Contrast medium induced acute kidney injury: a narrative review

Abstract

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.

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

“…This observation differentiates the LAAC procedure from interventions in the arterial system, as these cardiac procedures were shown to be associated with higher periprocedural complication rates and a worse outcome in CKD patients [10,11,17]. A fact which might be explained by intra-arterial administration being an independent risk factor for contrast-induced acute kidney injury [18]. Such low complication rates in contrast with the initial PROTECT-AF trial, reporting 8.9% of major adverse events, might also reflect the growing experience with the LAAC procedure [19].…”

Fenoldopam Mesylate: A Narrative Review of Its Use in Acute Kidney Injury

“…The types of surgical interventions most closely associated with PO-AKI are major surgical interventions such as cardiac surgery, vascular surgery, and thoracic surgery [22, 23]. In CI-AKI, a double kidney damage mechanism is observed: firstly, iodinated contrast media (CM) can lead to the formation of reactive oxygen species (ROS), which cause direct toxic renal damage to tubular epithelial cells and secondly, release of ROS results in vessel vasoconstriction leading to hypoxic-ischemic renal damage [24]. Lastly, ICU-AKI has a multifactorial pathogenic mechanism, which in the majority of cases is due to the use of nephrotoxic substances and above all due to a condition of renal ischemia linked to general anesthesia, the use of CM, and the presence of heart failure and sepsis (the last of which being the main causes of ICU-AKI) [25].…”

Application of diffusion tensor imaging and blood oxygenation level-dependent magnetic resonance imaging to assess bilateral renal function induced by Iohexol in rabbits

“…Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of hospital-acquired acute kidney injury. It is defined as a sudden deterioration of renal function 1-3 days after exposure to contrast agents (serum creatinine level increased by 25% or the absolute value of serum creatinine increased by 0.5 mg/dL) [1,2]. Nevertheless, the pathophysiological mechanism process of CI-AKI induced by different kinds of iodine contrast agents is still not completely understood.…”