Nephrotoxicity of iso-osmolar versus low-osmolar contrast media is equal in low risk patients

Feldkamp, Thorsten; Baumgart, DC; Elsner, Mareike; Herget–Rosenthal, Stefan; Pietruck, Frank; Erbel, R; Philipp, Th.; Kribben, Andreas

doi:10.5414/cnp66322

Cited by 60 publications

(38 citation statements)

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“…[20] Oxidative damage is one of the pathophysiological mechanisms thought to play a role in CIN. [2] In the recent years, two important antioxidant agents (i.e., acetylcysteine and ascorbic acid) have been investigated as to whether they have the potential to prevent CIN.…”

Section: Discussionmentioning

confidence: 99%

Ionic High-Osmolar Contrast Medium Causes Oxidant Stress in Kidney Tissue: Partial Protective Role of Ascorbic Acid

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Ionic High-Osmolar Contrast Medium Causes Oxidant Stress in Kidney Tissue: Partial Protective Role of Ascorbic Acid

et al. 2008

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“…The type of molecule used as contrast media was not a differential factor between the two groups: this is easily understandable considering that in our hemodynamic laboratory only low-osmolar non ionic monomers or iso-osmolar ionic and non-ionic dimers are used, in accordance with the latest evidences on the least dangerous molecules for the kidney. 43,44 Another very interesting aspect that came up from our study concerns the role of systemic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for contrast induced nephropathy: A study among Italian patients

Evola

Lunetta

Macaione

et al. 2012

Indian Heart Journal

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Atherosclerosis Percutaneous coronary intervention Coronary angiography a b s t r a c tThis study aimed to make a profile of patients at highest risk of developing contrast induced nephropathy (CIN) in order to take appropriate prevention measures. 591 patients undergoing coronary procedures were divided into two groups: patients with (CIN-group) and without (no-CIN) an increase in creatinine level equal or more than 25% from baseline values within 24e48 h after the coronary procedure. All patients underwent an accurate anamnesis, objective exam, hematochemical measurements, and diagnostic exams. The results of this study while confirming that, average age ( p ¼ 0.01), diabetes mellitus IntroductionContrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute renal failure, accounting for 10% of all cases of hospital-acquired renal failure. 1 It is commonly defined as an acute deterioration of the renal function characterized by a significant increase in serum creatinine levels, usually more than 0.5 mg/dl (44 mmol/L) or 25% of baseline levels, within 24e48 h after exposure to a contrast agent compared to baseline serum creatinine values, when alternative explanations for renal impairment have been excluded. 2 The CIN is associated with increased mortality and morbidity and costs, 3e5 in fact, although usually transient, its resolution needs 1e3 weeks on average, the impairment of renal function may be permanent in some cases with the risk of progression towards chronic renal failure and the necessity of a temporary or permanent dialysis. 6 Prevention is the key to reduce the incidence of CIN and it begins with identification of the high risk patient coupled with appropriate peri-procedural management. Many studies have been conducted to identify the main risk factors for CIN, in fact many score systems have been proposed 7e12 and increasing number of guidelines have been suggested in literature 13,14 to help lessen the complication of CIN. Available online at www.sciencedirect.com journal homepage: w ww.el sevier.com/locate /ihj i n d i a n h e a r t j o u r n a l 6 4 ( 2 0 1 2 ) 4 8 4 e4 9 1

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“…Randomized controlled trials in the interventional cardiology setting have shown that iodixanol has no advantage over iopromide (a low-osmolar agent) for patients with normal renal function. 64 However, in higher-risk populations, iodixanol has been shown to reduce the incidence of nephrotoxicity significantly more than iohexol (the Nephrotoxicity in High 67 These studies found low incidences of contrast-induced AKI with no significant difference in incidence between the iso-osmolar and low-osmolar groups. A third trial, the Patients with REnal impairment and DIabetes undergoing Computed Tomography [PREDICT] study, which also compared iopamidol and iodixanol in the CT setting but included patients with both CKD and diabetes, found similarly low incidences of contrast-induced AKI for the 2 agents (5.6% vs 4.9%).…”

mentioning

confidence: 90%

Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

Goldfarb

McCullough

McDermott

et al. 2009

Mayo Clinic Proceedings

139

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Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. © 2009 Mayo Foundation for Medical Education and ResearchA cute kidney injury (AKI) is a heterogeneous disorder with multiple etiologies, risk factors, and clinical presentations. Although patients with AKI are ultimately cared for by nephrologists, AKI occurs in various clinical settings and is associated with a specific etiology in each. The term contrast-induced AKI refers to the disorder as it occurs after exposure to iodinated contrast media, a disorder that has been more commonly known as contrastinduced nephropathy (CIN). The Acute Kidney Injury Network, recognizing the need for improving outcomes associated with the various forms of AKI, recently proposed using the following standardized diagnostic definition in all cases: an abrupt (within 48 hours) reduction in kidney function, evidenced by an increase in the serum creatinine concentration of at least 0.3 mg/dL (to convert to µmol/L, multiply by 88.4) or at least 50% from baseline or a reduction in urine output (documented oliguria of <0.5 mL/kg/h for >6 hours).1,2 The criterion of oliguria does not apply for many cases of contrast-induced AKI because patients are treated with intravenous fluids before and after the procedure with the goal of increasing periprocedural urine output. The most commonly used definition of CIN is an increase from the baseline serum creatinine concentration of at least 0.5 mg/dL or at least 25% within 48 to 72 hours after exposure to contrast media. [3][4][5] Because the medical community is moving to adopt the concept and terminology of the American College of Radiology (ACR) in reference to studies of contrast-induced renal dysfunction and its prevention, 6 this report will do the same. However, we rec...

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Nephrotoxicity of iso-osmolar versus low-osmolar contrast media is equal in low risk patients

Cited by 60 publications

References 0 publications

Ionic High-Osmolar Contrast Medium Causes Oxidant Stress in Kidney Tissue: Partial Protective Role of Ascorbic Acid

Ionic High-Osmolar Contrast Medium Causes Oxidant Stress in Kidney Tissue: Partial Protective Role of Ascorbic Acid

Risk factors for contrast induced nephropathy: A study among Italian patients

Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

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