Abstract
Contrast‐induced nephropathy, also known as contrast‐induced acute kidney injury, is associated with rapid and often irreversible decline in kidney function following the administration of iodinated contrast agents. Contrast‐induced nephropathy is the third leading cause of acute kidney injury in hospitalized patients, and substantially increases mortality, morbidity, and length of hospitalization. Contrast‐induced nephropathy follows a predictable time of onset and is potentially preventable. It has been the subject of numerous studies addressing characteristics of the populations at risk and prophylactic strategies. This evidence‐based review summarizes recent literature and provides a nephrologists' perspective on contrast‐induced nephropathy, focusing on: the pathophysiology of contrast‐induced nephropathy; identification of populations at risk; correlation between contrast‐induced nephropathy and the type of contrast agent used; and finally, measures to prevent contrast‐induced nephropathy, including intravenous fluids, sodium bicarbonate, N‐acetylcysteine, and hemofiltration/hemodialysis. Copyright © 2010 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (137.8 KB).
References
- 1. Nash K, Hafeez A, Hou S. Hospital‐acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930–936. [DOI] [PubMed] [Google Scholar]
- 2. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002; 105: 2259–2264. [DOI] [PubMed] [Google Scholar]
- 3. Lindsay J, Apple S, Pinnow EE, et al. Percutaneous coronary intervention‐associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine. Catheter Cardiovasc Interv 2003; 59: 338–343. [DOI] [PubMed] [Google Scholar]
- 4. Nikolsky E, Mehran R, Turcot D, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 2004; 94: 300–305. [DOI] [PubMed] [Google Scholar]
- 5. Gruberg L, Mintz GS, Mehran R, 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. J Am Coll Cardiol 2000; 36: 1542–1548. [DOI] [PubMed] [Google Scholar]
- 6. McCullough PA, Adam A, Becker CR, et al. Epidemiology and prognostic implications of contrast‐induced nephropathy. Am J Cardiol 2006; 98: 5K–13K. [DOI] [PubMed] [Google Scholar]
- 7. McCullough PA, Adam A, Becker CR, et al. Risk prediction of contrast‐induced nephropathy. Am J Cardiol 2006; 98: 27K–36K. [DOI] [PubMed] [Google Scholar]
- 8. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast‐induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004; 44: 1393–1399. [DOI] [PubMed] [Google Scholar]
- 9. Tumlin J, Stacul F, Adam A, et al. Pathophysiology of contrast‐induced nephropathy. Am J Cardiol 2006; 98: 14K–20K. [DOI] [PubMed] [Google Scholar]
- 10. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high‐risk patients undergoing angiography. N Engl J Med 2003; 348: 491–499. [DOI] [PubMed] [Google Scholar]
- 11. Jo SH, Youn TJ, Koo BK, 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. J Am Coll Cardiol 2006; 48: 924–930. [DOI] [PubMed] [Google Scholar]
- 12. Nguyen SA, Suranyi P, Ravenel JG, et al. Iso‐osmolality versus low‐osmolality iodinated contrast medium at intravenous contrast‐enhanced CT: effect on kidney function. Radiology 2008; 248: 97–105. [DOI] [PubMed] [Google Scholar]
- 13. Solomon RJ, Natarajan MK, Doucet S, 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. Circulation 2007; 115: 3189–3196. [DOI] [PubMed] [Google Scholar]
- 14. Rudnick MR, Davidson C, Laskey W, et al. Nephrotoxicity of iodixanol versus ioversol in patients with chronic kidney disease: the Visipaque Angiography/Interventions with Laboratory Outcomes in Renal Insufficiency (VALOR) Trial. Am Heart J 2008; 156: 776–782. [DOI] [PubMed] [Google Scholar]
- 15. Thomsen HS, Morcos SK, Erley CM, et al. The ACTIVE Trial: comparison of the effects on renal function of iomeprol‐400 and iodixanol‐320 in patients with chronic kidney disease undergoing abdominal computed tomography. Invest Radiol 2008; 43: 170–178. [DOI] [PubMed] [Google Scholar]
- 16. McCullough PA, Bertrand ME, Brinker JA, et al. A meta‐analysis of the renal safety of isosmolar iodixanol compared with low‐osmolar contrast media. J Am Coll Cardiol 2006; 48: 692–699. [DOI] [PubMed] [Google Scholar]
- 17. Davidson C, Stacul F, McCullough PA, et al. Contrast medium use. Am J Cardiol 2006; 98: 42K–58K. [DOI] [PubMed] [Google Scholar]
- 18. Freeman RV, O'Donnell M, Share D, et al. Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. Am J Cardiol 2002; 90: 1068–1073. [DOI] [PubMed] [Google Scholar]
- 19. Trivedi HS, Moore H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract 2003; 93: C29–C34. [DOI] [PubMed] [Google Scholar]
- 20. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media‐associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: 329–336. [DOI] [PubMed] [Google Scholar]
- 21. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast‐induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291: 2328–2334. [DOI] [PubMed] [Google Scholar]
- 22. Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N‐acetylcysteine, and saline for prevention of radiocontrast‐induced nephropathy. A comparison of 3 regimens for protecting contrast‐induced nephropathy in patients undergoing coronary procedures. A single‐center prospective controlled trial. Am Heart J 2007; 154: 539–544. [DOI] [PubMed] [Google Scholar]
- 23. Brar SS, Shen AY, Jorgensen MB, et al. Sodium bicarbonate vs sodium chloride for the prevention of contrast medium‐induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA 2008; 300: 1038–1046. [DOI] [PubMed] [Google Scholar]
- 24. Maioli M, Toso A, Leoncini M, et al. Sodium bicarbonate versus saline for the prevention of contrast‐induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol 2008; 52: 599–604. [DOI] [PubMed] [Google Scholar]
- 25. Adolph E, Holdt‐Lehmann B, Chatterjee T, et al. Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE): a randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast‐induced nephropathy. Coron Artery Dis 2008; 19: 413–419. [DOI] [PubMed] [Google Scholar]
- 26. From AM, Bartholmai BJ, Williams AW, et al. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: a retrospective cohort study of 7977 patients at mayo clinic. Clin J Am Soc Nephrol 2008; 3: 10–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Tepel M, van der GM, Schwarzfeld C, et al. Prevention of radiographic‐contrast‐agent‐induced reductions in renal function by acetylcysteine. N Engl J Med 2000; 343: 180–184. [DOI] [PubMed] [Google Scholar]
- 28. Kay J, Chow WH, Chan TM, et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial. JAMA 2003; 289: 553–558. [DOI] [PubMed] [Google Scholar]
- 29. Rashid ST, Salman M, Myint F, et al. Prevention of contrast‐induced nephropathy in vascular patients undergoing angiography: a randomized controlled trial of intravenous N‐acetylcysteine. J Vasc Surg 2004; 40: 1136–1141. [DOI] [PubMed] [Google Scholar]
- 30. Goldenberg I, Shechter M, Matetzky S, et al. Oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast‐induced nephropathy following coronary angiography. A randomized controlled trial and review of the current literature. Eur Heart J 2004; 25: 212–218. [DOI] [PubMed] [Google Scholar]
- 31. Alonso A, Lau J, Jaber BL, et al. Prevention of radiocontrast nephropathy with N‐acetylcysteine in patients with chronic kidney disease: a meta‐analysis of randomized, controlled trials. Am J Kidney Dis 2004; 43: 1–9. [DOI] [PubMed] [Google Scholar]
- 32. Kshirsagar AV, Poole C, Mottl A, et al. N‐acetylcysteine for the prevention of radiocontrast induced nephropathy: a meta‐analysis of prospective controlled trials. J Am Soc Nephrol 2004; 15: 761–769. [DOI] [PubMed] [Google Scholar]
- 33. Briguori C, Colombo A, Violante A, et al. Standard vs double dose of N‐acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J 2004; 25: 206–211. [DOI] [PubMed] [Google Scholar]
- 34. Marenzi G, Assanelli E, Marana I, et al. N‐acetylcysteine and contrast‐induced nephropathy in primary angioplasty. N Engl J Med 2006; 354: 2773–2782. [DOI] [PubMed] [Google Scholar]
- 35. Briguori C, Airoldi F, D'Andrea D, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation 2007; 115: 1211–1217. [DOI] [PubMed] [Google Scholar]
- 36. Recio‐Mayoral A, Chaparro M, Prado B, et al. The reno‐protective effect of hydration with sodium bicarbonate plus N‐acetylcysteine in patients undergoing emergency percutaneous coronary intervention: the RENO Study. J Am Coll Cardiol 2007; 49: 1283–1288. [DOI] [PubMed] [Google Scholar]
- 37. Marenzi G, Marana I, Lauri G, et al. The prevention of radiocontrast‐agent‐induced nephropathy by hemofiltration. N Engl J Med 2003. 349: 1333–1340. [DOI] [PubMed] [Google Scholar]
- 38. Lee PT, Chou KJ, Liu CP, et al. Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis. A randomized controlled trial. J Am Coll Cardiol 2007; 50: 1015–1020. [DOI] [PubMed] [Google Scholar]
- 39. Kelly AM, Dwamena B, Cronin P, et al. Meta‐analysis: effectiveness of drugs for preventing contrast‐induced nephropathy. Ann Intern Med 2008; 148: 284–294. [DOI] [PubMed] [Google Scholar]
- 40. Solomon R, Werner C, Mann D, et al. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994; 331: 1416–1420. [DOI] [PubMed] [Google Scholar]