Preventing contrastinduced acute kidney injury nice. Contrast induced nephropathy cin is defined as impairment of renal function, an increase in serum creatinine levels by more than 25 percent or 0. It is uncommon in the general population, with an incidence of 12%, and occurs within 72 hours of receiving contrast media, usually recovering over the following five days. Contrastinduced nephropathy cin is a sideeffect of intravascular administration of iodinated contrast material. We are drowning in information, but starved for knowledge john nesbitt, megatrends, 1987. Sodium bicarbonate vs sodium chloride for the prevention of contrast mediuminduced nephropathy in patients undergoing coronary angiography. Prevention strategies for contrastinduced nephropathy. Contrastinduced nephropathy cin is an iatrogenic acute renal failure arf occurring after the intravascular injection of iodinated. Incidence of contrast induced nephropathy reported through the patient safety network psn. Sodium bicarbonate therapy for prevention of contrast induced nephropathy. Contrastinduced nephropathy cin is the third most common reason for hospitalacquired acute kidney injury. The development of contrast induced nephropathy cin, also referred to as contrast induced acute kidney injury ci.
If renal function returns to normal, it usually does so within 7 to. Background patients with acute coronary syndrome acs are at high risk for ciaki, and the role of statin pretreatment in preventing renal damage remains uncertain. Algorithm for patients receiving contrast strategies for prevention of cin 1. Prevention of contrast induced nephropathy adult inpatient. Contrastinduced nephropathy cin is unique in that its risk factors are widely known, it is universally iatrogenic. Prevention of contrastinduced nephropathy through a knowledge. Contrastinduced nephropathy following angiography and. Contrastinduced nephropathy cin is a serious complication of coronary angiography that is associated with considerably increased mortality and morbidity, including the need for shortterm haemodialysis, extended hospitalisation and permanent impairment of renal function. This study is unique because nak citrate has been used to reduce the risk of cin for the first time. Contrastinduced nephropathy cin is the 3rd most common cause of hospitalacquired acute renal failure. Usually, contrastinduced nephropathy develops within the first 2 to 3 days with a peak in serum creatinine level 3 to 5 days after contrast exposure. Prevention of contrastinduced nephropathy with volume. Volume supplementation remains the cornerstone for the prevention of contrast induced nephropathy cin. Acute kidney injury frequently occurs in hospitalized.
Theophylline for prevention of contrast induced nephropathy. The prevention of contrastinduced aki ciaki has been a longstanding subject of much interest, with a recent pubmed search for contrast nephropathy clinical trial yielding 1700 references. Contrastinduced nephropathy is one of the few preventable forms of acute kidney injury. This is an extreme presentation of a common iatrogenic problem. Contrastinduced nephropathy cin is one of the most important complications of contrast media. Predictors, prevention, and management 1 contrast induced nephropathy predictors, prevention, and management roxana mehran, md columbia university medical center cardiovascular research foundation 2 disclosures research grant to crf tyco, guerbert consultant advisory board flowmedica 3 cardiorenal risk. In 2006, a consensus panel for contrastinduced nephropathy recom. The mechanism is poorly understood in humans, with the majority of information on the pathophysiology coming from. However, the field has been hindered by underpowered studies with heterogeneous inclusion criteria and trial end points, as well as uncertainty. Prevention of contrastinduced nephropathy with nak. Prevention of contrastinduced nephropathy 20091001. Contrastinduced nephropathy cin is defined as impairment of renal function occurring within 48 hours of administration of contrast media. The primary goal should be avoiding contrast media to prevent contrastinduced nephropathy, if at all possible, and risk factors should be recognized. Acetylcysteine in the prevention of contrastinduced.
Nacetylcysteine and contrastinduced nephropathy in primary angioplasty. The incidence of contrastinduced nephropathy cin has been reported to range from 0% to 24%. Contrastinduced nephropathy effective health care program. Introduction contrast induced nephropathy cin is defined as an increase in serum creatinine beyond 44. These guidelines represent a practical approach to identification and management of patients at risk for cin. These guidelines are intended as a practical approach to risk stratification and prevention. Prevention of contrast induced acute kidney injury ciaki in adult. Contrastinduced acute kidney injury or contrastinduced nephropathy cin is a significant complication of intravascular contrast medium cm. Contrastinduced nephropathy is a serious condition in patients with stsegmentelevation myocardial infarction treated with primary percutaneous coronary intervention. The increasing use of cm, an aging population and an increase in chronic kidney disease ckd will result in an increased incidence of contrast induced. Canadian association of radiologists consensus guidelines. Request pdf prevention of contrast induced nephropathy contrast induced nephropathy cin is a wellknown and serious complication in patients with chronic renal insufficiency undergoing.
Prevention of contrast induced nephropathy request pdf. Consensus guidelines for the prevention of contrast. Preventive strategies for contrastinduced acute kidney injury. The uwhc guidelines for the prevention of contrastinduced nephropathy in adults was updated with a literature search using medline, cochrane, agency for healthcare research and quality reports and. Prevention of contrast induced nephropathy cin guidelines. Selecting a strategy for prevention of contrastinduced. Effectiveness of prevention strategies for contrastinduced nephropathy. Contrastinduced nephropathy cin is a form of kidney damage in which there has been recent exposure to medical imaging contrast material without another clear cause for the acute kidney injury. Prevention strategies for contrastinduced nephropathy eric b. Sodium bicarbonate therapy for prevention of contrast. Consensus guidelines for the prevention of contrast induced nephropathy 2 abstract the development of contrast induced nephropathy cin, also referred to as contrast induced acute kidney injury ciaki is a significant complication of intravascular contrast medium cm use which is linked with excess morbidity and mortality.
Contrastinduced nephropathy cin is the third most common cause of hospitalacquired acute renal failure. Prevention ganesh shidham, md division of nephrology the ohio state university outline 1. There is increasing evidence that cin has a significant adverse impact on patient morbidity and mortality. A series of studies have demonstrated that volume expansion, particularly with. Contrastinduced acute kidney injury is a common iatrogenic complication associated with increased health resource utilization and adverse outcomes, including short and longterm mortality and accelerated progression of preexisting renal insufficiency. Nacetylcysteine in the prevention of contrastinduced nephropathy. Consensus guidelines for the prevention of contrast induced. Contrastinduced acute kidney injury in the preserve trial. Prevention of contrastinduced nephropathy with volume expansion.
Finally, we will suggest individualized recommendations for cin prevention. Trimetazidine in the prevention of contrastinduced. Prospective studies of patients admitted with acute renal failure arf demonstrate that intravascular contrast medium cm was responsible in 1114. Prevention of contrast mediaassociated nephropathy. With great interest, we have read the article reported by markota et al. Contrastinduced nephropathy cin is the third most common reason for hospital acquired acute kidney injury. Cin is classically defined as a serum creatinine increase of at least 25% andor an absolute increase in serum creatinine of 0.
Clinical practice guideline on prevention of contrast. Comparative effect of contrast media type on the incidence of contrastinduced nephropathy. A maastricht contrastinduced nephropathy guidelines study. Objectives this study sought to determine if in addition to standard preventive measures onadmission, highdose rosuvastatin exerts a protective effect against contrastinduced acute kidney injury ciaki. It occurs in % of nondiabetics, and in 20% of diabetics who received contrast. Pentoxifylline for the prevention of contrastinduced. Fenoldopam is a vasodilator that was derived by modifying the phenethylamine structure of dopamine. Nonoliguric renal failure typically occurs within 2472 hours. From evidencebased practice center, johns hopkins university, baltimore, maryland. Pharmacological prophylaxis c briguori1,2 and g marenzi3 1laboratory of interventional cardiology, clinica mediterranea, naples, italy.
Contrastinduced nephropathy guideline that reports that in 660 patients deemed to be at risk of ciaki 52% undergoing intravenous contrast procedures, no prophylaxis was noninferior to intravenous hydration for the prevention of ciaki and was also cost saving. Prevention of contrast induced nephropathy canadian. Volume supplementation remains the cornerstone for the prevention of contrastinduced nephropathy cin. Several pharmacologic agents have been evaluated for the prevention of contrastinduced nephropathy, yet disappointingly, few have been shown conclusively to reduce the risk for this condition. Nacetylcysteine plus intravenous fluids versus intravenous fluids alone to prevent contrastinduced nephropathy in emergency computed tomography. The present study was a randomized clinical trial, which was investigated the impact of ptx in the prevention of cin among 90 diabetic patients undergoing. Current evidence suggests that the combination of intravenous and oral volume supplementation effectively prevents cin in low and moderaterisk patients. Prevention of contrast induced acute kidney injury the renal. The objective of this study was to estimate the inhospital and 1. We aimed to evaluate the preventive effects of pentoxifylline ptx on cin in diabetic patients undergoing angioplasty using cystatin c. Contrastinduced nephropathy is a common cause of acute renal functional impairment and accounts forsignificant morbidity and mortality. Prevention of contrastinduced nephropathy in the emergency department.