basic principles! J Invasive Cardiol. 2016;28(10):E126–7.

    PubMed  Google Scholar 

  16. Gurm HS, Dixon SR, Smith DE, et al. Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol. 2011;58(9):907–14.

    Article  PubMed  Google Scholar 

  17. Choyke PL, Cady J, DePollar SL, Austin H. Determination of serum creatinine prior to iodinated contrast media: is it necessary in all patients? Tech Urol. 1998;4(2):65–9.

    CAS  PubMed  Google Scholar 

  18. Azzouz M, Rømsing J, Thomsen HS. Can a structured questionnaire identify patients with reduced renal function? Eur Radiol. 2014;24(3):780–4.

    Article  PubMed  Google Scholar 

  19. Chang P, Saddleton E, Laumann AE, et al. Comparison of the sensitivity of a pre-MRI questionnaire and point of care eGFR testing for detection of impaired renal function. Acad Radiol. 2012;19(10):1181–5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Moos SI, de Weijert RS, Nagan G, Stoker J, Bipat S. Cost of screening strategies for kidney disease before intravenous contrast administration. Neth J Med. 2014;72(5):271–80.

    CAS  PubMed  Google Scholar 

  21. Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material–induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013;268(3):719–28.

    Article  PubMed  Google Scholar 

  22. • Ho Y-F, Hsieh K-L, Kung F-L, et al. Nephrotoxic polypharmacy and risk of contrast medium–induced nephropathy in hospitalized patients undergoing contrast-enhanced CT. Am J Roentgenol. 2015;205(4):703–708. One of few studies that have investigated CIN after contraast-enhanced CT.

  23. Kong D-G, Hou Y-F, Ma L-L, Yao D-K, Wang L-X. Comparison of oral and intravenous hydration strategies for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography or angioplasty: a randomized clinical trial. Acta Cardiol. 2012;67(5):565–9.

    Article  PubMed  Google Scholar 

  24. Akyuz S, Karaca M, Kemaloglu Oz T, et al. Efficacy of oral hydration in the prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention. Nephron Clin Pract. 2014;128(1–2):95–100.

    Article  CAS  PubMed  Google Scholar 

  25. Martin-Moreno PL, Varo N, Martínez-Ansó E, et al. Comparison of intravenous and oral hydration in the prevention of contrast-induced acute kidney injury in low-risk patients: a randomized trial. Nephron. 2015;131(1):51–8.

    Article  CAS  PubMed  Google Scholar 

  26. Wróbel W, Sinkiewicz W, Gordon M, Woźniak-Wiśniewska A. Oral versus intravenous hydration and renal function in diabetic patients undergoing percutaneous coronary interventions. Kardiol Pol. 2010;68(9):1015–20.

    PubMed  Google Scholar 

  27. Hiremath S, Akbari A, Shabana W, Fergusson DA, Knoll GA. Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence. Yang X, ed. PLoS ONE. 2013;8(3):e60009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Cheungpasitporn W, Thongprayoon C, Brabec B, Edmonds P, O′Corragain O, Erickson S. Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological procedures: a systematic review and meta-analysis of randomized controlled trials. N Am J Med Sci. 2014;6(12):618.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Chen SL, Zhang J, Yei F, et al. Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol. 2008;126(3):407–13.

    Article  PubMed  Google Scholar 

  30. Jurado-Román A, Hernández-Hernández F, García-Tejada J, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol. 2015;115(9):1174–8.

    Article  PubMed  Google Scholar 

  31. Luo Y, Wang X, Ye Z, et al. Remedial hydration reduces the incidence of contrast-induced nephropathy and short-term adverse events in patients with ST-segment elevation myocardial infarction: a single-center, randomized trial. Intern Med. 2014;53(20):2265–72.

    Article  PubMed  Google Scholar 

  32. Kooiman J, Sijpkens YWJ, van Buren M, et al. Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography. J Thromb Haemost. 2014;12(10):1658–66.

    Article  CAS  PubMed  Google Scholar 

  33. Masuda M, Yamada T, Mine T, et al. Comparison of usefulness of sodium bicarbonate versus sodium chloride to prevent contrast-induced nephropathy in patients undergoing an emergent coronary procedure. Am J Cardiol. 2007;100(5):781–6.

    Article  CAS  PubMed  Google Scholar 

  34. Merten GJ, Burgess WP, Rittase RA, Kennedy TP. Prevention of contrast-induced nephropathy with sodium bicarbonate. Crit Pathw Cardiol A J Evid Based Med. 2004;3(3):138–43.

    Article  Google Scholar 

  35. Boucek P, Havrdova T, Oliyarnyk O, et al. Prevention of contrast-induced nephropathy in diabetic patients with impaired renal function: A randomized, double blind trial of sodium bicarbonate versus sodium chloride-based hydration. Diabetes Res Clin Pract. 2013;101(3):303–8.

    Article  CAS  PubMed  Google Scholar 

  36. Solomon R, Gordon P, Manoukian SV, et al. Randomized trial of bicarbonate or saline study for the prevention of contrast-induced nephropathy in patients with CKD. Clin J Am Soc Nephrol. 2015;10(9):1519–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Lee S-W, Kim W-J, Kim Y-H, et al. Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention or arteriography (the PREVENT Trial). Am J Cardiol. 2011;107(10):1447–52.

    Article  PubMed  Google Scholar 

  38. Hafiz AM, Jan MF, Mori N, et al. Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions: randomized comparison of two preventive strategies. Catheter Cardiovasc Interv. 2012;79(6):929–37.

    Article  PubMed  Google Scholar 

  39. • Kama A, Yılmaz S, Yaka E, et al. Comparison of short-term infusion regimens of N-acetylcysteine plus intravenous fluids, sodium bicarbonate plus intravenous fluids, and intravenous fluids alone for prevention of contrast-induced nephropathy in the emergency department. Acad Emerg Med. 2014;21(6):615–622. Different preventive strategies for CIN.

  40. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent–induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):180–4.

    Article  CAS  PubMed  Google Scholar 

  41. Jaffery Z, Verma A, White CJ, et al. A randomized trial of intravenous N-acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes. Catheter Cardiovasc Interv. 2012;79(6):921–6.

    Article  PubMed  Google Scholar 

  42. Sun Z, Fu Q, Cao L, Jin W, Cheng L, Li Z. Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy: a meta-analysis of randomized, controlled trials. PLoS ONE. 2013;8(1):e55124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Poletti P-A, Platon A, De Seigneux S, et al. N-acetylcysteine does not prevent contrast nephropathy in patients with renal impairment undergoing emergency CT: a randomized study. BMC Nephrol. 2013;14(1):119.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Subramaniam RM, Suarez-Cuervo C, Wilson RF, et al. Effectiveness of prevention strategies for contrast-induced nephropathy. Ann Intern Med. 2016;164(6):406.

    Article  PubMed  Google Scholar 

  45. Farmer JA. Pleiotropic effects of statins. Curr Atheroscler Rep. 2000;2(3):208–17.

    Article  CAS  PubMed  Google Scholar 

  46. Marenzi G, Cosentino N, Werba JP, Tedesco CC, Veglia F, Bartorelli AL. A meta-analysis of randomized controlled trials on statins for the prevention of contrast-induced acute kidney injury in patients with and without acute coronary syndromes. Int J Cardiol. 2015;183:47–53.

    Article  PubMed  Google Scholar 

  47. Cheungpasitporn W, Thongprayoon C, Kittanamongkolchai W, et al. Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: a systematic review and meta-analysis of randomized controlled trials. Renal Fail. 2015;37(4):664–71.

    Article  CAS  Google Scholar 

  48. Liu Y, Liu Y, Duan C, et al. Statins for the prevention of contrast-induced nephropathy after coronary angiography/percutaneous interventions. J Cardiovasc Pharmacol Ther. 2015;20(2):181–92.

    Article  CAS  PubMed  Google Scholar 

  49. Li H, Wang C, Liu C, Li R, Zou M, Cheng G. Efficacy of short-term statin treatment for the prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography/percutaneous coronary intervention: a meta-analysis of 21 randomized controlled trials. Am J Cardiovasc Drugs. 2016;16(3):201–19.

    Article  CAS  PubMed  Google Scholar 

  50. Jo S-H, Lee JM, Park J, Kim H-S. The impact of renin-angiotensin-aldosterone system blockade on contrast-induced nephropathy: a meta-analysis of 12 studies with 4493 patients. Cardiology. 2015;130(1):4–14.

    Article  CAS  PubMed  Google Scholar 

  51. Peng F, Su J, Lin J, Niu W. Impact of renin-angiotensin-aldosterone system-blocking agents on the risk of contrast-induced acute kidney injury: a prospective study and meta-analysis. J Cardiovasc Pharmacol. 2015;65(3):262–8.

    Article  CAS  PubMed  Google Scholar 

  52. Wu Z, Zhang H, Jin W, et al. The effect of renin-angiotensin-aldosterone system blockade medications on contrast-induced nephropathy in patients undergoing coronary angiography: a meta-analysis. PLoS ONE. 2015;10(6):e0129747.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Morcos SK, Thomsen HS, Webb JAW. Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR). Dialysis and contrast media. Eur Radiol. 2002;12(12):3026–30.

    PubMed  Google Scholar 

  54. Shinoda T, Hata T, Nakajima K, Yoshimoto H, Niwa A. Time-course of iodine elimination by hemodialysis in patients with renal failure after angiography. Ther Apher Dial. 2002;6(6):437–42.

    Article  CAS  Google Scholar 

  55. Song K, Jiang S, Shi Y, Shen H, Shi X, Jing D. Renal replacement therapy for prevention of contrast-induced acute kidney injury: a meta-analysis of randomized controlled trials. Am J Nephrol. 2010;32(5):497–504.

    Article  PubMed  Google Scholar 

  56. Cruz DN, Goh CY, Marenzi G, Corradi V, Ronco C, Perazella MA. Renal replacement therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Med. 2012;125(1):66–78.

    Article  PubMed  Google Scholar 

  57. Choi M-J, Yoon J-W, Han S-J, et al. The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: a comparison with periprocedural hemofiltration. Int J Cardiol. 2014;176(3):941–5.

    Article  PubMed  Google Scholar 

  58. Gong L, Goswami S, Giacomini KM, Altman RB, Klein TE. Metformin pathways: pharmacokinetics and pharmacodynamics. Pharmacogenetics Genom. 2012;22(11):820–7.

    Article  CAS  Google Scholar 

  59. Connelly PJ, Lonergan M, Soto-Pedre E, Donnelly L, Zhou K, Pearson ER. Acute kidney injury, plasma lactate concentrations and lactic acidosis in metformin users: a GoDarts study. Diabetes Obes Metab. 2017. doi:10.1111/dom.12978.

    Google Scholar 

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  1. Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, 2730, Copenhagen, Denmark

    Yousef W. Nielsen & Henrik S. Thomsen

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Yousef W. Nielsen and Henrik S. Thomsen each declare no potential conflicts of interest.

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Nielsen, Y.W., Thomsen, H.S. Current Evidence of Contrast Medium-Induced Nephropathy (CIN) After Administration of Low-Osmolarity Iodine-Based Contrast Agents. Curr Radiol Rep 5, 52 (2017). https://doi.org/10.1007/s40134-017-0244-6

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