Contrast induced acute kidney injury in interventional cardiology: an update and key guidance for clinicians

Abstract

Contrast-induced acute kidney injury (CI-AKI) is a serious complication that can affect outcome and prognosis of patients undergoing percutaneous diagnostic and interventional procedures in catheterization laboratories. There have been advancements in case definition and epidemiology. Additionally strategies have emerged that are positioned to have impact in the catheterization laboratory for patients undergoing cardiovascular procedures. The aim of this review is to provide the state-of-the-art of diagnosis, prevention and management of CI-AKI in interventional cardiology.

The renoprotective effects of Heme Oxygenase-1 during contrast-induced acute kidney injury in preclinical diabetic models

“…Kidney vasoconstriction and direct nephrotoxicity are associated with kidney parenchymal hypoxia, generation of reactive oxygen species, and inflammatory processes, all of which play pivotal roles in kidney damage. In addition, the predisposition of diabetic kidneys to CI-AKI may be related to chronic hyperglycemia due to increased levels of NADPH oxidase and mitochondrial protein glycation in favor of oxidative stress, resulting in a state of glucose toxicity (2,6,8,10).…”

“…Contrast-induced acute kidney injury (CI-AKI) is an iatrogenic syndrome that arises after iodinated contrast (IC) administration, which is used to perform diagnostic imaging tests such as cardiac catheterization (1,2). Its incidence varies from 3% to 19%, but risk factors such as chronic kidney disease, advanced age, and diabetes mellitus (DM) can increase it to 26% (3)(4)(5).…”

“…The pathophysiology of CI-AKI is poorly understood. Hypoxia is the main mechanism underlying CI-AKI and is caused by prolonged vasoconstriction that induces adhesion molecule expression, leukocyte-endothelium interaction, and activation of inflammatory mediators such as cytokines and eicosanoids (2,(8)(9)(10). Nevertheless, high osmolality and viscosity of IC may enhance its toxic effect in the kidney tubules by increasing intratubular pressure and reducing kidney blood flow (KBF) and glomerular filtration rate (GFR).…”

Contrast-free percutaneous pulmonary valve replacement: a safe approach for valve-in-valve procedures

“…The reintervention and complication rate of 4.7% in our series relates to 1 patient, who, in retrospect, lies outside the suggested scope for contrast-free valve implantation. Renal protection strategies such as pre-hydration, sodium bicarbonate administration or N-acetylcysteine administration could have been employed to justify a contrast angiographic evaluation of this patient’s RVOT [ 16 , 26 ]. The most extensive report to date on patients with Sapien 3 PPVI reports complication rates of 10% accounting for all RVOT substrates [ 27 ].…”

Risk assessment of contrast-induced acute kidney injury in patients with acute myocardial infarction after coronary angiography and percutaneous coronary intervention

“…Контраст-индуцированное острое почечное повреждение (КИ-ОПП) -опасное осложнение ангиографических процедур, обусловленное прямым и опосредованным воздействием на почечные структуры йодсодержащих рентгеноконтрастных препаратов, которые в настоящее время широко применяются в неотложной и плановой кардиологии [1,2]. Развитие рассматриваемой острой ятрогенной патологии почек в условиях стационара увеличивает сроки госпитализации пациента, а также повышает смертность [3,4].…”