Selecting Appropriate Contrast Media for Preventing Contrast-Induced Nephropathy

IntroductionContrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI) following the administration of contrast media for coronary interventions or procedures such as diagnostic coronary angiography. The optimal way of preventing CIN remains uncertain. However, preliminary intravenous hydration, minimizing the volume of contrast media, and avoiding the use of nephrotoxic drugs are recommended in current management guidelines. The aim of this analysis was to compare the RenalGuard® system with standard care.MethodsA comprehensive literature search was conducted in PubMed and Google Scholar to identify evidence on the clinical and economic effectiveness of forced diuresis with matched hydration using the RenalGuard system for preventing CIN. Multiple criteria decision analysis (MCDA) was used to assess the performance of the method in hospital settings, compared with alternative options.ResultsSeveral systematic reviews with meta-analyses demonstrated that forced diuresis with matched hydration using the RenalGuard system was associated with a significantly lower relative risk of CIN among high-risk patients with chronic kidney disease. However, the evidence supporting the advantage of the proposed method over current forced diuresis techniques with manual calculation of the volumes for matched hydration in the hospital setting was limited.ConclusionsAlthough the effectiveness of the RenalGuard system has been demonstrated in meta-analyses, its clinical advantage over forced diuresis with manual hydration calculation is uncertain. It is also worth noting the lack of evidence to date on this technology, the fact that it is still at the research stage in some countries, and that it is not included in CIN management guidelines.

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Radiologic Contrast Media Desensitization for Delayed Cardiac Catheterization

Allergy & Rhinology ◽

10.1177/2152656719892844 ◽

2019 ◽

Vol 10 ◽

pp. 215265671989284 ◽

Cited By ~ 1

Author(s):

Neha Sanan ◽

Marija Rowane ◽

Robert Hostoffer

Keyword(s):

High Risk ◽

Contrast Media ◽

Cardiac Catheterization ◽

Contrast Material ◽

Preventative Measure ◽

Contrast Induced Nephropathy ◽

Radiographic Contrast ◽

Radiographic Contrast Material ◽

Medical Emergencies ◽

Anaphylactoid Reactions

This protocol for rapid desensitization to intravenous radiographic contrast material (RCM) improves the strategy first reported by Uppal et al. Desensitization is a validated preventative measure for medical emergencies, such as cardiac catheterization, when patients present with histories of anaphylactoid reactions to the allergen of concern. The patient required another catheterization that was modified to repeat the final dosage of 320 mg/mL of Visipaque®, accommodating cardiac catheterization postponement, contrary to readministration of doses 4 (0.625 mg/mL) and 8 (10 mg/mL) as reported in Uppal et al. Our risk score calculations suggested that the patient was at low risk of contrast-induced nephropathy (CIN) that did not necessitate reduced dosage. No complications were reported following catheterization. We propose repetition of the final RCM dosage as a more effective and efficient desensitization strategy, as long as the scoring system does not indicate high risk for CIN.

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Quercetin, a Promising Clinical Candidate for The Prevention of Contrast-Induced Nephropathy

International Journal of Molecular Sciences ◽

10.3390/ijms20194961 ◽

2019 ◽

Vol 20 (19) ◽

pp. 4961 ◽

Cited By ~ 5

Author(s):

Laura Vicente-Vicente ◽

David González-Calle ◽

Alfredo Ginés Casanova ◽

María Teresa Hernández-Sánchez ◽

Marta Prieto ◽

...

Keyword(s):

Contrast Media ◽

Experimental Studies ◽

High Dose ◽

Preventive Strategy ◽

Contrast Induced Nephropathy ◽

Effective Prevention ◽

Clinical Phase ◽

Coronary Catheterization ◽

Iodinated Contrast ◽

Prophylactic Measures

Iodinated contrast media (CM) are the leading cause of acute renal failure of toxic origin. Between 21% and 50% of patients that receive them develop contrast-induced nephropathy (CIN). All prophylactic measures used so far have failed to provide effective prevention. Since oxidative stress is involved in the damage, a possible preventive strategy could be the administration of antioxidant substances, such as quercetin. This compound has shown renoprotective effects in experimental studies. The aim of this study was to evaluate whether quercetin may be helpful in preventing CIN in patients undergoing coronary catheterization. A clinical phase II study was conducted. Patients were distributed in two groups, namely, CM (patients who only received contrast media) and CM+Q (patients who were pretreated with quercetin orally for 3–5 days). Results showed less incidence of CIN in the CM+Q group, possibly due to glomerular protection, evidenced by a lower increase in serum creatinine and albuminuria; and a lower decrease in the glomerular filtration rate (GFR). Furthermore, in this group, the relative risk of developing CIN observed in patients that received a high dose of contrast media was inferior. In conclusion, this is the first study that demonstrates that quercetin is a promising safe candidate in preventing CIN.

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Just Pediatrics: Kids, Contrast Media, Contrast-Induced Nephropathy, and Nephrogenic Systemic Fibrosis

Journal of Radiology Nursing ◽

10.1016/j.jradnu.2014.03.002 ◽

2014 ◽

Vol 33 (2) ◽

pp. 88-89

Author(s):

Susanne M. Matich

Keyword(s):

Contrast Media ◽

Nephrogenic Systemic Fibrosis ◽

Contrast Induced Nephropathy

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ACE-I/ARB Therapy prior to Contrast Exposure: What Should the Clinician Do?

BioMed Research International ◽

10.1155/2014/423848 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Robert Kalyesubula ◽

Peace Bagasha ◽

Mark A. Perazella

Keyword(s):

Contrast Media ◽

Angiotensin Receptor Blockers ◽

Kidney Injury ◽

Current Evidence ◽

Contrast Induced Nephropathy ◽

Contrast Exposure ◽

Receptor Blockers ◽

Stage Renal Disease ◽

End Stage ◽

Prolonged Hospital

Contrast-induced nephropathy (CIN) is now one of the three leading causes of acute kidney injury in the world. A lot is known about the risk factors of CIN, yet it remains a major cause of morbidity, end stage renal disease, prolonged hospital stay, and increased costs as well as a high mortality. Many patients undergoing contrast-based radiological investigations are treated with angiotensin converting inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) for their cardiac and renal benefits and their known mortality benefits. However, controversy exists among clinicians as to whether ACE-Is and ARBs should be continued or discontinued prior to contrast media exposure. In this paper we review the current evidence on ACE-I/ARB therapy for patients undergoing procedures involving use of contrast media and provide recommendations as to whether these drugs should be continued or held prior to contrast exposure.

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