Contrast-induced Acute Kidney Injury: A Contemporary Review

Abstract

Clinically significant Contrast-Induced Acute Kidney Injury (CIAKI) is a severe complication of interventional contrast-based procedures of all kinds. It involves high morbidity, mortality, social and financial losses. Acute renal damage after coronary angiography or percutaneous coronary intervention may occur in 1-2% of cases in the general population or 50+% of cases with high CIAKI exposure. It is essential to detect high-risk patients with renal damage as a major and frequent CIAKI predisposing factor. There are novel biomarkers with rapid or nearly instant response to acute subclinical contrast-induced renal damage, which are highly valuable in CIAKI diagnosis and for this reason desire deeper clinical research. Despite a number of controversies, prophylactic and therapeutic measures are practically the same in a vast majority of guidelines. An intravenous 0.9% NaCl solution remains the only proven measure in CIAKI prophylaxis and treatment, while the use of other pharmacological approaches still needs more relevant prospective clinical research. The aim of this paper was to review contemporary evidencebased CIAKI data.

Victim Of Medical Investigation or Treatment: contrast associated acute kidney injury

“…She fulfilled the criteria for contrast induced acute kidney injury (CI‐AKI), i.e. an increase in serum creatinine of 25% or 26.5μmol/L, a temporal relationship to the contrast agent (generally two to three days), and other causes of renal impairment excluded 1,2 . Risk factors for CI‐AKI 2,3 are: age; female gender; diabetes mellitus; hypertension; renal impairment; heart failure; myeloma; albuminuria; anaemia; hypovolaemia; nephrotoxic drugs; hypoalbuminaemia; higher glucose level; and higher LDL level.…”

“…The patient had several risk factors: age, gender, diabetes, hypertension, renal impairment, hyperglycaemia, raised LDL level, and ACE inhibitor use. Characteristics of the contrast (intra-arterial, non-ionic, hyperosmolar or larger volumes) also increase the risk of CI-AKI, [1][2][3] but modern weight-based contrast dosing minimises this. Some risk factors can be modified, some cannot.…”

“…6 To avoid CI-AKI, one can consider other imaging modalities, hold potentially nephrotoxic drugs 24 hours before contrast, preload with intravenous normal saline and use safest contrast. 2,3 Systematic community control of glucose, cholesterol and blood pressure might have helped this patient; there was no time to achieve this as an inpatient since pulmonary emboli on CTPA can disappear within 48 hours.…”