J Clin Outcomes Manage
Prevention of contrast-induced acute kidney injury
Weisbord SD, Palevsky PM
Abstract: Objective: To review the risk factors, definition, pathophysiology, prevention, and adverse outcomes associated with the development of acute kidney injury resulting from iodinated contrast. Methods: Case presentation and evaluation of the medical literature. Results: Contrast-induced acute kidney injury (CIAKI) is characterized by the abrupt loss of kidney function following the intravascular administration of iodinated contrast media. Typically defined in clinical practice and research by increases in serum creatinine of ? 25% and/or ? 0.5 mg/dL within 2 to 4 days of contrast administration, CIAKI occurs in up to 10% to 15% of at-risk patients overall and as many as 30% or more of high-risk hospitalized patients. Underlying renal insufficiency is the principal risk factor for CIAKI, while diabetes mellitus significantly amplifies the risk in patients with baseline kidney disease. The principal intervention for the prevention of CIAKI in high-risk patients is the provision of intravenous fluids prior to and following the administration of iodinated contrast. The use of iso-osmolal or specific low-osmolal contrast agents also minimizes risk. N-acetylcysteine, a vasodilatory antioxidant, has been investigated in dozens of clinical trials and meta-analyses with conflicting results. Conclusion: CIAKI is a common iatrogenic condition that is associated with serious adverse outcomes. Knowledge of the key risk factors and data supporting the use of specific preventive interventions will inform the implementation of evidence-based care to minimize the incidence and potential sequelae of this iatrogenic condition.
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