Methods for Reducing Contrast Use and Avoiding Acute Kidney Injury During Endovascular Procedures

Abstract

: Iodinated Contrast Media (CM) has a plethora of applications in routine non-invasive or percutaneous invasive imaging examinations and therapeutic interventions. Unfortunately, the use of CM is not without complications, with contrast-induced acute kidney injury (CI-AKI) being among the most severe. : CI-AKI is a syndrome defined as a rapid development of renal impairment after a few days of CM endovascular injection, without the presence of any other underlying related pathologies. Although mostly transient and reversible, for a subgroup of patients with comorbidities related to renal failure, CI-AKI is directly leading to longer hospitalization, elevated rates of morbidity and mortality, as well as the increased cost of funding. : Thus, a need for classification in accordance with clinical and peri-procedural criteria is emerged. This would be very useful for CI-AKI patients in order to predict the ones who would have the greatest advantage from the application of preventive strategies. : This article provides a practical review of the recent evidence concerning CI-AKI incidence, diagnosis, and sheds light on prevention methods for reducing contrast use and avoiding AKI during endovascular procedures. : In conclusion, despite the lack of a specific treatment protocol, cautious screening, assessment, identification of the high-risk patients, and thus the application of simple interventions -concerning modifiable risk factors- can significantly reduce CI-AKI risk.

Contrast-associated acute kidney injury: An update of risk factors, risk factor scores, and preventive measures

“…For a patient using one of these drugs who receives an examination requiring contrast media, the clinician must maintain awareness to the possibility of CA-AKI and take precautions in advance. Although most cases of CA-AKI are transient and reversible, patients often require hospitalization, have increased risk of morbidity and mortality, and have increased hospital costs (especially subgroups with CKD) [41]. Therefore, it is necessary to carefully screen, evaluate, and identify highrisk patients [41].…”

An Analysis of the Prevalence and Risk Factors of Contrast-Associated Acute Kidney Injury in Patients With Diabetic Foot Ulcer

“…CKD, CHF, DM, and advanced age are nonmodifiable factors, while hypotension, anemia, nephrotoxic drug usage, CM type and volume, and periprocedural dehydration/hypovolemic states are modifiable. 3,28 Pre-existing kidney disease is well known to be the most significant risk factor, and there is a strong correlation between the risk of CA-AKI and the degree of kidney disease. 1,2 Furthermore, advanced age was found to be a risk factor for CA-AKI in almost all studies.…”

“…[1][2][3]29 Heart failure may aggravate CM's ischemic and toxic effects on the renal system by decreasing effective intravascular volume and renal perfusion. 3,4,22,27,28 Several biological mechanisms have been proposed to explain the relationship between anemia and CA-AKI risk. Low hemoglobin levels, decreased blood volume, and insufficient effective circulation all impede oxygen transport to the kidneys.…”

Performance of contrast-associated acute kidney injury predictive risk models in Thai cardiac angiography or angioplasty patients

“…The primary outcomes were the ability to discriminate between the three risk prediction models for CA-AKI established by Chen, Inohara, and Tziakas 10,12,[14][15] . The secondary outcome was the occurrence of CA-AKI (defined as an increase in SCr ≥0.3 mg/dL within two days or an increase in SCr ≥50% within seven days after radiocontrast administration) 1,16 .…”