Prevention, Incidence, and Outcomes of Contrast-Induced Acute Kidney Injury (original) (raw)
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Nephrology Dialysis Transplantation, 2013
Background. Contrast-induced acute kidney injury (CIAKI) has been linked to unfavorable consequences. In routine clinical practice, small increases in serum creatinine (SCr) following coronary angiography tend to be underestimated, especially in patients without chronic kidney disease (CKD). Methods. We conducted a retrospective observational cohort study to analyze in-hospital and long-term outcomes of CIAKI following coronary angiography in patients with or without CKD (eGFR ≥ 60 mL/min/1.73 m 2 ) from January 2008 through December 2009. CIAKI was defined as SCr either ≥ 25% or ≥ 0.5 mg/dL from baseline within 72 h after contrast exposure. Multivariable logistic regression for in-hospital mortality and Cox proportional hazards calculations for long-term mortality and requirement for dialysis were performed. Results. A total of 1160 patients were included in the study. CIAKI occurred in 19% of CKD patients and in 18% of non-CKD patients. In CKD and non-CKD patients, CIAKI was more frequent in patients requiring mechanical ventilation or inotropes or in those given furosemide, and it was associated with adverse in-hospital ( prolonged hospitalization, acute dialysis and mortality) and long-term (increased creatinine, initiation of dialysis and mortality) outcomes. In multivariable analysis, CKD patients had greater in-hospital mortality if they developed CIAKI (adjusted OR 8, 95% CI 1.9-34.5, P = 0.005), and non-CKD patients had greater long-term mortality if they developed CIAKI (adjusted HR 2.2, 95% CI 1.2-4.1, P = 0.016). Conclusions. CIAKI following coronary angiography was associated with adverse in-hospital and long-term outcomes in both CKD and non-CKD patients.
Clinical and Experimental Nephrology, 2012
Background The occurrence of contrast-induced acute kidney injury (CIAKI) has paralleled the increased number of diagnostic interventions requiring radiographic contrast media (CM). Several strategies aimed at preventing renal injury following iodine have been carried out over the last several years. The aim of this study was to evaluate the impact of three different strategies aimed at preventing CIAKI in patients with renal dysfunction (serum creatinine [1.25 mg/dl or estimated creatinine clearance \45 ml/ min) receiving low osmolar CM for diagnostic-therapeutic procedures. Methods Candidates received 154 mmol NaHCO 3 solution (B0) at a rate of 3 ml/kg/h from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 6-12 h; the same schedule plus N-acethyl-cysteine (NAC) 600 mg twice daily the day before and the day of the procedure (BN) or NAC as above plus 154 mmol NaCl solution at a rate of 3 ml/kg/h from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 6-12 h (SN). Serum creatinine (SCr) was measured at baseline and on days 2 or occasionally 3 after CM. The main outcome measure was the occurrence of CIAKI, defined as a C25 % increase in SCr within 2-3 days of CM. Results The three groups were similar with regard to age, gender distribution, weight, baseline serum levels of creatinine, sodium, potassium, urate and estimated creatinine clearance. A larger proportion of individuals received ACEIs/ARAs in the BN group (p \ 0.05), but in the SN group, more patients declared a past history of acute myocardial infarction or had high blood pressure, and few displayed mild-moderate left ventricular dysfunction (p \ 0.05). CIAKI occurred in 24/123 (19.5 %) assessable patients (15/42 in the B0 group, 3/43 in the BN group and 6/38 in the SN group; p \ 0.01). Thus, 15/42 patients who did not receive NAC developed CIAKI in contrast to 9/81 who did (p \ 0.01). Multivariate logistic regression models showed that the use of NAC was the unique factor associated with a statistically significant influence for the occurrence of CIAKI (OR: 0.18; 95 % CI: 0.04-0.72; p = 0.016). Conclusions The results from this study show that: (1) the occurrence of CIAKI after low-osmolar CM administration is similar to that reported worldwide. (2) NAC-based renoprotective measures are superior for the prevention of CIAKI in patients with previous renal dysfunction. (3) They also demonstrate that bicarbonate expansion alone has limited value in preventing CIAKI. For those individuals at risk, combination prophylaxis including volume expansion plus NAC should be recommended to reduce the chance of overt kidney injury following CM administration.
A hospital-based study on risk factors and outcomes of Contrast Induced Acute Kidney Injury (CI-AKI
2021
Background: Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of hospital-acquired AKI. This study was aimed to analyse the incidence of CI-AKI and associated risk factors in hospitalized patients undergoing CT or Catheter related contrast based procedures. Materials and Methods: This cross-sectional observational study was conducted between September 2016 and August 2018. Hospitalized patients of either sex, aged >18 years scheduled for contrastenhanced computed tomography (CECT), peripheral angiography (PAG), percutaneous transluminal coronary angioplasty (PTCA), or coronary angiography (CAG), with eGFR >30 were evaluated for CI-AKI after excluding other causes of AKI. Results: A total of 300 patients were enrolled, of which 266 patients completed the study (CECT/PAG, n=138; PTCA/CAG, n=128). The mean age of the patients was 45.85 ± 15.14 years and the majority of patients were males (n=164, 61.6%). The incidence of CI-AKI was 15.6% (n=41). A total of 28.8% of patients with diabetes and 31.1% patients aged >60 years developed CI-AKI. Overall, the increasing contrast volume significantly (p=0.002) increased the incidence of CI-AKI. The incidence of CI-AKI in patients mild renal dysfunction increased significantly (from 5.5% at <50ml to 44% at 150-200 ml) with the increasing volume of contrast, and was significantly higher (38.8%) in patients with moderate renal dysfunction. Conclusion: Results showed that radio-contrast related procedure carries a significant risk of nephropathy and patients with diabetes, pre-existing renal dysfunction, and advanced age are at higher risk of CI-AKI.
Journal of Nephrology, 2012
Background: Contrast-induced acute kidney injury (CI-AKI) represents an important cause of hospital-acquired AKI. The aim of this study was to evaluate the incidence of CI-AKI after coronary angiography (CA) or percutaneous coronary intervention (PCI) and the role of patient-/procedure-related risk factors. Methods: For 11 months, patients undergoing CA or PCI were prospectively evaluated for CI-AKI, and factors possibly affecting CI-AKI were analyzed. Statistical analysis was completed using Student's t-test, chi-square or Fisher exact test, and multivariate logistic regression. Results: Among 585 consecutive patients, incidence of CI-AKI was 5.1% (n=30) and renal replacement therapy was required in 10% of those (n=3). Incidence of CI-AKI was higher in patients with anemia or chronic kidney disease (CKD) associated with diabetes. Basal hemoglobin was significantly lower in CI-AKI patients while Mehran score, contrast medium (CM) volume, contrast ratio (CM volume / maximum contrast dose) and ratio glomerular filtration rate (CM volume / GFR) were significantly higher. Multivariate analysis selected a higher contrast ratio as a factor independently associated with a higher risk of CI-AKI which otherwise appeared to be lower with increasing basal hemoglobin. Conclusions: The incidence of CI-AKI after CA or PCI was higher in patients with CKD associated with diabetes. Lower levels of basal hemoglobin appeared to be related to a higher risk of CI-AKI, and contrast media volume, especially if exceeding the dose adjusted for renal function, was a strong modifiable risk factor for CI-AKI.
Impact of contrast-induced acute kidney injury definition on clinical outcomes
American Heart Journal, 2011
Background Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3% and 30%, depending on the definition. The aim of this study was to identify which methodology was more effective at recognizing patients at high risk for in-hospital and out-of-hospital adverse events. Methods and Results Serum creatinine increases, after contrast agent infusion, were evaluated in 755 consecutive and unselected patients. Incidences of CIAKI diagnosed by 2 common definitions varied from 6.9% (creatinine increase of ≥0.5 mg/dL, CIAKI-0.5) to 15.9% (creatinine increase of ≥25%, CIAKI-25%). Significant differences appeared between the 2 definitions of sensitivity to predict renal failure according to receiver operating characteristic curve analysis (98% for CIAKI-0.5 and 62% for CIAKI-25%), using a cutoff value of postprocedural glomerular filtration rate of 60 mL/min. Both definitions of CIAKI were related to composite adverse events, but CIAKI-0.5 showed a stronger predicting value (odds ratio 2.875 vs 1.802, P = .036). In multivariate linear regression, only CIAKI-0.5 was a predictive variable of death (odds ratio 3.174, 95% CI 1.368-7.361). Conclusions An increase in serum creatinine of ≥0.5 mg/dL is more sensitive because it recognizes more selectively those patients with a higher risk of mortality and morbidity. Serum creatinine increases of ≥25% overestimate CIAKI by including many patients without postprocedural relevant deterioration of renal function and affected by a lower risk of adverse events at follow-up.
Canadian journal of kidney health and disease, 2015
Acute kidney injury (AKI) following imaging procedures with contrast medium in hospitalized patients is commonly attributed to contrast-induced nephropathy (CIN). This study sought to establish a benchmark of the incidence of AKI in hospitalized patients who underwent computed tomography (CT) scans, with and without intravenous contrast administration. This was a multi-center observational cohort study. Hospitalized patients in four hospitals with CT scans during two time periods in 2012 and 2013 were included. AKI post-scan was defined as a change in serum creatinine (sCr) in absolute terms of ≥26.5 μmol/L (≥0.3 mg/dl), occurring within 7 days of the CT scan. AKI incidence was examined by study phases and CT-scan types using logistic regression models. Multinomial logistic regression was used to examine the proportions of sCr availability between two study phases. Three hundred and twenty-five patients in Period 1 and 518 patients in Period 2 were included in the study. The inciden...
CE: Preventing Contrast-Induced Acute Kidney Injury
2016
I ntravascular iodinated contrast agents used in radiographic imaging studies are an essential part of the clinical management of many patient conditions, and millions of contrast doses are administered safely in North America each year. 1, 2 Yet contrast agents can cause adverse effects in some patients, including acute kidney injury (AKI). 1, 2 The terms contrast-induced AKI (CI-AKI) and contrastinduced nephropathy are used interchangeably; both refer to the adverse effects that can occur as the result of administering contrast agents. CI-AKI increases health care costs and adversely affects patient morbidities and quality of life. The National Kidney Foundation estimates that, depending on the definition used ABSTRACT: Diagnostic radiographic imaging scans using intravascular iodinated contrast media can lead to various complications. The most salient of these is contrast-induced acute kidney injury (CI-AKI) or contrastinduced nephropathy, a potentially costly and serious patient safety concern. Prevention strategies are the cornerstone of evidence-based clinical management for patients receiving contrast agents. These include preprocedure screening, stratification of patients based on risk factors, and protective interventions, the most important of which is hydration both before and after the radiographic imaging scan. There is a gap, however, between best evidence and clinical practice in terms of exact hydration protocols. Nurses play an important role in nephropathy prevention and need to be familiar with CI-AKI as a potential complication of radiographic imaging scans. In order to ensure safe, high-quality care, nurses must be involved in efforts to prevent CI-AKI as well as interventions that minimize patients' risk of kidney injury.
Contrast medium induced acute kidney injury: a narrative review
Journal of Nephrology, 2018
Background and aims Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of hospital-acquired acute kidney injury. It is more commonly observed following intra-arterial administration of iodinated contrast media (CM) for cardiac procedures in patients with pre-existing chronic kidney disease (CKD), and is associated with increased short-and long-term morbidity and mortality. This review investigates the key current evidence on CI-AKI definition, epidemiology and pathogenesis, as a basis for recommending preventive measures that can be implemented in clinical practice. Methods An extensive literature search was performed to identify the relevant studies describing the epidemiology, pathogenesis, outcome and prevention of CI-AKI. Results and conclusion Pre-existing CKD, intra-arterial administration and CM volume are the most important risk factors for CI-AKI. Since risk factors for CI-AKI are well defined, and the timing of renal insult is known, patients should be carefully stratified before the administration of CM, in order to reduce the negative impact of modifiable risk factors on renal function. The intravenous administration of moderate amounts of isotonic saline solution or bicarbonate solution still represents the principal intervention with documented and acceptable effectiveness for CI-AKI prevention. More data are needed on aggressive volume expansion strategies along with diuretics, targeting forced diuresis with high urinary output. The role of antioxidant agents remains controversial, and only moderate evidence exists in favour of N-acetylcysteine. Statins could contribute to reducing the incidence of CI-AKI, although their mechanism of action is not fully ascertained. No robust data demonstrate a reduction of CI-AKI incidence by peri-procedural hemodialysis/hemofiltration; renal replacement therapies may carry instead unnecessary risks. Remote ischemic preconditioning might represent a simple, non-invasive and cost effective preventive measure for CI-AKI prevention, but few data are currently available about its clinical application in patients at high risk of CI-AKI.
Contrast-induced acute kidney injury following PCI
European Journal of Clinical Investigation, 2013
Objective: We conducted a meta-analysis to compare the incidence of acute kidney injury (AKI) with carbon dioxide (CO 2) versus iodinated contrast media (ICM). Background: Contrast induced-acute kidney injury (CI-AKI) is a known complication following endovascular procedures with ICM. CO 2 has been employed as an alternative imaging medium as it is nontoxic to the kidneys. Methods: Search of indexed databases was performed and 1,732 references were retrieved. Eight studies (7 observational, 1 Randomized Controlled Trial) formed the meta-analysis. Primary outcome was AKI. Fixed effect model was used when possible in addition to analysis of publication bias. Results: In this meta-analysis, 677 patients underwent 754 peripheral angiographic procedures. Compared with ICM, CO 2 was associated with a decreased incidence of AKI (4.3% vs. 11.1%; OR 0.465, 95% CI: 0.218-0.992; P 5 0.048). Subgroup analysis of four studies that included granular data for patients with chronic kidney disease (CKD) did not demonstrate a decreased incidence of AKI with CO 2 (4.1% vs. 10.0%; OR 0.449, 95% CI: 0.165-1.221, P 5 0.117). Patients undergoing CO 2 angiography experienced a higher number of nonrenal events including limb/abdominal pain (11 vs. 0; P 5 0.001) and nausea/vomiting (9 vs. 1; P 5 0.006). Conclusions: In comparison to ICM, CO 2 use is associated with a modestly reduced rate of AKI with more frequent adverse nonrenal events. In studies that use CO 2 as the primary imaging agent, the average incidence of AKI remained high at 6.2%-supporting the concept that factors other than renal toxicity from ICM may contribute to renal impairment following peripheral angiography. V