High-Risk Situations and Procedures

Contrast-Induced Acute Kidney Injury

“…Many clinical situations may arise in which the risk of contrast-induced AKI is increased, with the most common scenario in the catheterization laboratory being cardiogenic shock (6). While in general, the benefits of revascularization outweigh the risks of the procedure, in the setting of shock requiring the placement of an intra-aortic balloon pump, considerably higher rates of contrast-induced AKI can be expected.…”

“…The term "risk marker" as opposed to "risk factor" is preferred since many of the indicators of risk for contrastinduced AKI are nonmodifiable and are not necessarily causative (6). Baseline renal filtration function is a surrogate for reduced nephron mass and renal parenchymal function (9).…”

Radiocontrast-Induced Acute Kidney Injury

“…A systematic search of the literature was undertaken to identify all references relevant to the subject of contrast-induced AKI, as a result of which 865 potentially relevant papers were identified and reviewed. The results of the literature search were used to compile reviews covering the epidemiology and pathogenesis of AKI, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use and preventive strategies [6,7,8,9,10,11,12]. After reviewing all the evidence, a series of consensus statements was developed and has been published elsewhere (table 1) [13].…”

“…Because of the added insult of cardiopulmonary bypass, the risk of contrast-induced AKI in patients undergoing emergency coronary artery bypass surgery following angiography is increased. Finally, the published literature on the risk of contrast-induced AKI in heart or renal transplant recipients is inconsistent and clinicians should be conservative and consider them at high risk [6]. …”

“…At the same time, many hospitalized patients have compromised renal function [4, 5] which is the most important risk factor for contrast-induced AKI. This paper highlights conclusions from the Contrast-Induced Nephropathy (CIN) Consensus Working Panel, an international multidisciplinary group convened to address the challenges of contrast-induced AKI whose findings were published in 2006 [6,7,8,9,10,11,12]. …”