Contrast Material‐Induced Renal Failure: An Overview

Abstract

The administration of iodinated contrast media (CM) is integral to many cardiovascular procedures. While it is clear that CM provide significant diagnostic benefit, there is some risk of contrast medium-related adverse events in a small percentage of patients. Potentially the most serious complication associated with the use of iodinated contrast agents is contrast-induced nephropathy (CIN). Most patients undergoing contrast-enhanced radiographic procedures are not at risk for CIN, however subjects with pre-existing renal insufficiency, diabetes mellitus, or cardiovascular disease receiving intra-arterial administrations of contrast material are at increased risk. Typically, patients with CIN will experience changes in serum creatinine 1-5 days following contrast exposure. While decrements in renal function are generally small and transient, some patients experience a more prolonged decrease and, in rare cases, require dialysis. More importantly, there is substantial literature documenting that patients with CIN after cardiac intervention experience greater morbidity (including prolonged hospitalization) and acute and 1-year mortality. The present article aims to briefly review the pathogenesis of CIN and reviews current opinion on how best to prevent CIN and manage at-risk patients.

Incidence of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Outpatient Setting

“…The primary end point of this study was CIN defined as an increase in sCr of Ն0.5 mg/dl or Ն25% within 2 to 7 d of contrast administration (2,4,6,8,11,16). The secondary end point was the composite of either severe renal failure or death with renal failure as a contributing cause within 45 d. We followed patients for 45 d, using a combination of telephone and medical record review.…”

“…C ontrast-induced nephropathy (CIN) is a known complication of intravenous, iodinated contrast; is a common cause of renal failure in the inpatient setting (1)(2)(3)(4)(5); and is associated with both short-and long-term adverse outcomes (6,7). Previous reports indicated that CIN occurs in 4 to 20% of patients after intra-arterial administration after coronary angiography (5)(6)(7)(8)(9).…”

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

“…CIN is a life-threatening dose-dependent reaction and is commonly defined as a decrease in renal function 24-48 hours after contrast media administration, with a rise in serum creatinine levels of more than 25% from the baseline (or an absolute increase greater than 0.5 mg/dL) three to five days after the procedure. [1][2][3][4][5][6][7][8][9] Preventative measures for CIN in cardiovascular procedures include pre-hydration, prophylactic administration of N-acetylcysteine and utilisation of iso-osmolar/hypo-osmolar contrast media. However, reducing the volume of contrast media within the procedure was found to be the most effective.…”

The Incidence of Contrast-Induced Nephropathy in Saudi Population after Cardiac Catheterization

“…It is a transient and reversible form of acute kidney injury. However, the development of CIN is associated with a longer hospital stay, an increased morbidity, and mortality, in addition to a higher financial cost [6].Contrast-induced nephropathy (CIN) is a known complication of intravenous, iodinated contrast; It is a common cause of renal failure in the inpatient setting [6,[7][8][9][10]; and is associated with both short-and long-term adverse outcomes [11,12]. Previous reports indicated that CIN occurs in 4 to 20% of patients after intra-arterial administration after coronary angiography [13,14].…”