Therapeutic strategies to prevent contrast-induced acute kidney injury.
OBJECTIVE
Contrast-induced acute kidney injury (CI-AKI) accounts for approximately 10% of all causes of hospital-acquired renal failure, causes a prolonged in-hospital stay, and represents a powerful predictor of poor early and late outcome. Here, we highlight endpoints used to assess major strategies to prevent CI-AKI.


RESULTS
A general consensus exists on the beneficial prophylactic effect of hydration. This seems to act by increasing urine flow rate and, thereby, by limiting the time of contact between the contrast media and the epithelial tubular cells. On the contrary, both observational trials and randomized studies are often controversial in their conclusions on the efficacy of several drugs tested to prevent CI-AKI. Compounds evaluated include diuretics (furosemide), antioxidants (i.e., N-acetylcysteine and statins), and vasodilators (i.e., calcium antagonists, dopamine, and fenoldopam). Due to the negative and/or controversial clinical results, none of these drugs has been currently recommended to prevent CI-AKI.


CONCLUSIONS
More reliable markers of acute kidney injury and new prophylactic strategies are warranted to prevent the incidence of CI-AKI.
aDepartment of Molecular Medicine and Medical Biotechnologies, 'Federico II' University of Naples and IEOS, CNR, Naples bFondazione SDN, Napoli cLaboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
Cristina
C
Quintavalle
Elvira
E
Donnarumma
Danilo
D
Fiore
Carlo
C
Briguori
Gerolama
G
Condorelli
D000111:Acetylcysteine / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000975:Antioxidants / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D004232:Diuretics / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use; D018818:Fenoldopam / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods*; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007902:Length of Stay; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000975:Antioxidants; D002121:Calcium Channel Blockers; D003287:Contrast Media; D004232:Diuretics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014665:Vasodilator Agents; D005665:Furosemide; D018818:Fenoldopam; D004298:Dopamine; D000111:Acetylcysteine