Methods for Reducing Contrast Use and Avoiding Acute Kidney Injury During Endovascular Procedures

2020 ◽  
Vol 25 (44) ◽  
pp. 4648-4655 ◽  
Author(s):  
Chrysovalantis Vergadis ◽  
Georgios Festas ◽  
Eleni Spathi ◽  
Paris Pappas ◽  
Stavros Spiliopoulos
Keyword(s):  
Acute Kidney Injury ◽  
Endovascular Procedures ◽  
Rapid Development ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Iodinated Contrast ◽  
Risk Patients ◽  
Prevention Methods

: Iodinated Contrast Media (CM) has a plethora of applications in routine non-invasive or percutaneous invasive imaging examinations and therapeutic interventions. Unfortunately, the use of CM is not without complications, with contrast-induced acute kidney injury (CI-AKI) being among the most severe. : CI-AKI is a syndrome defined as a rapid development of renal impairment after a few days of CM endovascular injection, without the presence of any other underlying related pathologies. Although mostly transient and reversible, for a subgroup of patients with comorbidities related to renal failure, CI-AKI is directly leading to longer hospitalization, elevated rates of morbidity and mortality, as well as the increased cost of funding. : Thus, a need for classification in accordance with clinical and peri-procedural criteria is emerged. This would be very useful for CI-AKI patients in order to predict the ones who would have the greatest advantage from the application of preventive strategies. : This article provides a practical review of the recent evidence concerning CI-AKI incidence, diagnosis, and sheds light on prevention methods for reducing contrast use and avoiding AKI during endovascular procedures. : In conclusion, despite the lack of a specific treatment protocol, cautious screening, assessment, identification of the high-risk patients, and thus the application of simple interventions -concerning modifiable risk factors- can significantly reduce CI-AKI risk.

Contrast and the Kidney

2019 ◽  
pp. 241-252
Author(s):  
Ayub Akbari ◽  
Swapnil Hiremath
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Isotonic Saline ◽  
Kidney Injury ◽  
Disease Status ◽  
Acute Injury ◽  
Risk Scores ◽  
Iodinated Contrast ◽  
Risk Patients ◽  
High Risk Populations

Iodinated contrast has revolutionized diagnosis and therapy but carries the risk of adverse effects, specifically acute kidney injury, in select high risk populations. This risk is substantially lower with the current generation of low- and iso-osmolar contrast media. Acute kidney injury in most cases is mild with favorable prognostic implications, and severe acute injury requiring dialysis is rare. Risk scores, typically including level of kidney function, diabetes, and cardiovascular disease status, can identify patients at high risk of developing acute kidney injury after contrast-enhanced procedures. Volume expansion with isotonic saline remains the most robust method of preventing acute kidney injury in select high risk patients.

scholarly journals Sodium Bicarbonate versus Statins to Prevent Contrast-induced Acute Kidney Injury: A Comprehensive Review

2021 ◽  
Author(s):  
Sanam Dolati ◽  
Ata Mahmoodpoor ◽  
Nafiseh Gharizadeh ◽  
Saina Gholipouri ◽  
Hassan Soleimanpour
Keyword(s):  
Acute Kidney Injury ◽  
Sodium Bicarbonate ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Short Term ◽  
Iodinated Contrast ◽  
Intravenous Hydration ◽  
Diagnostic Radiography ◽  
Inflammatory Action ◽  
Different Doses

Iodinated contrast agents are commonly used in diagnostic radiography techniques along with therapeutic interventions. Contrast-Induced Acute Kidney Injury (CI-AKI) is a significant problem of all angiographic procedures, triggered by the use of Iodinated Contrast Media (ICM). There are conflicting data concerning the prevention and treatment of CI-AKI. Numerous approaches have been studied to prevent CI-AKI, but the therapy of choice remains undetermined. The cornerstones of CI-AKI prevention include low-osmolar ICM and intravenous hydration. The recommended hydration must be achieved by means of an isotonic solution of saline. Statins were tested against AKI due to their anti-inflammatory action and antioxidant effect on endothelial function. Novel approaches are required to investigate the short-term effects of high dosage atorvastatin versus sodium bicarbonate on CI-AKI prevention. The objective of this review is to compare the findings of various studies that had applied different doses of statins, sodium bicarbonate, and other agents for preventing CI-AKI.

scholarly journals Contrast-Induced Acute Kidney Injury: Definition, Epidemiology, and Outcome

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Felix G. Meinel ◽  
Carlo N. De Cecco ◽  
U. Joseph Schoepf ◽  
Richard Katzberg
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Insufficiency ◽  
Time Window ◽  
Contrast Material ◽  
Kidney Injury ◽  
Preventive Strategy ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced

Contrast-induced acute kidney injury (CI-AKI) is commonly defined as a decline in kidney function occurring in a narrow time window after administration of iodinated contrast material. The incidence of AKI after contrast material administration greatly depends on the specific definition and cutoff values used. Although self-limiting in most cases, postcontrast AKI carries a risk of more permanent renal insufficiency, dialysis, and death. The risk of AKI from contrast material, in particular when administered intravenously for contrast-enhanced CT, has been exaggerated by older, noncontrolled studies due to background fluctuations in renal function. More recent evidence from controlled studies suggests that the risk is likely nonexistent in patients with normal renal function, but there may be a risk in patients with renal insufficiency. However, even in this patient population, the risk of CI-AKI is probably much smaller than traditionally assumed. Since volume expansion is the only preventive strategy with a convincing evidence base, liberal hydration should be encouraged to further minimize the risk. The benefits of the diagnostic information gained from contrast-enhanced examinations will still need to be balanced with the potential risk of CI-AKI for the individual patient and clinical scenario.

scholarly journals Skin autofluorescence as a novel predictor of acute kidney injury after liver resection

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maciej Krasnodębski ◽  
Karolina Grąt ◽  
Marcin Morawski ◽  
Jan Borkowski ◽  
Piotr Krawczyk ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Resection ◽  
Operative Time ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Extent Of Resection ◽  
Primary Outcome Measure ◽  
Skin Autofluorescence ◽  
Predictive Values ◽  
Risk Patients

Abstract Background Skin autofluorescence (SAF) reflects accumulation of advanced glycation end-products (AGEs). The aim of this study was to evaluate predictive usefulness of SAF measurement in prediction of acute kidney injury (AKI) after liver resection. Methods This prospective observational study included 130 patients undergoing liver resection. The primary outcome measure was AKI. SAF was measured preoperatively and expressed in arbitrary units (AU). Results AKI was observed in 32 of 130 patients (24.6%). SAF independently predicted AKI (p = 0.047), along with extent of resection (p = 0.019) and operative time (p = 0.046). Optimal cut-off for SAF in prediction of AKI was 2.7 AU (area under the curve [AUC] 0.611), with AKI rates of 38.7% and 20.2% in patients with high and low SAF, respectively (p = 0.037). Score based on 3 independent predictors (SAF, extent of resection, and operative time) well stratified the risk of AKI (AUC 0.756), with positive and negative predictive values of 59.3% and 84.0%, respectively. In particular, SAF predicted AKI in patients undergoing major and prolonged resections (p = 0.010, AUC 0.733) with positive and negative predictive values of 81.8%, and 62.5%, respectively. Conclusions AGEs accumulation negatively affects renal function in patients undergoing liver resection. SAF measurement may be used to predict AKI after liver resection, particularly in high-risk patients.

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

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