Thursday, December 15, 2016

Acute kidney injury due to iodinated contrast

CI-AKI remains a concern for patients undergoing cardiac interventional procedures utilizing intravascular iodinated contrast. This form of renal injury appears to be amenable to volume expansion and to measures to increase urine flow and removal of highly water-soluble contrast. Minimizing contrast by use of ALARA principles and strategies to maximize the benefit of contrast exposure (i.e., revascularization) are reasonable. Although no adjunctive therapy is prophylactic or therapeutic for CI-AKI, statin use appears to reduce the incidence and severity of AKI, whereas continuation of RASi appears to increase the risk for CI-AKI. Further research is needed in the development of less toxic contrast agents, as well as therapies that can reduce cardiorenal complication of interventional cardiovascular procedures. Such agents hold the promise of improving long-term outcomes by minimizing the hazards of intercurrent events, such as ACS, and urgent and planned catheterization procedures.

The review focused on coronary angiography. Conspicuously absent were mention of ascorbic acid and ischemic preconditioning. An earlier review was posted here.

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