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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Practical guide to prevention of contrast-induced acute kidney injury after percutaneous coronary intervention
Giulia Bugani1, Francesco Ponticelli2, Francesco Giannini2
1Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.
Insights
Preventing contrast-induced acute kidney injury (CI-AKI) involves effective hydration and reduced contrast volume. While some strategies like N-acetylcysteine are ineffective, others like statins show promise for better patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Contrast-induced acute kidney injury (CI-AKI) is a significant complication following procedures involving iodinated contrast media, impacting renal function and long-term prognosis.
- Numerous prophylactic strategies have been investigated, but many lack robust evidence from randomized trials, leading to discouraged clinical implementation.
Purpose of the Study:
- To review and summarize effective preventive strategies for CI-AKI.
- To provide pragmatic recommendations for improving clinical practice in CI-AKI prevention.
Main Methods:
- Review of existing literature on CI-AKI prevention strategies.
- Analysis of evidence from randomized trials regarding the efficacy of various interventions.
- Synthesis of findings into actionable clinical recommendations.
Main Results:
- Pre-procedural hydration and minimizing contrast volume are effective preventive measures.
- Strategies like bicarbonate, N-acetylcysteine, and withdrawal of ACE inhibitors/ARBs have shown limited or no benefit.
- Pharmacological treatments with statins and adoption of zero/ultra-low contrast techniques are effective.
Conclusions:
- Focus on pre-procedural hydration, contrast volume reduction, and specific pharmacological agents like statins for CI-AKI prevention.
- Avoidance of ineffective strategies is crucial for optimizing patient care.
- Implementation of evidence-based recommendations can improve clinical practice and patient outcomes.
Abstract:
Contrast-induced acute kidney injury (CI-AKI) represents a common but serious complication of percutaneous coronary interventions (PCI)-and in general of all those examinations requiring iodinated contrast injection-which affects not only renal function but also long-term prognosis. While several prophylactic approaches were designed in order to prevent CI-AKI, most failed to demonstrate clear benefits in randomized trials, and their implementation is therefore discouraged in clinical practice. The most notorious examples include pre-procedural bicarbonate or N-acetylcysteine, and preprocedural withdrawal of ACE inhibitors/Angiotensin receptor blockers. Those strategies that were instead demonstrated effective include the appropriate use of preprocedural hydration, reduction in contrast volume utilization, adoption of techniques for zero- or ultra-low-contrast procedures, and pharmacological treatments with statins. In this brief review, we summarize the main preventive strategies into brief and pragmatic recommendations designed to improve everyday clinical practice.
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