Strategies for the prevention of contrast-induced acute kidney injury.
OBJECTIVE
The intravascular administration of iodinated contrast media for diagnostic imaging is a common cause of acute kidney injury and a leading cause of iatrogenic renal disease. The purpose of this review is to describe the principal risk factors for contrast-induced acute kidney injury and to summarize recent data describing the efficacy of various preventive interventions for this condition.


RESULTS
Whereas earlier studies suggested that certain low-osmolal contrast agents including iohexol and ioxaglate are more nephrotoxic than iso-osmolal iodixanol, recent clinical trials and meta-analyses comparing other low-osmolal contrast agents with iodixanol have found little difference in risk. The provision of prophylactic renal replacement therapy does not ameliorate the risk of contrast-induced acute kidney injury, and likely poses undue risk. Despite some research supporting a benefit of atrial natriuretic peptide, statins, and prostaglandin analogs, additional data from large, adequately powered studies are needed before these agents can be recommended. N-Acetylcysteine and isotonic intravenous bicarbonate have been investigated intensely, yet the data on these interventions are conflicting due to methodological limitations in past studies.


CONCLUSIONS
Prevention of contrast-induced acute kidney injury involves the identification of high-risk patients, consideration of alternative imaging procedures that do not involve the administration of iodinated contrast, and integration of the cumulative data available on preventive interventions in high-risk patients.
Weisbord
Steven D
SD
Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA.
Palevsky
Paul M
PM
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006801:Humans; D007049:Iatrogenic Disease; D017410:Practice Guidelines as Topic; D020011:Protective Agents / Q000627:therapeutic use*; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D003287:Contrast Media; D020011:Protective Agents