Contrast-induced acute kidney injury.

Cardiac angiography and coronary/vascular interventions depend on iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired renal failure, with adverse effects on prognosis and health care costs. The epidemiology and pathogenesis of contrast-induced AKI, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use, and preventive strategies are discussed in this report. An advanced algorithm is suggested for the risk stratification and management of contrast-induced AKI as it relates to patients undergoing cardiovascular procedures. Contrast-induced AKI is likely to remain a significant challenge for cardiologists in the future because the patient population is aging and chronic kidney disease and diabetes are becoming more common.

[1]  F. del Greco,et al.  Acute renal failure. Association with administration of radiographic contrast material. , 1978, JAMA.

[2]  G. Dangas,et al.  The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. , 2000, Journal of the American College of Cardiology.

[3]  C. Becker,et al.  High-risk situations and procedures. , 2006, The American journal of cardiology.

[4]  C. Becker,et al.  Strategies to reduce the risk of contrast-induced nephropathy. , 2006, The American journal of cardiology.

[5]  S. Bagshaw,et al.  One-year mortality in critically ill patients by severity of kidney dysfunction: a population-based assessment. , 2006, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[6]  R. Garrick.  Contrast-Induced Nephropathy After Percutaneous Coronary Interventions in Relation to Chronic Kidney Disease and Hemodynamic Variables , 2007 .

[7]  I. Michishita,et al.  A novel contrast removal system from the coronary sinus using an adsorbing column during coronary angiography in a porcine model. , 2006, Journal of the American College of Cardiology.

[8]  S. Pocock,et al.  Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. , 2005, Kidney international.

[9]  C. Becker,et al.  Contrast medium use. , 2006, The American journal of cardiology.

[10]  A. Pichard,et al.  Causes of acute renal dysfunction after percutaneous coronary intervention and comparison of late mortality rates with postprocedure rise of creatine kinase-MB versus rise of serum creatinine. , 2004, The American journal of cardiology.

[11]  F. Veglia,et al.  Comparison of two hemofiltration protocols for prevention of contrast-induced nephropathy in high-risk patients. , 2006, The American journal of medicine.

[12]  N. Powe,et al.  Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial. , 1992, Radiology.

[13]  P. Choyke,et al.  Determination of serum creatinine prior to iodinated contrast media: is it necessary in all patients? , 1998, Techniques in urology.

[14]  C. Becker,et al.  Baseline renal function screening. , 2006, The American journal of cardiology.

[15]  B. Barrett,et al.  Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. , 1993, Radiology.

[16]  W. O’Neill,et al.  A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy ☆: Results of the P.R.I.N.C.E. study , 1999 .

[17]  G. Stone,et al.  Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention. , 2002, The Journal of invasive cardiology.

[18]  J. J. Griffin,et al.  Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction , 2003, Circulation.

[19]  Rosario V. Freeman,et al.  Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. , 2002, The American journal of cardiology.

[20]  F. Veglia,et al.  Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. , 2004, Journal of the American College of Cardiology.

[21]  G. Stone,et al.  Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. , 2004, The American journal of cardiology.

[22]  J. Dinger,et al.  Renal tolerance of iotrolan 280 —a meta-analysis of 14 double-blind studies , 1995, European Radiology.

[23]  C. Viscoli,et al.  The effect of acute renal failure on mortality. A cohort analysis. , 1996, JAMA.

[24]  A. Gomes,et al.  Risk of renal failure after major angiography. , 1983, Archives of surgery.

[25]  Jerry T. Wong,et al.  Removal of iodine contrast from coronary sinus in swine during coronary angiography. , 2006, Journal of the American College of Cardiology.

[26]  S. Marsch,et al.  Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. , 2002, Archives of internal medicine.

[27]  G. Marenzi,et al.  The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. , 2003, The New England journal of medicine.

[28]  K. Harjai,et al.  Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. , 2004, The American journal of cardiology.

[29]  F. Veglia,et al.  N-Acetylcysteine and Contrast-Induced Nephropathy in Primary Angioplasty , 2006 .

[30]  R. Conetta,et al.  Nephropathy in critically Ill patients without preexisting renal disease. , 2005, Proceedings of the Western Pharmacology Society.

[31]  D. Baumgarten,et al.  Are screening serum creatinine levels necessary prior to outpatient CT examinations? , 2000, Radiology.

[32]  Qing Ma,et al.  Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery , 2005, The Lancet.

[33]  E. Halpern,et al.  Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. , 1995, Kidney international.

[34]  J. Olsen,et al.  Utility of the creatinine prior to intravenous contrast studies in the emergency department. , 1996, The Journal of emergency medicine.

[35]  N. Chalmers,et al.  Comparison of iodixanol and iohexol in renal impairment. , 1999, The British journal of radiology.

[36]  Venu Gopal Reddy.  Prevention of postoperative acute renal failure. , 2002, Journal of postgraduate medicine.

[37]  S. Khanal,et al.  Interventional cardiologyAbstractStatin Therapy Reduces Contrast-Induced Nephropathy: An Analysis of Contemporary Percutaneous Interventions , 2005 .

[38]  Kdoqi Disclaimer.  K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[39]  J. Tumlin,et al.  Economic burden of contrast-induced nephropathy: implications for prevention strategies , 2007, Journal of medical economics.

[40]  R. Solomon.  The role of osmolality in the incidence of contrast-induced nephropathy: a systematic review of angiographic contrast media in high risk patients. , 2005, Kidney international.

[41]  Allen J. Taylor,et al.  Clinical InvestigationsCardiologyPREPARED: PREParation for Angiography in REnal Dysfunction: A Randomized Trial of Inpatient vs Outpatient Hydration Protocols for Cardiac Catheterization in Mild-to-Moderate Renal Dysfunction , 1998 .

[42]  H. Bachórzewska-Gajewska,et al.  Neutrophil-Gelatinase-Associated Lipocalin and Renal Function after Percutaneous Coronary Interventions , 2006, American Journal of Nephrology.

[43]  Charles Davidson,et al.  Risk prediction of contrast-induced nephropathy. , 2006, The American journal of cardiology.

[44]  Y. Wang,et al.  Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. , 1990, The American journal of medicine.

[45]  A. Gomes,et al.  Acute renal dysfunction after major arteriography. , 1985, AJR. American journal of roentgenology.

[46]  Samin K. Sharma,et al.  Cardiac Angiography in Renally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease , 2007, Circulation.

[47]  C. Becker,et al.  Epidemiology and prognostic implications of contrast-induced nephropathy. , 2006, The American journal of cardiology.

[48]  M. Hlatky,et al.  Cardiovascular and renal toxicity of a nonionic radiographic contrast agent after cardiac catheterization. A prospective trial. , 1989, Annals of internal medicine.

[49]  A. Colombo,et al.  Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): A Randomized Comparison of 3 Preventive Strategies , 2007, Circulation.

[50]  P. McCullough,et al.  Statin therapy in renal disease: Harmful or protective? , 2007, Current diabetes reports.

[51]  S. Hou,et al.  Hospital-acquired renal insufficiency. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[52]  F. Markowetz,et al.  Acetylcysteine for prevention of contrast nephropathy: meta-analysis , 2003, The Lancet.

[53]  Young‐Bae Park,et al.  Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER study: a randomized controlled trial. , 2006, Journal of the American College of Cardiology.

[54]  K. Kent,et al.  Percutaneous coronary intervention‐associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine , 2003, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[55]  D. Greenwood,et al.  Ascorbic Acid Prevents Contrast-Mediated Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention , 2004, Circulation.

[56]  D. Chew,et al.  Morbidity, mortality and economic burden of renal impairment in cardiac intensive care , 2006, Internal medicine journal.

[57]  J. Brinker,et al.  A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. , 2006, Journal of the American College of Cardiology.

[58]  Jordan J. Cohen,et al.  Hospital-Acquired Renal Insufficiency: A Prospective Study , 1983 .

[59]  M. Nijsten,et al.  Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast: a retrospective analysis , 2006, Intensive Care Medicine.

[60]  H. Thomsen.  Guidelines for contrast media from the European Society of Urogenital Radiology. , 2003, AJR. American journal of roentgenology.

[61]  R. Bersin,et al.  Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. , 2004, JAMA.

[62]  Kathryn E. McGoldrick,et al.  Nephrotoxic Effects in High-Risk Patients Undergoing Angiography , 2004 .

[63]  Kirk N. Garratt,et al.  Incidence and Prognostic Importance of Acute Renal Failure After Percutaneous Coronary Intervention , 2002, Circulation.

[64]  Gilles Soulez,et al.  Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease Undergoing Computed Tomography: A Double-Blind Comparison of Iodixanol and Iopamidol , 2006, Investigative radiology.

[65]  W. Laskey,et al.  Volume-to-creatinine clearance ratio: a pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. , 2007, Journal of the American College of Cardiology.

[66]  W. O’Neill,et al.  Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. , 1997, The American journal of medicine.

[67]  W. F. Mason,et al.  A comparative study of the nephrotoxicity of iohexol, iopamidol and ioxaglate in peripheral angiography. , 1990, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[68]  C. Becker,et al.  Pathophysiology of contrast-induced nephropathy. , 2006, The American journal of cardiology.