Publication details

Contrast-induced acute kidney injury and its contemporary prevention

Authors

SŮVA Marek KALA Petr POLOCZEK Martin KAŇOVSKÝ Jan ŠTÍPAL Roman RADVAN Martin HLÁSENSKÝ Jiří HUDEC Martin BRÁZDIL Vojtěch ŘEHOŘOVÁ Jitka

Year of publication 2022
Type Article in Periodical
Magazine / Source Frontiers in Cardiovascular Medicine
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.frontiersin.org/articles/10.3389/fcvm.2022.1073072/full
Doi http://dx.doi.org/10.3389/fcvm.2022.1073072
Keywords PCI; nephrotoxicity; acute kidney injury; contrast-induced acute kidney injury; chronic renal insufficiency; prevention
Description The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.

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