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Contrast induced nephropathy in vascular surgery.

G T C Wong1, E Y P Lee2, M G Irwin3

  • 1Department of Anaesthesiology, University of Hong Kong, Room 424, K Block, Queen Mary Hospital, Pokfulam, Hong Kong gordon@hku.hk.

British Journal of Anaesthesia
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Summary

Anesthetists must understand contrast-induced nephropathy (CIN) risks in patients undergoing endovascular procedures. This review examines preventive strategies like hydration and N-acetylcysteine to minimize contrast media-related kidney injury.

Keywords:
acute kidney injurycontrast mediaendovascular procedures

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Area of Science:

  • Nephrology
  • Cardiology
  • Anesthesiology

Background:

  • Contrast-induced nephropathy (CIN) is a growing concern, particularly in patients undergoing endovascular treatments requiring iodinated contrast media (CM).
  • Anesthetists play a crucial role in managing perioperative risks, including acute kidney injury from CM.
  • Existing data on CIN prevention predominantly comes from non-surgical patient populations.

Purpose of the Study:

  • To review current evidence on preventive measures against CIN in patients undergoing endovascular procedures.
  • To contextualize these preventive strategies within the perioperative setting for anesthetists.
  • To highlight the importance of awareness regarding risk factors and mitigation strategies for CM-induced kidney injury.

Main Methods:

  • Systematic review of recent data on CIN prevention.
  • Evaluation of evidence for measures such as peri-procedural hydration, N-acetylcysteine, statins, remote ischemic preconditioning, renal vasodilators, and renal replacement therapy.
  • Discussion of alternatives to iodinated contrast agents.

Main Results:

  • Various preventive measures, including hydration and N-acetylcysteine, show potential in mitigating CIN.
  • The efficacy of these measures is often extrapolated from non-surgical cohorts.
  • Limited data specifically addresses CIN prevention in the context of endovascular surgical treatments.

Conclusions:

  • Anesthetists require updated knowledge on CIN risk factors and preventive strategies for patients undergoing endovascular procedures.
  • Further research is needed to validate preventive measures in surgical endovascular patient populations.
  • Proactive management and awareness are key to reducing CM-related acute kidney injury.