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Therapeutic strategies to prevent contrast-induced acute kidney injury

Quintavalle, Cristinaa; Donnarumma, Elvirab; Fiore, Daniloa; Briguori, Carloc; Condorelli, Gerolamaa

doi: 10.1097/HCO.0b013e3283653f41
ISCHEMIC HEART DISEASE: Edited by Peter H. Stone

Purpose of review Contrast-induced acute kidney injury (CI-AKI) accounts for approximately 10% of all causes of hospital-acquired renal failure, causes a prolonged in-hospital stay, and represents a powerful predictor of poor early and late outcome. Here, we highlight endpoints used to assess major strategies to prevent CI-AKI.

Recent findings A general consensus exists on the beneficial prophylactic effect of hydration. This seems to act by increasing urine flow rate and, thereby, by limiting the time of contact between the contrast media and the epithelial tubular cells. On the contrary, both observational trials and randomized studies are often controversial in their conclusions on the efficacy of several drugs tested to prevent CI-AKI. Compounds evaluated include diuretics (furosemide), antioxidants (i.e., N-acetylcysteine and statins), and vasodilators (i.e., calcium antagonists, dopamine, and fenoldopam). Due to the negative and/or controversial clinical results, none of these drugs has been currently recommended to prevent CI-AKI.

Conclusion More reliable markers of acute kidney injury and new prophylactic strategies are warranted to prevent the incidence of CI-AKI.

aDepartment of Molecular Medicine and Medical Biotechnologies, ‘Federico II’ University of Naples and IEOS, CNR, Naples

bFondazione SDN, Napoli

cLaboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy

Correspondence to Gerolama Condorelli, MD, PhD, Department of Molecular Medicine and Medical Biotechnologies, and IEOS, CNR, Federico II University of Naples, Via Pansini, 5, I-80121, Naples, Italy. Tel: +39 081 7464416; fax: +39 081 7463308; e-mail: gecondor@unina.it

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