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Cardiovascular Intervention and Therapeutics

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01-07-2020 | Kidney Injury | Invited Review Article

Contrast-induced acute kidney injury

Authors: Rishi Chandiramani, Davide Cao, Johny Nicolas, Roxana Mehran

Published in: Cardiovascular Intervention and Therapeutics | Issue 3/2020

Abstract

Although major advancements in the field of cardiology have allowed for an increasing number of patients to undergo minimally invasive imaging and interventional procedures, contrast-induced acute kidney injury (CI-AKI) continues to be a dreaded complication among patients receiving intravascular contrast media. CI-AKI is characterized by progressive decline in kidney function within a few days of contrast medium administration. Physiological changes resulting from the direct nephrotoxic effect of contrast media on tubular epithelial cells and release of vasoactive molecules have been implicated in creating a state of increased oxidative stress and subsequent ischemic renal cell injury. Over the last several years, preventive strategies involving intravenous hydration, pharmaceutical agents and renal replacement therapies have resulted in lower rates of CI-AKI. However, due to the evolving paradigm of diagnostic and therapeutic interventions, several unanswered questions remain. This review highlights the epidemiology, pathogenesis and preventive strategies of CI-AKI.

Rear R, Bell RM, Hausenloy DJ. Contrast-induced nephropathy following angiography and cardiac interventions. Heart. 2016;102:638–48.PubMedCrossRef

McCullough PA, Soman SS. Contrast-induced nephropathy. Crit Care Clin. 2005;21:261–80.PubMedCrossRef

Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int. 2006;69:S11–5.CrossRef

Bartels ED, Brun GC, Gammeltoft A, Gjorup PA. Acute anuria following intravenous pyelography in a patient with myelomatosis. Acta Med Scand. 1954;150:297–302.PubMedCrossRef

Killmann SA, Gjorup S, Thaysen JH. Fatal acute renal failure following intravenous pyelography in a patient with multiple myeloma. Acta Med Scand. 1957;158:43–6.PubMedCrossRef

Wilhelm-Leen E, Montez-Rath ME, Chertow G. Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol. 2017;28:653–9.PubMedCrossRef

Caspi O, Habib M, Cohen Y, Kerner A, Roguin A, Abergel E, et al. Acute kidney injury after primary angioplasty: is contrast-induced nephropathy the culprit? J Am Heart Assoc. 2017;6(6):e005715.PubMedPubMedCentralCrossRef

Hinson JS, Ehmann MR, Fine DM, Fishman EK, Toerper MF, Rothman RE, et al. Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med. 2017;69(577–86):e4.

Chertow GM, Normand SL, McNeil BJ. “Renalism”: inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency. J Am Soc Nephrol. 2004;15:2462–8.PubMedCrossRef

10.

Wong JA, Goodman SG, Yan RT, Wald R, Bagnall AJ, Welsh RC, et al. Temporal management patterns and outcomes of non-ST elevation acute coronary syndromes in patients with kidney dysfunction. Eur Heart J. 2009;30:549–57.PubMedCrossRef

11.

Medi C, Montalescot G, Budaj A, Fox KA, Lopez-Sendon J, FitzGerald G, et al. Reperfusion in patients with renal dysfunction after presentation with ST-segment elevation or left bundle branch block: gRACE (Global Registry of Acute Coronary Events). JACC Cardiovasc Interv. 2009;2:26–33.PubMedCrossRef

12.

KDIGO KJKIS. Section 4: contrast-induced AKI. Kidney Int Suppl. 2012;2:69–88.CrossRef

13.

Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179–84.PubMed

14.

Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med. 2019;380:2146–55.PubMedCrossRef

15.

McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997;103:368–75.PubMedCrossRef

16.

Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105:2259–64.PubMedCrossRef

17.

Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014;7:1–9.PubMedPubMedCentralCrossRef

18.

Amin AP, Salisbury AC, McCullough PA, Gosch K, Spertus JA, Venkitachalam L, et al. Trends in the incidence of acute kidney injury in patients hospitalized with acute myocardial infarction. Arch Intern Med. 2012;172:246–53.PubMedCrossRef

19.

McDonald JS, McDonald RJ, Comin J, Williamson EE, Katzberg RW, Murad MH, et al. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 2013;267:119–28.PubMedCrossRef

20.

Weisbord SD, Mor MK, Resnick AL, Hartwig KC, Sonel AF, Fine MJ, et al. Prevention, incidence, and outcomes of contrast-induced acute kidney injury. Arch Intern Med. 2008;168:1325–32.PubMedCrossRef

21.

Heyman SN, Clark BA, Kaiser N, Spokes K, Rosen S, Brezis M, et al. Radiocontrast agents induce endothelin release in vivo and in vitro. J Am Soc Nephrol. 1992;3:58–65.PubMed

22.

Heyman SN, Rosen S, Brezis M. Radiocontrast nephropathy: a paradigm for the synergism between toxic and hypoxic insults in the kidney. Exp Nephrol. 1994;2:153–7.PubMed

23.

Azzalini L, Spagnoli V, Ly HQ. Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol. 2016;32:247–55.PubMedCrossRef

24.

McCullough PA, Choi JP, Feghali GA, Schussler JM, Stoler RM, Vallabahn RC, et al. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2016;68:1465–73.PubMedCrossRef

25.

Heyman SN, Rosen S, Rosenberger C. Renal parenchymal hypoxia, hypoxia adaptation, and the pathogenesis of radiocontrast nephropathy. Clin J Am Soc Nephrol. 2008;3:288–96.PubMedCrossRef

26.

Ando G, Cortese B, Russo F, Rothenbhler M, Frigoli E, Gargiulo G, et al. Acute kidney injury after radial or femoral access for invasive acute coronary syndrome management AKI-MATRIX. J Am Coll Cardiol. 2017;69:2592–603.CrossRef

27.

Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393–9.PubMed

28.

Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Spartà I, et al. Mehran contrast-induced nephropathy risk score predicts short-and long-term clinical outcomes in patients with ST-elevation—myocardial infarction. Circ Cardiovasc Interv. 2010;3:491–8.PubMedCrossRef

29.

McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, et al. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98:27K–36K.PubMedCrossRef

30.

Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int. 1995;47:254–61.PubMedCrossRef

31.

Gurm HS, Seth M, Kooiman J, Share D. A novel tool for reliable and accurate prediction of renal complications in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2013;61:2242–8.PubMedCrossRef

32.

Bartholomew BA, Harjai KJ, Dukkipati S, Boura JA, Yerkey MW, Glazier S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol. 2004;93:1515–9.PubMedCrossRef

33.

Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality. A cohort analysis. JAMA. 1996;275:1489–94.PubMedCrossRef

34.

James MT, Ghali WA, Tonelli M, Faris P, Knudtson ML, Pannu N, et al. Acute kidney injury following coronary angiography is associated with a long-term decline in kidney function. Kidney Int. 2010;78:803–9.PubMedCrossRef

35.

Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15:1597–605.PubMedCrossRef

36.

Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BA, Janssen MM, Vermeeren MA, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. 2017;389:1312–22.PubMedCrossRef

37.

Timal RJ, Kooiman J, Sijpkens YWJ, de Vries JPM, Verberk-Jonkers I, Brulez HFH, et al. Effect of no prehydration vs sodium bicarbonate prehydration prior to contrast-enhanced computed tomography in the prevention of postcontrast acute kidney injury in adults with chronic kidney disease: the Kompas randomized clinical trial. JAMA Intern Med. 2020;2:45. https://doi.org/10.1001/jamainternmed.2019.7428.CrossRef

38.

Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract. 2003;93:C29–34.PubMedCrossRef

39.

Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty [see comments]. Arch Intern Med. 2002;162:329–36.PubMedCrossRef

40.

Brar SS, Aharonian V, Mansukhani P, Moore N, Shen AY, Jorgensen M, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014;383:1814–23.PubMedCrossRef

41.

Qian G, Fu Z, Guo J, Cao F, Chen Y. Prevention of contrast-induced nephropathy by central venous pressure-guided fluid administration in chronic kidney disease and congestive heart failure patients. JACC Cardiovasc Interv. 2016;9:89–96.PubMedCrossRef

42.

Maioli M, Toso A, Leoncini M, Musilli N, Grippo G, Ronco C, et al. Bioimpedance-guided hydration for the prevention of contrast-induced kidney injury: the HYDRA study. J Am Coll Cardiol. 2018;71:2880–9.PubMedCrossRef

43.

Briguori C, Visconti G, Focaccio A, Airoldi F, Valgimigli M, Sangiorgi GM, et al. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) RenalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation. 2011;124:1260–9.PubMedCrossRef

44.

Briguori C, D’Amore C, De Micco F, Signore N, Esposito G, Napolitano G, et al. Renal insufficiency following contrast media administration trial III: urine flow rate-guided versus left-ventricular end-diastolic pressure-guided hydration in high-risk patients for contrast-induced acute kidney injury. Rationale and design. Catheter Cardiovasc Interv. 2019. https://doi.org/10.1002/ccd.28386.

45.

Adolph E, Holdt-Lehmann B, Chatterjee T, Paschka S, Prott A, Schneider H, et al. Renal Insufficiency Following Radiocontrast Exposure Trial (REINFORCE): a randomized comparison of sodium bicarbonate versus sodium chloride hydration for the prevention of contrast-induced nephropathy. Coron Artery Dis. 2008;19:413–9.PubMed

46.

Brar SS, Shen AY, Jorgensen MB, Kotlewski A, Aharonian VJ, Desai N, et al. Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA. 2008;300:1038–46.PubMedCrossRef

47.

Brar SS, Hiremath S, Dangas G, Mehran R, Brar SK, Leon MB. Sodium bicarbonate for the prevention of contrast induced-acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4:1584–92.PubMedPubMedCentralCrossRef

48.

Weisbord SD, Gallagher M, Kaufman J, Cass A, Parikh CR, Chertow GM, et al. Prevention of contrast-induced AKI: a review of published trials and the design of the prevention of serious adverse events following angiography (PRESERVE) trial. Clin J Am Soc Nephrol. 2013;8:1618–31.PubMedPubMedCentralCrossRef

49.

Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med. 2018;378:603–14.PubMedCrossRef

50.

Rosner MH. Prevention of contrast-associated acute kidney injury. Mass Med Soc. 2018;378:671–2.

51.

Authors/Task Force M, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al. ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;2014(35):2541–619.

52.

Jain MK, Ridker PM. Anti-inflammatory effects of statins: clinical evidence and basic mechanisms. Nat Rev Drug Discov. 2005;4:977–87.PubMedCrossRef

53.

Shishehbor MH, Brennan ML, Aviles RJ, Fu XM, Penn MS, Sprecher DL, et al. Statins promote potent systemic antioxidant effects through specific inflammatory pathways. Circulation. 2003;108:426–31.PubMedCrossRef

54.

Jo SH, Koo BK, Park JS, Kang HJ, Cho YS, Kim YJ, et al. Prevention of radiocontrast medium-induced nephropathy using short-term high-dose simvastatin in patients with renal insufficiency undergoing coronary angiography (PROMISS) trial—a randomized controlled study. Am Heart J. 2008;155(499):e1–8.

55.

Leoncini M, Toso A, Maioli M, Tropeano F, Badia T, Villani S, et al. Early high-dose rosuvastatin and cardioprotection in the protective effect of rosuvastatin and antiplatelet therapy on contrast-induced acute kidney injury and myocardial damage in patients with acute coronary syndrome (PRATO-ACS) study. Am Heart J. 2014;168:792–7.PubMedCrossRef

56.

Ukaigwe A, Karmacharya P, Mahmood M, Pathak R, Aryal MR, Jalota L, et al. Meta-analysis on efficacy of statins for prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography. Am J Cardiol. 2014;114:1295–302.PubMedCrossRef

57.

Han Y, Zhu G, Han L, Hou F, Huang W, Liu H, et al. Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease. J Am Coll Cardiol. 2014;63:62–70.PubMedCrossRef

58.

Zhang T, Shen LH, Hu LH, He B. Statins for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Am J Nephrol. 2011;33:344–51.PubMedCrossRef

59.

Kandula P, Shah R, Singh N, Markwell SJ, Bhensdadia N, Navaneethan SD. Statins for prevention of contrast-induced nephropathy in patients undergoing non-emergent percutaneous coronary intervention. Nephrology (Carlton). 2010;15:165–70.CrossRef

60.

Mariani J Jr, Guedes C, Soares P, Zalc S, Campos CM, Lopes AC, et al. Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial. JACC Cardiovasc Interv. 2014;7:1287–93.PubMedPubMedCentralCrossRef

61.

Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44:349–56.PubMedCrossRef

62.

Mann T, Cubeddu G, Bowen J, Schneider JE, Arrowood M, Newman WN, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol. 1998;32:572–6.PubMedCrossRef

63.

Ando G, Costa F, Trio O, Oreto G, Valgimigli M. Impact of vascular access on acute kidney injury after percutaneous coronary intervention. Cardiovasc Revasc Med. 2016;17:333–8.PubMedCrossRef

64.

Aragon J, Lee MS, Kar S, Makkar RRJC, Interventions c. Percutaneous left ventricular assist device: “TandemHeart” for high-risk coronary intervention. Catheter Cardiovasc Interv. 2005;65:346–52.PubMedCrossRef

65.

Cohen MG, Matthews R, Maini B, Dixon S, Vetrovec G, Wohns D, et al. Percutaneous left ventricular assist device for high-risk percutaneous coronary interventions: real-world versus clinical trial experience. Am Heart J. 2015;170:872–9.PubMedCrossRef

66.

Burzotta F, Trani C, Doshi SN, Townend J, van Geuns RJ, Hunziker P, et al. Impella ventricular support in clinical practice: collaborative viewpoint from a European expert user group. Int J Cardiol. 2015;201:684–91.PubMedCrossRef

67.

Sauren LD, Accord RE, Hamzeh K, De Jong M, Van Der Nagel T, Van Der Veen FH, et al. Combined impella and intra-aortic balloon pump support to improve both ventricular unloading and coronary blood flow for myocardial recovery: an experimental study. Artif Org. 2007;31:839–42.CrossRef

68.

Dixon SR, Henriques JP, Mauri L, Sjauw K, Civitello A, Kar B, et al. A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (The PROTECT I Trial): initial US experience. JACC Cardiovasc Interv. 2009;2:91–6.PubMedCrossRef

69.

O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126:1717–27.PubMedCrossRef

70.

O’Neill WW, Schreiber T, Wohns DH, Rihal C, Naidu SS, Civitello AB, et al. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol. 2014;27:1–11.PubMedCrossRef

71.

Dangas GD, Kini AS, Sharma SK, Henriques JP, Claessen BE, Dixon SR, et al. Impact of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump on prognostically important clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (from the PROTECT II randomized trial). Am J Cardiol. 2014;113:222–8.PubMedCrossRef

72.

Flaherty MP, Pant S, Patel SV, Kilgore T, Dassanayaka S, Loughran JH, et al. Hemodynamic support with a microaxial percutaneous left ventricular assist device (Impella) protects against acute kidney injury in patients undergoing high-risk percutaneous coronary intervention. Circ Res. 2017;120:692–700.PubMedCrossRef

73.

Dhruva SS, Ross JS, Mortazavi BJ, Hurley NC, Krumholz HM, Curtis JP, et al. Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2020;323(8):734–45.CrossRefPubMedPubMedCentral

Title: Contrast-induced acute kidney injury
Authors: Rishi Chandiramani
Davide Cao
Johny Nicolas
Roxana Mehran
Publication date: 01-07-2020
Publisher: Springer Japan
Keywords: Kidney Injury
Acute Kidney Injury
Angiography
Intravascular Ultrasound
Acute Kidney Injury
Published in: Cardiovascular Intervention and Therapeutics / Issue 3/2020
Print ISSN: 1868-4300
Electronic ISSN: 1868-4297
DOI: https://doi.org/10.1007/s12928-020-00660-8

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