Preventing contrast medium-induced acute kidney injury (original) (raw)
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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.
European Radiology, 2018
Purpose The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. Areas covered in part 1 Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. Key Points • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.
Journal of Cardiovascular Development and Disease
Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN prevention (statin prescription, prehydration, contrast media (CM) clearance from the blood system, and decrease amounts of contrast volume). The CM volume to patient’s creatinine clearance ratio is the main factor to predict the risk of CIN development. The safe CM to creatinine clearance ratio limits have been established. The usage of CM amount depends on personal operators habits and inside center regulations. There is no standardized contrast usage protocol worldwide. The aim of this study was to establish an easy to use, cheap, and efficient protocol to estimate a personalized safe CM dose limit for every patient based on their kidney function. These limits are announced d...
American Heart Journal, 2013
Background Direct comparisons between risk of contrast induced acute kidney injury (CI-AKI) after intra-arterial versus intravenous contrast administration are scarce. We estimated and compared the risk of CI-AKI and its clinical course after both modes of contrast administration in patients who underwent both. Methods One hundred seventy patients who received both intra-arterial and intravenous contrast injections within one year between 2001 and 2010 were included. Primary outcome was occurrence of CI-AKI. Secondary outcomes were duration of hospital stay, the need for dialysis, recovery of renal function, and mortality. Results The risk of CI-AKI was 24/170 (14.0%, 95% CI 9.6-20.2) after intra-arterial contrast injection versus 20/170 (11.7%, 95% CI 7.7-17.5) after intravenous contrast administration, which led to a relative risk of 1.2 (95% CI 0.7-2.1). None of the patients had a need for dialysis. Median duration of hospital stay in CI-AKI patients was 15.0 days (2.5-97.5, percentile 1-92) after intra-arterial and 15.5 days (2.5-97.5, percentile 0-38) after intravenous contrast procedures. Renal function recovered after CI-AKI in 13/24 after intra-arterial and in 10/20 patients after intravenous contrast administration. Mortality risks in CI-AKI patients were slightly higher than in non-CI-AKI patients, hazard ratios 1.6 (95% CI 0.7-3.7) for intra-arterial and 1.7 (95% CI 0.7-4.4) for intravenous contrast administration, adjusted for confounders. Conclusion The risk of CI-AKI, and its clinical course was similar after intra-arterial and intravenous contrast media administration, after adjustment by design for patient-related risk factors.
Canadian Association of Radiologists Journal, 2014
The development of acute renal failure significantly complicates intravascular contrast medium (CM) use and is linked with high morbidity and mortality. The increasing use of CM, an aging population, and an increase in chronic kidney disease (CKD) will result in an increased incidence of contrast-induced nephropathy (CIN)-unless preventive measures are used. The Canadian Association of Radiologists has developed these guidelines as a practical approach to risk stratification and prevention of CIN. The major risk factor predicting CIN is preexisting CKD, which can be predicted from the glomerular filtration rate (GFR). In terms of being an absolute measure, serum creatinine (SCr) is an unreliable measure of renal function.
To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). However, often it is not easy to determine such a dose. This study assessed the usefulness of the ratio of CM-dose to estimated glomerular filtration rate (eGFR) in predicting the risks of CIN and sought to determine the safe level of CM-dose/eGFR in patients undergoing non-emergent percutaneous coronary intervention (PCI). Subjects and Methods: We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those with nephropathy requiring dialysis (NRD) were also evaluated. Results: Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3% and 80%, respectively. Of patients (n=51) with g-I/ eGFR ≥1.42, 23.6% (13/51) and 7.8% (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001) and NRD (0%, 0/171, p<0.001). Conclusion: It can be concluded that a g-I/eGFR <1.42 is a simple, useful indicator for determining the safe CM-dose based on the pre-PCI eGFR values. Furthermore, g-I/eGFR might have a close relationship with the development of NRD as well as CIN. (Korean Circ J 2011;41:265-271)
Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines
European Radiology, 2011
Purpose The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN). Areas covered Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points • Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed. • CIN risk is lower with intravenous than intra-arterial iodinated contrast medium.
Minimal risk of contrast-induced kidney injury in a randomly selected cohort with mildly reduced GFR
European Radiology
Objectives Previous large studies of contrast-induced or post-contrast acute kidney injury (CI-AKI/PC-AKI) have been observational, and mostly retrospective, often with patients undergoing non-enhanced CT as controls. This carries risk of inclusion bias that makes the true incidence of PC-AKI hard to interpret. Our aim was to determine the incidence of PC-AKI in a large, randomly selected cohort, comparing the serum creatinine (Scr) changes after contrast medium exposure with the normal intraindividual fluctuation in Scr. Methods In this prospective study of 1009 participants (age 50–65 years, 48% females) in the Swedish CArdioPulmonary bioImage Study (SCAPIS), with estimated glomerular filtration rate (eGFR) ≥ 50 mL/min, all received standard dose intravenous iohexol at coronary CT angiography (CCTA). Two separate pre-CCTA Scr samples and a follow-up sample 2–4 days post-CCTA were obtained. Change in Scr was statistically analyzed and stratification was used in the search of possib...
Italian Journal of Medicine, 2018
Contrast-induced acute kidney injury (CI-AKI) is defined as an acute kidney failure following iodine-based contrast medium administration determining relevant health and socio-sanitary implications. Knowledge of pathophysiology, early diagnosis, and prevention in patients at risk are critical points in CI-AKI management. Determination of risk and functional kidney evaluation must precede every iodine-based contrast medium (CM) administration in order to eventually introduce medical prophylaxis. Furthermore, early laboratoristic evaluation after iodine-based CM exposure should be performed for a prompt identification of acute kidney injury. Therefore, clinicians must know and strictly follow valid recommendations to minimize the development of complications.