Contrast medium induced acute kidney injury: a narrative review

  title={Contrast medium induced acute kidney injury: a narrative review},
  author={Valentina Pistolesi and Giuseppe Regolisti and Santo Morabito and Ilaria Gandolfini and Silvia Corrado and Giovanni Piotti and Enrico Fiaccadori},
  journal={Journal of Nephrology},
Background and aimsContrast-induced acute kidney injury (CI-AKI) is the third leading cause of hospital-acquired acute kidney injury. It is more commonly observed following intra-arterial administration of iodinated contrast media (CM) for cardiac procedures in patients with pre-existing chronic kidney disease (CKD), and is associated with increased short- and long-term morbidity and mortality. This review investigates the key current evidence on CI-AKI definition, epidemiology and pathogenesis… 
Long-Term Follow-Up of Contrast-Induced Acute Kidney Injury: A Study from a Developing Country
CI-AKI is a common complication post percutaneous catheterization (PCI), which may increase the risk for CKD, but not death or the need for recatheterization, and preventive measures must be taken early to decrease the morbidity.
Contrast-Associated Acute Kidney Injury: Advances and Challenges
The diagnostic criteria, epidemiology, risk factors, pathophysiological mechanisms and treatment of CA-AKI are reviewed to provide optimized imaging procedures in clinical practice.
Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes
In addition to association with adverse short- and long-term survival AKI had a strong association with new-onset or progression of CKD when patients were followed longitudinally, and for iso-osmolar contrast, the risk of AKI related to contrast dose was evident for higher amount of contrast in patients with baseline eGFR.
Contrast-associated acute kidney injury in patients with arterial hypertension and stable coronary artery disease
Patients with stable CAD and AH and indications for interventions requiring intraarterial administration of contrast media were included in the prospective open observational cohort study and proteinuria, baseline creatinine and contrast volume were statistically significant risk factors of CA-AKI in logistic regression model.
Risk factors for acute renal injury caused by contrast media after percutaneous coronary intervention and coronary angiography
Meta-analysis was used to summarize the risk factors of CI-AKI in patients with PCI/CAG, and to explore the characteristics of high-risk groups of CI -AKI, to provide reference for early identification and prevention of clinical doctors and nurses.
Comparative Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease: A Network Meta-Analysis
A network meta-analysis showed that statin loading before contrast administration was associated with a significantly reduced risk of CI-AKI in patients with CKD undergoing cardiac catheterization, and atorvastatin and rosuvASTatin administered at high dose may be the most effective treatments to reduce incidence.
Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies
Management measures, including the need for careful perioperative clinical examination, timely detection and management of AKI complications, and administration of dexmedetomidine for renal protection, and renal replacement therapy are emphasized.
[Anemia as a risk factor of contrast-associated acute kidney injury].
The prevalence of CA-AKI was higher in the group of patients with anemia, but didnt meet statistical significance and needs further evaluation in larger studies.
Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study
The data suggest that low-osmolar iopamidol carries a low incidence of nephrotoxicity, even in subjects with various comorbid conditions or reduced renal function.
Meta-analysis on allopurinol preventive intervention on contrast-induced acute kidney injury with random controlled trials
Allopurinol may cause reduces in the incidence of CI-AKI in patients undergoing interventional coronary procedures, and fixed-effects or random-effects models according to I2 statistics are used.


Contrast-associated acute kidney injury is a myth: Yes
A growing body of evidence, derived from studies that include adequate control populations and discussed in more detail below, now suggests that risk for AKI attributable to CM administration is modest at most.
Contrast-induced acute kidney injury: is there a risk after intravenous contrast?
  • R. Solomon
  • Medicine
    Clinical journal of the American Society of Nephrology : CJASN
  • 2008
This association between CIN and long-term adverse outcomes has been best demonstrated by retrospective analyses of cardiac angiography cohorts (1–3); however, 90% of contrast media are used for computed tomography (CT) imaging, and patients who undergo contrast-enhanced CT may differ significantly from those who undergoAngiography.
Incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography.
Lower levels of basal hemoglobin appeared to be related to a higher risk of CI-AKI, and contrast media volume, especially if exceeding the dose adjusted for renal function, was a strong modifiable risk factor for CI- AKI.
Contrast-induced acute kidney injury in interventional cardiology: Emerging evidence and unifying mechanisms of protection by remote ischemic conditioning.
  • A. Atanda, O. Olafiranye
  • Medicine, Biology
    Cardiovascular revascularization medicine : including molecular interventions
  • 2017
Post-contrast acute kidney injury – Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors
PC-AKI is the preferred term for renal function deterioration after contrast medium, and the risk of AKI caused by intravascular contrast medium has been overstated.
Persistent Renal Damage After Contrast-Induced Acute Kidney Injury: Incidence, Evolution, Risk Factors, and Prognosis
The results suggest that CI-AKI is not always a transient, benign creatininopathy, but rather a direct cause of worsening renal function, and can identify patients at increased risk of cardiovascular events.
Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)
This review is an abridged version of the guideline for AKI and provides additional rationale and commentary for those recommendation statements that most directly impact the practice of critical care.
Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy.
AIM We sought to examine the short- and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25%
Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis.
Control contrast medium-induced nephropathy studies demonstrate a similar incidence of AKI, dialysis, and death between the contrast medium group and control group.
Renalguard system in high-risk patients for contrast-induced acute kidney injury.
The RenalGuard therapy seems to be a promising new approach in preventing CI-AKI in high risk patients.