Contrast-induced nephropathy prevention

Lameier NH. Contrast-induced nephropathy—prevention and risk reduction. Nephrol... 

Contrast-induced nephropathy has been defined as an increase in serum creatinine of at least 25% or an absolute increase in serum creatinine of at least 0.5 mg/dL within 48 to 72 hours of iodinated contrast administration and is associated with significant morbidity and mortality (75). Important risk factors include diabetes mellitus, chronic renal insufficiency, administration of large volumes of high osmolar contrast agents, and intravascular volume depletion. Numerous pharmacologic preventive measures have been studied, but consistent benefits have not been demonstrated. In a recent large retrospective study, preprocedural statin therapy was independently associated with a lower risk of contrast nephropathy and nephropathy requiring dialysis (76). 

Merten GJ, Burgess WR Gray LY et al, Prevention of contrast-induced nephropathy with sodium bicarbonate a randomized controlled trial. JAMA 2004 291 2328-2334. 

Bagshaw SM, Culleton BE Contrast-induced nephropathy epidemiology and prevention. Minerva Cardioangiol 2006 54 109-129. 

Rudnick MR, Kesselheim A, Goldfarb S. Contrast-induced nephropathy how it develops, howto prevent it. Cleve Clin J Med 2006 73 75-80, 83-87. 

Bagshaw SM, McAlister FA, Manns BJ, et al. Acetylcysteine in the prevention of contrast-induced nephropathy a case study of the pitfalls in the evolution of evidence. Arch Intern Med 2006 166 161-166. 

Stone GW, McCullough PA, Tumlin JA, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy a randomized controlled trial. JAMA 2003 290 2284-2291. 

Gupta RK, Kapoor A, Tewari S, et al. Captopril for prevention of contrast-induced nephropathy in diabetic patients a randomised study. Indian Heart J I 999 51 521 —526. 

Bagshaw SM, Ghali WA, Theophylline for prevention of contrast-induced nephropathy a systematic review and metaanalysis. Arch Intern Med 2005 165 1087-93. 

Intravenous fluids clearly reduce the risk of AKI across a spectrum of etiologies. For example, in the prevention of contrast-induced nephropathy, one study compared IV hydration with 0.9% saline at 1 ml/kg/ hour beginning 12 hours prior to the study with unrestricted oral fluids. The incidence of AKI (as defined by a 0.5 mg/ dL or greater rise in serum creatinine) was 3.7% in the IV hydration group and 34.6% in the oral fluid group [95]. Saline-based therapies may not be as effective as a bicarbonate-based solution in this setting [96], however confirmation will be necessary from other centers. 

Merten GJ, Burgess WP, Gray LV, Holleman JH, Roush TS, KowalchukGJ, Bersin RM, Van Moore A, Simonton CA 3rd, Rittase RA, Norton HJ, Kennedy TP Prevention of contrast-induced nephropathy with sodium bicarbonate A randomized controlled trial. JAMA 291 2328-2334, 2004. 

Eishbane S. N-acetylcysteine in the prevention of contrast-induced nephropathy. Clin J Am Soc Nephrol 2008 3 281-287. 

Webb JG, Pate GE, Humphries KH, Buller CE, Shalansky S, Al Shamari A, Sutander A, WilliamsT, Fox RS, Levin A A randomized controlled trial of Intravenous N-acetylcystelne for the prevention of contrast-induced nephropathy after cardiac catheterization Lackof effect. Am Hearfi 148 422-429, 2004. 

Huber W, Jeschke B, Kreymann B, et al. Haemodialysis for the prevention of contrast-induced nephropathy. Invest Radiol 2002 37 471 81. 

Stevens MA, McCullough PA, Tobin KJ, et al. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy results of the P.R.I.N.C.E. Study. Prevention of Radio-contrast Induced Nephropathy Clinical Evaluation. J Am Coll Cardiol 1999 33 403 11. 

Reginster F, Jadoul M, van Ypersele DS (1997) Oiinese herbs nephropathy presentation, natural history and fate after transplantation. Nephrol Dial Transplant 12 81-86 Rossert J (2001) Drag-induced acute interstitial nephritis. Kidney Int 60 804—817 Rudnick MR, Kesselheim A, Goldfarb S (2006) Contrast-induced nephropathy how it develops, how to prevent it. Cleve Clin J Med 73 75-77... 

Zoungas S, Ninomiya T, Huxley R, Cass A, Jardine M, Gallagher M, Patel A, Vashegani-Farahani A, Sadigh G, Perkovic V. Systematic review. Sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med 2009 151 631-8. 

Diabetics and patients with borderline renal function should be prehydrated to reduce the chances of contrast-induced nephropathy. A recent randomized controlled trial suggested that prehydration with sodium bicarbonate is more effective than sodium chloride in preventing contrast-induced renal failure [8]. For those patients with contrast allergies, prophy-... 

Access site complications are unusual as a large-diameter common femoral artery access is rarely required for the embolization. Iatrogenic arterial dissection occasionally occurs at the celiac artery origin during difficult catheterization. In patients with borderline hepatic or renal function, the risk of contrast induced nephropathy and hepatorenal syndrome can usually be prevented with optimal hydration and by limiting the volume ofliver embo-lized. 

Solomon R, Deray G, Consensus Panel for CIN How to prevent contrast-induced nephropathy and manage risk patients practical recommendations. Kidney Int 2006 69 S51-S53. 

ElUs JH, Cohan RH Prevention of contrast-induced nephropathy an overview. Radiol CUn North Am 2009 47 801-811, v. 

Comparative studies In a prospective randomised trial including 156 participants, the effectiveness of oral and injectable vitamin C in the prevention of contrast-induced nephropathy was evaluated [27 ]. Most of the adverse events were reported as not serious and self-resolving. 

Berwanger O, Cavalcanti AB, Sousa AM, Buehler A, CasteUo-Junior HJ, CantarelU MJ, et al. Acetylcysteine for the prevention of renal outcomes in patients with diabetes meUitus undergoing coronary and peripheral vascular angiography a substudy of the acetylcysteine for contrast-induced nephropathy trial. Circ Cardiovasc Interv. 2013 Apr 6(2) 139-45. 

Marenzi G, Marana I, l auri G, et al. The prevention of radio-contrast-agent-induced nephropathy by hemofiltration. N Engl J Med 2003 349 1333-1340. 

The use of iodinated contrast media (CM) continues to be a common cause of hospital-acquired acute renal failure (ARF) and its development increases the in-hospital mortality significantly [1, 2,3, 4] as well as increasing the length of hospital stay [5]. Contrast media-induced nephropathy (CMIN) is defined as an otherwise unexplained acute deterioration of renal function after intravascular administration of iodinated CM. Although the clinical features and the histopathological findings of CMIN have been well described [6-9], its pathogenesis, prevention and best treatment modality remain uncertain. 

E. Dosage for prevention of radiocontrast-induced nephropathy. Give 600 mg of PO NAG twice on the day before and the day of the procedure (4 doses total). This is coupled with IV hydration using M2 NS at 1 mL/kg/h for 12 hours before and after the administration of the contrast agent. 

Barrett BJ, Parfrey PS. Clinical practice, Preventing nephropathy induced by contrast medium, N Engl J Med 2006 354 379-386. 

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