Contrast-Induced Acute Kidney Injury: The At-Risk Patient and Protective Measures

Abstract

Contrast-induced acute kidney injury (CI-AKI) is a major complication following radiocontrast procedures. In this review, we characterize the recent literature on CI-AKI, risk factors, prevention, biomarkers, and new technologies. The premise of CI-AKI prophylaxis should focus on implementing mandatory standing orders before and after cardiac catheterization for hydration with normal saline or sodium bicarbonate and use of high-dose (1200-mg) N-acetylcysteine. Contrast agents may play a role in preventing CI-AKI. Implement catheter-laboratory technology and awareness to limit the amount of contrast dye used for any patient.

Contrast-induced acute kidney injury

“…Even if the clinical data are controversial, the molecular mechanisms of NAC on CI-AKI prevention have been clearly elucidated in in-vitro experiments. Our studies demonstrate that NAC exerts its antioxidant properties preventing kidney cell death by inhibiting oxygen free radical production and thus stress kinases and apoptosis activation upon contrast media exposure [2,8,15,56,57]. The protective role of NAC on kidney cells has also been reported in noncontrast media agent induced kidney injury.…”

“…CI-AKI is defined as an impairment of renal function following contrast media administration in the absence of alternative causes [1]. Moreover, patients developing CI-AKI are at a higher risk of both a further deterioration of kidney function and an unfavourable clinical outcome [2]. On the basis of the possible mechanisms of CI-AKI, different strategies have been proposed to prevent this complication.…”

Incidence and In‐Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis‐Requiring AKI (AKI‐D) After Cardiac Catheterization in the National Inpatient Sample

“…Determining the incidence of, and mortality risk associated with, AKI and AKI‐D among cardiac catheterization or PCI patients allows health care providers to understand the clinical significance of this adverse outcome. Although specific therapies for treatment of AKI are nonexistent, hospitals with cardiac catheterization capability should invest in implementing and standardizing prevention measures and avoiding further kidney damage to address mortality in this population . Moving forward, additional research is needed to examine differences in AKI and AKI‐D incidence across additional cardiac catheterization or PCI patient subgroups, including geographical and socioeconomic subclasses.…”

Cardiac catheterization within 1 to 3 days of proximal aortic surgery is not associated with increased postoperative acute kidney injury

“…We can only conclude that this is due to greater preoperative kidney protection and medical optimization in patients undergoing short interval catheterization, and that these benefits are more pronounced in higher-risk patients and outweigh the insult of CI-AKI. Although we adjusted for preoperative hydration in the multivariable models, unmeasured confounders related to hospital preadmission, such as medical optimization, blood pressure and glycemic control, and careful review and discontinuation of nephrotoxic medications, likely account for the reduced risk of AKI in short interval catheterization patients (22). However, as this remains a speculative hypothesis that is untested in our study, we refrain from recommending short interval catheterization for high-risk patients and instead suggest that long interval catheterization followed by hospital preadmission for aggressive preoperative renal protection may lead to optimal results.…”