Risk Factors for Acute Renal Failure after Cardiac Catheterization Most Cited in the Literature: An Integrative Review

Abstract

Acute renal failure (ARF) represents 17% of the complications of cardiac catheterization (CC), with a high death rate and longer hospitalization time. The objective of this review is to describe the most cited risk factors for acute kidney failure in the literature. It is a descriptive and exploratory Integrative Literature Review (ILR) with a qualitative approach, using articles published in the Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases between the years of 2009 and 2019 in English, Portuguese, and Spanish, including original articles, reviews, and case studies. The search was made using the following descriptors: cardiac catheterism, kidney diseases, risk factors, coronary catheterization, acute kidney injury, acute renal failure, and nephropathies. The organization and analysis of the data was through the application of a questionnaire that was structured by the authors, and the results are presented in a table. For the final sample, 10 articles were sought. The highlighted factors were being elderly, hypertensive, and diabetic; having previous kidney disease, hypotension, heart failure, higher contrast volumes, and types; the use of non-steroidal anti-inflammatory drugs associated to other risk factors; and atrial fibrillation. Atrial fibrillation was the main finding, which has recently been documented. The identification of risk factors provides health professionals with information to plan measures to prevent ARF, minimizing complications, length of stay, and mortality.

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“…They highlight as a characteristic the increase of troponin type I associated with electrocardiographic and echocardiographic alterations, presenting segmental abnormality of the wall movement or reduction of the left ventricle ejection fraction [36]. Thus, the clinical presentation of the acute cardiac lesion may manifest as myocarditis or acute myocardial infarction, with thoracic pain and ST-segment elevation, requiring percutaneous cardiac procedure [37,38], which is an intervention that presents a risk of acute renal failure in hospitalized patients with comorbidities, due to the use of contrasts, and can increase hospitalization and mortality [39]. Showing that this complication requires procedures that can influence or enhance clinical conditions for a worse outcome.…”

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“…However, for most patients with PDA, a large amount of contrast agent is required in aortography, and in some cases, images obtained are not clear enough to assess PDA anatomy ( 106 , 107 ), so the size of PDA may be underestimated, thus affecting the surgeon’s choice of device, and leading to risk of embolization ( 108 ). In addition, patients with contrast agent allergy or renal insufficiency ( 108 – 110 ) are at risk with aortography. The results of available studies suggest that ICE is comparable to aortography or cardiac CTA in terms of the accuracy of measuring PDA diameter on the pulmonary artery side, but the amount of contrast agent required for ICE-guided PDA assessment is significantly lower than that for aortography.…”

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“…Other associated factors for contrast induced nephropathy include hypotension, longer procedure time, and atrial fibrillation. [145] In patients with intermediate lesions (30 – 70%), FFR should be performed to assess for functional (hemodynamic) significance. In stable patients with moderate or severe ischemia and without clinically significant angina or left main CAD (e.g., via CCTA), an initial invasive strategy of coronary catheterization with or without revascularization may not reduce the risk of ischemic CVD or death from any cause compared to medical therapy, suggesting that cardiac catheterization might reasonably be reserved for optimal medical therapy failure.…”

“…Other associated factors for contrast induced nephropathy include hypotension, longer procedure time, and atrial fibrillation. [145] …”