Radiocontrast-induced nephropathy and percutaneous coronary intervention: a review of preventive measures.
Injectable and absorbable contrast media for the use in radiology, all of which contains iodine as an essential component, has been, and continues to be, one of the main sources of agents which cause hospital-acquired renal failure. Although numerous methods have been explored to prevent renal contrast damage, radiocontrast-induced nephropathy continues to be a concern in patients with existing renal insufficiency, who undergo contrast-enhanced radiographic examinations. Patients who develop contrast-induced nephropathy (CIN) have a worse prognosis and an increased risk of complications and mortality. Prevention of CIN during radiocontrast procedures continues to elude clinicians and is a chief concern during percutaneous coronary intervention, as these patients often have multiple comorbidities. A wide variety of animal and clinical investigations, and substances have been tried in order to prevent this complication, including: dialysis, contrast volume and type; adenosine antagonists; acetylcysteine; fenoldopam; and various others. The purpose of this review is to appraise all the past and current strategies employed to prevent CIN, especially during percutaneous coronary intervention.
Division of Invasive Cardiology, Department of Cardiology, Rambam Medical Center, Haifa 31096, Israel.
Edward P
EP
Mintz
Luis
L
Gruberg
D015906:Angioplasty, Balloon, Coronary; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D004232:Diuretics / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000000981:diagnostic imaging; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use*
D002121:Calcium Channel Blockers; D003287:Contrast Media; D004232:Diuretics; D012965:Sodium Chloride