Meta-Analysis of the Effect of Automated Contrast Injection Devices Versus Manual Injection and Contrast Volume on Risk of Contrast-Induced Nephropathy

Minsinger, Kristopher D.; Kassis, Hayah; Block, Clay A.; Sidhu, Mandeep S.; Brown, Jeremiah R.

doi:10.1016/j.amjcard.2013.08.040

Cited by 39 publications

(37 citation statements)

References 13 publications

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“…26 According to the European Society of Cardiology guidelines, this treatment is rated as a class IIb recommendation for patients at a high risk of CIN. 27 that included studies comparing the amount of CM volume delivery between automated contrast injectors and manual manifold injection demonstrated a decrease of contrast volume delivery by 45 mL/case and significant reduction in CIN incidence.…”

Section: Furosemide With Matched Hydrationmentioning

confidence: 99%

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Chau

Williams

2016

Circ: Cardiovascular Interventions

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P atients treated by the interventional cardiologist are now older and more frequently have coexistent renal insufficiency than in the past. Exacerbation of renal function can be a serious, morbid complication of cardiac catheterization or intervention and efforts to avoid this untoward event are important to acknowledge.The incidence of contrast-induced nephropathy (CIN) ranges from 2% in patients with normal baseline renal function to as high as 20% to 30% in patients with a baseline creatinine >2 mg/dL.1,2 The most commonly used definition of CIN is an absolute rise in serum creatinine (SCr) of 0.5 mg/dL or a 25% increase from the baseline value, assessed within 48 hours after the procedure. Risk AssessmentMost CIN risk factors can be accessed from clinical history, physical examination, and common laboratory tests. Preexisting chronic kidney disease is probably the most important preprocedural risk factor for CIN. Because an estimated glomerular filtration rate <60 mL/min per 1.73 m 2 is a major risk factor for CIN, 4 the baseline estimated glomerular filtration rate should be determined before any procedure in which contrast is administered. Other independent predictors for CIN include the presence of diabetes mellitus, volume depletion, the use of nephrotoxic drugs, hypotension, age >75 years, advanced heart failure, left ventricular systolic function <45%, and anemia.5,6 Different scoring schemes have been proposed to predict the risk for CIN, but none has been adequately validated. When at-risk patients are identified, various measures can be offered to reduce CIN occurrence. Before the Procedure Withdrawal of Potentially Nephrotoxic MedicationsPatients should be advised to withhold all nonessential medications that may be nephrotoxic for 24 hours before the procedure (Table). Although there has been controversy as to whether angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may predispose to nephrotoxicity, a recent study demonstrated no such effect.7 Accordingly, it is reasonable to continue angiotensin-converting enzyme inhibitors or angiotensin receptor blockers if patients are already taking these drugs. Pharmacological StrategiesN-acetylcysteine was considered a renal protective agent against CIN in the past. However, recent studies have failed to demonstrate a benefit.8 Thus, current guidelines of both the American Heart Association and the European Society of Cardiology do not recommend the use of N-acetylcysteine to prevent CIN in patients undergoing angiographic procedures. 9,10Because of their anti-inflammatory and antithrombotic effects in preservation of endothelial function at the level of the glomerulus, statins seem to play a role in CIN prevention. Several studies have shown the efficacy of short-term, high-dose statins in reducing the incidence of CIN in patients undergoing cardiac catheterization.11,12 Thus, the implementation of high-dose statin before coronary angiography should be considered as an additional preventive measure in patients without contraindic...

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Section: Furosemide With Matched Hydrationmentioning

confidence: 99%

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Chau

Williams

2016

Circ: Cardiovascular Interventions

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“…(58) A most recent meta-analysis has also proven that reduction of CM volume with the use of automated contrast injector significantly reduces the incidence of CIN in patients undergoing coronary angiography. (59) However, according to ACR manuals, there is a lack of robust data to support a dose-toxicity relationship for intravenous iodinated CM, as only intracardiac iodinated CM shows a directly proportional relationship. (19) MR imaging is an alternative imaging modality when CT cannot be performed.…”

Section: During the Proceduresmentioning

confidence: 99%

Renal-related adverse effects of intravenous contrast media in computed tomography

Leow¹,

Wu²,

Tan³

2015

smedj

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Renal-related adverse effects of intravascular contrast media (CM) include contrast-induced nephropathy in computed tomography and angiography. While large retrospective studies have been published, the exact pathogenesis of this condition is still unknown. We review the main international guidelines, including the American College of Radiology white paper and the guidelines of European Society of Urogenital Radiology, Royal College of Radiologists and Canadian Association of Radiologists, as well as their references, regarding this subject. We present a simplified, concise approach to renal-related adverse effects of CM, taking into consideration the basis for each recommendation in these published guidelines. This will allow the reader to better understand the rationale behind appropriate patient preparation for crosssectional imaging.

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“…CM volume is a key risk factor for CI-AKI and matters the most in high-risk patients [21]. Use of automated contrast injectors can help achieve this as it reduces the CM volume used [22]. …”

Section: Effect Of Route Of CM On Ci-akimentioning

confidence: 99%

Contrast Medium-Induced Acute Kidney Injury

et al. 2015

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Contrast medium-induced acute kidney injury (CI-AKI) is a predominant cause of hospital-acquired renal insufficiency. With an increasing number of contrast medium-enhanced radiological procedures being performed in a rapidly increasing ageing population in the Western world, it is imperative that more attention is given to understand the aetiology of CI-AKI to devise novel diagnostic methods and to formulate effective prophylactic and therapeutic regimens to reduce its incidence and its associated morbidity and mortality. This article presents high-yield information on the above-mentioned aspects of CI-AKI, primarily based on results of randomised controlled trials, meta-analyses, systematic reviews and international consensus guidelines.

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Meta-Analysis of the Effect of Automated Contrast Injection Devices Versus Manual Injection and Contrast Volume on Risk of Contrast-Induced Nephropathy

Cited by 39 publications

References 13 publications

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Renal-related adverse effects of intravenous contrast media in computed tomography

Contrast Medium-Induced Acute Kidney Injury

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