scholarly journals Nonpharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Paweena Susantitaphong ◽  
Somchai Eiam-Ong
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Media ◽  
Kidney Injury ◽  
Minimum Volume ◽  
Routine Identification ◽  
Risk Patients ◽  
Nephrotoxic Drugs ◽  
Hospital Acquired ◽  
Functioning Kidney ◽  
Selection Of

Contrast-induced AKI (CI-AKI) has been one of the leading causes for hospital-acquired AKI and is associated with independent risk for adverse clinical outcomes including morbidity and mortality. The aim of this review is to provide a brief summary of the studies that focus on nonpharmacological strategies to prevent CI-AKI, including routine identification of at-risk patients, use of appropriate hydration regimens, withdrawal of nephrotoxic drugs, selection of low-osmolar contrast media or isoosmolar contrast media, and using the minimum volume of contrast media as possible. There is no need to schedule dialysis in relation to injection of contrast media or injection of contrast agent in relation to dialysis program. Hemodialysis cannot protect the poorly functioning kidney against CI-AKI.

scholarly journals 992 Short Term Effectiveness of Interventions Aimed at Preventing Post-Operative Acute Kidney Injury (AKI) In Patients Undergoing Elective Lower Limb Arthroplasty

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
V Jaitley ◽  
E Phoenix
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Lower Limb ◽  
Kidney Injury ◽  
Nice Guidelines ◽  
Improve Compliance ◽  
Patients At Risk ◽  
Risk Patients ◽  
Nephrotoxic Drugs

Abstract Introduction Acute kidney injury (AKI) is a potentially avoidable complication in patients undergoing elective lower limb arthroplasty. The National Institute for Health and Care Excellence (NICE) offers guidelines to identity and manage AKI. This is a closed loop audit aiming to assess i) adherence to NICE guidelines and ii) whether simple interventions will improve compliance. Method We closed the loop on a departmental audit carried out in 2017. NICE guidelines were applied to stratify patients at risk of post-operative AKI. High risk patients included those on nephrotoxic drugs and with pre-existing co-morbidities. We then applied the AKIN criteria to identify post-operative AKI. We presented this data at our departmental trauma meeting. Following this we implemented the following interventions i) poster & ii) aid memoir on patient admission proformas to identity those at risk. Results In 2017, post-operative AKI incidence was found to be 11.7%. Following intervention, in 2019 the incidence was 10% at 1 month and 5% at 7 months. Additionally, 80% of AKIs were identified on day 1 post-arthroplasty, compared to only 30% in 2017. Conclusions This audit showed that simple interventions reduced the incidence of post-operative AKI. Moving forward, we plan to assess long term effectiveness including the effect of junior doctor rotations.

scholarly journals The Choice of the Iodinated Radiographic Contrast Media to Prevent Contrast-Induced Nephropathy

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Michele Andreucci ◽  
Teresa Faga ◽  
Antonio Pisani ◽  
Massimo Sabbatini ◽  
Domenico Russo ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Media ◽  
Kidney Injury ◽  
Prevention Measures ◽  
Intravascular Injection ◽  
Contrast Induced Nephropathy ◽  
Adequate Hydration ◽  
Radiographic Contrast ◽  
Radiographic Contrast Media ◽  
Nephrotoxic Drugs

In patients with preexisting renal impairment, particularly those who are diabetic, the iodinated radiographic contrast media may cause contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI), that is, an acute renal failure (ARF), usually nonoliguric and asymptomatic, occurring 24 to 72 hours after their intravascular injection in the absence of an alternative aetiology. Radiographic contrast media have different osmolalities and viscosities. They have also a different nephrotoxicity. In order to prevent CIN, the least nephrotoxic contrast media should be chosen, at the lowest dosage possible. Other prevention measures should include discontinuation of potentially nephrotoxic drugs, adequate hydration with i.v. infusion of either normal saline or bicarbonate solution, and eventually use of antioxidants, such as N-acetylcysteine, and statins.

Hospital-Acquired Acute Kidney Injury in Older Patients: Clinical Characteristics and Drug Analysis

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Wei Liu ◽  
Xing-ji Lian ◽  
Yuan-han Chen ◽  
Yi-ping Zou ◽  
Jie-shan Lin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Hospital Outcomes ◽  
Prior Use ◽  
Nephrotoxic Drugs ◽  
Medical Wards ◽  
Hospital Acquired

<b><i>Background:</i></b> Information on older patients with hospital-acquired acute kidney injury (HA-AKI) and use of drugs is limited. <b><i>Aim:</i></b> This study aimed to assess the clinical characteristics, drug uses, and in-hospital outcomes of hospitalized older patients with HA-AKI. <b><i>Methods:</i></b> Patients aged ≥65 years who were hospitalized in medical wards were retrospectively analyzed. The study patients were divided into the HA-AKI and non-AKI groups based on the changes in serum creatinine. Disease incidence, risk factors, drug uses, and in-hospital outcomes were compared between the groups. <b><i>Results:</i></b> Of 26,710 older patients in medical wards, 4,491 (16.8%) developed HA-AKI. Older patients with HA-AKI had higher rates of multiple comorbidities and Charlson Comorbidity Index score than those without AKI (<i>p</i> &#x3c; 0.001). In the HA-AKI group, the proportion of patients with prior use of drugs with possible nephrotoxicity was higher than that of patients with prior use of drugs with identified nephrotoxicity (<i>p</i> &#x3c; 0.05). The proportions of patients with critical illness, use of nephrotoxic drugs, and the requirements of intensive care unit treatment, cardiopulmonary resuscitation, and dialysis as well as in-hospital mortality and hospitalization duration and costs were higher in the HA-AKI than the non-AKI group; these increased with HA-AKI severity (all <i>p</i> for trend &#x3c;0.001). With the increase in the number of patients with continued use of drugs with possible nephrotoxicity after HA-AKI, the clinical outcomes showed a tendency to worsen (<i>p</i> &#x3c; 0.001). Moreover, HA-AKI incidence (adjusted odds ratio [OR], 10.26; 95% confidence interval (CI), 8.27–12.74; <i>p</i> &#x3c; 0.001), and nephrotoxic drugs exposure (adjusted OR, 1.76; 95% CI, 1.63–1.91; <i>p</i> &#x3c; 0.001) had an association with an increased in-hospital mortality risk. <b><i>Conclusion:</i></b> AKI incidence was high among hospitalized older patients. Older patients with HA-AKI had worse in-hospital outcomes and higher resource utilization. Nephrotoxic drug exposure and HA-AKI incidence were associated with an increased in-hospital mortality risk.

scholarly journals Drug-Induced Acute Kidney Injury

2021 ◽  
Vol 9 (3) ◽  
pp. 117-127
Author(s):  
E. V. Zakharova ◽  
O. D. Ostroumova ◽  
M. V. Klepikova
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Female Gender ◽  
Close Monitoring ◽  
Drug Induced ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Nephrotoxic Drugs

Drug-induced nephrotoxicity is the third most common cause of acute kidney injury (AKI). The aim of the study was to analyse and summarise data on the factors and mechanisms responsible for increased risk of drug-induced AKI, to analyse potential methods of its prevention and treatment. At present, the following phenotypes of drug-induced AKI are distinguished: acute vascular disease, acute glomerular disease, acute tubular injury / necrosis, and acute interstitial nephritis. It was discovered that most often these complications occur following the use of antimicrobial drugs, renin-angiotensin-aldosterone system inhibitors, non-steroidal anti-inflammatory drugs, and anticancer drugs, including targeted therapy. Risk factors for drug-induced AKI include age >65, female gender, low body weight, pre-existing chronic kidney disease, hypovolemia, hypoalbuminemia, acute and chronic heart failure, diabetes, malignancies, liver cirrhosis, prolonged use of nephrotoxic drugs, and simultaneous use of two or more nephrotoxic drugs. Discontinuation of the drug which resulted in kidney failure is the first and foremost principle for managing not only drug-induced, but all AKI patients. The use of potentially nephrotoxic drugs should be avoided, especially in high-risk patients, in order to prevent drug-induced AKI. If a patient needs a drug that affects renal hemodynamics, the therapy should begin with a minimum effective dose, and combinations of two and more nephrotoxic drugs should be avoided. Close monitoring of kidney function is crucial for high-risk patients. They should also be informed about the importance of adequate water consumption schedule for prevention of hypovolemia.

scholarly journals Trends in contrast-induced acute kidney injury rate after percutaneous coronary interventions in coronary artery disease

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
O Mironova ◽  
OA Sivakova ◽  
VV Fomin
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Media ◽  
Preventive Measures ◽  
Clinical Importance ◽  
Injury Rate ◽  
Kidney Injury ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background. Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated. Purpose. The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively. Methods. 1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury.  Results. The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p &lt; 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs). Conclusion. The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.

Hydroxyethyl starch and acute kidney injury in high-risk patients undergoing cardiac surgery: A prospective multicenter study

2021 ◽  
Vol 73 ◽  
pp. 110367
Author(s):  
David Nagore ◽  
Angel Candela ◽  
Martina Bürge ◽  
Pablo Monedero ◽  
Eduardo Tamayo ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
High Risk ◽  
Hydroxyethyl Starch ◽  
Multicenter Study ◽  
Kidney Injury ◽  
Prospective Multicenter Study ◽  
High Risk Patients ◽  
Risk Patients
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