Preventing contrast nephropathy: what is the best strategy? A review of the literature.
Patients receiving radiocontrast for diagnostic and interventional procedures are at risk for developing contrast nephropathy (CN). In fact, radiocontrast nephropathy is currently the third leading cause of hospital-acquired renal failure. Understanding that CN has been associated with increased length of hospitalization and mortality, determining the best prevention strategy is of utmost importance. Patients at the greatest risk for developing acute renal failure are patients with diabetes and underlying renal insufficiency. Several therapies have been investigated for the prevention of CN; unfortunately, very few have shown a consistent benefit. Therapies that have been studied include saline hydration, N-acetylcysteine (NAC), theophylline, calcium channel blockers, diuretics, dopamine, endothelin receptor antagonists, atrial natriuretic peptide, angiotensin-converting enzyme inhibitors, and prostaglandin E-1. Using adequate hydration, using low-osmolar dyes, and minimizing the dose of contrast have all been shown to be effective in reducing CN and are considered the standard of care. While trials with many pharmacologic agents have produced conflicting results, intervention with NAC has also been promising. This article reviews the pathophysiology, risk factors, and therapies that are currently available for the prevention of CN.
Cox
Craig D
CD
Texas Tech University Health Sciences Center, School of Pharmacy, Lubbock, TX 79430, USA.
Tsikouris
James P
JP
D000111:Acetylcysteine / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D005440:Fluid Therapy; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D051437:Renal Insufficiency / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D012307:Risk Factors
D003287:Contrast Media; D016166:Free Radical Scavengers; D000111:Acetylcysteine