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Strategies for the prevention of contrast-induced acute kidney injury

Weisbord, Steven Da,b; Palevsky, Paul Ma,b

Current Opinion in Nephrology and Hypertension: November 2010 - Volume 19 - Issue 6 - p 539–549
doi: 10.1097/MNH.0b013e32833d42e3
Diagnostics and techniques: Edited by Maatreen Taal

Purpose of review The intravascular administration of iodinated contrast media for diagnostic imaging is a common cause of acute kidney injury and a leading cause of iatrogenic renal disease. The purpose of this review is to describe the principal risk factors for contrast-induced acute kidney injury and to summarize recent data describing the efficacy of various preventive interventions for this condition.

Recent findings Whereas earlier studies suggested that certain low-osmolal contrast agents including iohexol and ioxaglate are more nephrotoxic than iso-osmolal iodixanol, recent clinical trials and meta-analyses comparing other low-osmolal contrast agents with iodixanol have found little difference in risk. The provision of prophylactic renal replacement therapy does not ameliorate the risk of contrast-induced acute kidney injury, and likely poses undue risk. Despite some research supporting a benefit of atrial natriuretic peptide, statins, and prostaglandin analogs, additional data from large, adequately powered studies are needed before these agents can be recommended. N-Acetylcysteine and isotonic intravenous bicarbonate have been investigated intensely, yet the data on these interventions are conflicting due to methodological limitations in past studies.

Summary Prevention of contrast-induced acute kidney injury involves the identification of high-risk patients, consideration of alternative imaging procedures that do not involve the administration of iodinated contrast, and integration of the cumulative data available on preventive interventions in high-risk patients.

aRenal Section, VA Pittsburgh Healthcare System, USA

bRenal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Correspondence to Paul M. Palevsky, MD, Room #7E123 (111F-U), VA Pittsburgh Healthcare System, University Drive Division, Pittsburgh, PA 15240, USA Tel: +1 412 688 3932; fax: +1 412 688 6908; e-mail: palevsky@pitt.edu

© 2010 Lippincott Williams & Wilkins, Inc.