When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention

Isaac Tea; Salima Gilani; Neal S. Kleiman

doi:10.14797/mdcvj.1136

When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention

Methodist DeBakey Cardiovascular Journal

Volume 18 (2022): Issue 4

By: Isaac Tea, Salima Gilani and Neal S. Kleiman

Open Access

|Sep 2022

Abstract

Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.

References

Ix JH, Shlipak MG, Liu HH, Schiller NB, Whooley MA. Association between renal insufficiency and inducible ischemia in patients with coronary artery disease: the heart and soul study. J Am Soc Nephrol. 2003 Dec;14(12):3233-8. doi: 10.1097/01.asn.0000095642.25603.7a
Open DOI Search in Google Scholar Back to article
Shlipak MG, Smith GL, Rathore SS, Massie BM, Krumholz HM. Renal function, digoxin therapy, and heart failure outcomes: evidence from the digoxin intervention group trial. J Am Soc Nephrol. 2004 Aug;15(8):2195-203. doi: 10.1097/01.ASN.0000135121.81744.75
Open DOI Search in Google Scholar Back to article
Matsushita K, van der Velde M, Astor BC, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010 Jun 12;375(9731):2073-81. doi: 10.1016/S0140-6736(10)60674-5
Open DOI Search in Google Scholar Back to article
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C-y. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305. doi: 10.1056/NEJMoa041031
Open DOI Search in Google Scholar Back to article
Manjunath G, Tighiouart H, Ibrahim H, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003 Jan 1;41(1):47-55. doi: 10.1016/s0735-1097(02)02663-3
Open DOI Search in Google Scholar Back to article
Holman RL. Complete anuria due to blockage of renal tubules by protein casts in a case of multiple myeloma. Arch Path. 1939;27:748-52.
Search in Google Scholar Back to article
Azzalini L, Spagnoli V, Ly HQ. Contrast-Induced Nephropathy: From Pathophysiology to Preventive Strategies. Can J Cardiol. 2016 Feb;32(2):247-55. doi: 10.1016/j.cjca.2015.05.013
Open DOI Search in Google Scholar Back to article
McDonald RJ, McDonald JS, Bida JP, et al. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon? Radiology. 2013 Apr;267(1):106-18. doi: 10.1148/radiol.12121823
Open DOI Search in Google Scholar Back to article
Andò G, Cortese B, Russo F, et al. Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. J Am Coll Cardiol. 2017 May 11;S0735-1097(17)36897-3. doi: 10.1016/j.jacc.2017.02.070
Open DOI Search in Google Scholar Back to article
Section 4: Contrast-induced AKI. Kidney Int Suppl (2011). 2012 Mar;2(1):69-88. doi: 10.1038/kisup.2011.34
Open DOI Search in Google Scholar Back to article
Lindsay J, Apple S, Pinnow EE, et al. Percutaneous coronary intervention-associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine. Catheter Cardiovasc Interv. 2003 Jul;59(3):338-43. doi: 10.1002/ccd.10534
Open DOI Search in Google Scholar Back to article
Blackman DJ, Pinto R, Ross JR, et al. Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention. Am Heart J. 2006 Jan;151(1):146-52. doi: 10.1016/j.ahj.2005.03.018
Open DOI Search in Google Scholar Back to article
McCullough PA, Adam A, Becker CR, et al. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol. 2006 Sep 18;98(6A):5K-13K. doi: 10.1016/j.amjcard.2006.01.019
Open DOI Search in Google Scholar Back to article
Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002 May 14;105(19):2259-64. doi: 10.1161/01.cir.0000016043.87291.33
Open DOI Search in Google Scholar Back to article
Tsai TT, Patel UD, Chang TI, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014 Jan;7(1):1-9. doi: 10.1016/j.jcin.2013.06.016
Open DOI Search in Google Scholar Back to article
Gruberg L, Mehran R, Dangas G, et al. Acute renal failure requiring dialysis after percutaneous coronary interventions. Catheter Cardiovasc Interv. 2001 Apr;52(4):409-16. doi: 10.1002/ccd.1093
Open DOI Search in Google Scholar Back to article
Brown JR, Malenka DJ, DeVries JT, et al. Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: insights from the Dartmouth Dynamic Registry. Catheter Cardiovasc Interv. 2008 Sep 1;72(3):347-354. doi: 10.1002/ccd.21619
Open DOI Search in Google Scholar Back to article
Mohebi R, Karimi Galougahi K, Garcia JJ, et al. Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: An ADAPT-DES Substudy. JACC Cardiovasc Interv. 2022 Apr 11;15(7):753-766. doi: 10.1016/j.jcin.2021.11.026
Open DOI Search in Google Scholar Back to article
Deray G, Baumelou B, Martinez F, Brillet G, Jacobs C. Renal vasoconstriction after low and high osmolar contrast agents in ischemic and non ischemic canine kidney. Clin Nephrol. 1991 Aug;36(2):93-6
Search in Google Scholar Back to article
Talner LB, Davidson AJ. Renal hemodynamic effects of contrast media. Invest Radiol. 1968 Sep-Oct;3(5):310-7. doi: 10.1097/00004424-196809000-00002
Open DOI Search in Google Scholar Back to article
McCullough PA, Choi JP, Feghali GA, et al. Contrast-Induced Acute Kidney Injury. J Am Coll Cardiol. 2016 Sep 27;68(13):1465-1473. doi: 10.1016/j.jacc.2016.05.099
Open DOI Search in Google Scholar Back to article
Humes HD, Hunt DA, White MD. Direct toxic effect of the radiocontrast agent diatrizoate on renal proximal tubule cells. Am J Physiol. 1987 Feb;252(2 Pt 2):F246-55. doi: 10.1152/ajprenal.1987.252.2.F246
Open DOI Search in Google Scholar Back to article
Chen SL, Zhang J, Yei F, et al. Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol. 2008 Jun 6;126(3):407-13. doi: 10.1016/j.ijcard.2007.05.004
Open DOI Search in Google Scholar Back to article
Dangas G, Iakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005 Jan 1;95(1):13-9. doi: 10.1016/j.amjcard.2004.08.056.
Open DOI Search in Google Scholar Back to article
McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997 Nov;103(5):368-75. doi: 10.1016/S0002-9343(97)00150-2
Open DOI Search in Google Scholar Back to article
Parfrey PS, Griffiths SM, Barrett BJ, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med. 1989 Jan 19;320(3):143-9. doi: 10.1056/NEJM198901193200303
Open DOI Search in Google Scholar Back to article
Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int. 1995 Jan;47(1):254-61. doi: 10.1038/ki.1995.32
Open DOI Search in Google Scholar Back to article
Li W-h, Li D-y, Han F, Xu T-d, Zhang Y-b, Zhu H. Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. Int Urol Nephrol. 2013 Aug;45(4):1065-70. doi: 10.1007/s11255-012-0340-8
Open DOI Search in Google Scholar Back to article
Kalyesubula R, Bagasha P, Perazella MA. ACE-I/ARB therapy prior to contrast exposure: what should the clinician do? Biomed Res Int. 2014;2014:423848. doi: 10.1155/2014/423848
Open DOI Search in Google Scholar Back to article
Bainey KR, Rahim S, Etherington K, et al. Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization: Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Cardiac Catheterization (CAPTAIN) trial. Am Heart J. 2015 Jul;170(1):110-6. doi: 10.1016/j.ahj.2015.04.019
Open DOI Search in Google Scholar Back to article
Tecson KM, Brown D, Choi JW, et al. Major adverse renal and cardiac events after coronary angiography and cardiac surgery. Ann Thorac Surg. 2018 Jun;105(6):1724-1730. doi: 10.1016/j.athoracsur.2018.01.010
Open DOI Search in Google Scholar Back to article
Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004 Oct 6;44(7):1393-9. doi: 10.1016/j.jacc.2004.06.068
Open DOI Search in Google Scholar Back to article
Wickenbrock I, Perings C, Maagh P, et al. Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome: differences in STEMI and NSTEMI. Clin Res Cardiol. 2009 Dec;98(12):765-72. doi: 10.1007/s00392-009-0058-5
Open DOI Search in Google Scholar Back to article
Shah M, Gajanana D, Wheeler DS, et al. Effects of staged versus ad hoc percutaneous coronary interventions on renal function-Is there a benefit to staging? Cardiovasc Revasc Med. 2017 Jul-Aug;18(5):344-348. doi: 10.1016/j.carrev.2017.02.017
Open DOI Search in Google Scholar Back to article
Kane GC, Doyle BJ, Lerman A, Barsness GW, Best PJ, Rihal CS. Ultra-low contrast volumes reduce rates of contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography. J Am Coll Cardiol. 2008 Jan 1;51(1):89-90. doi: 10.1016/j.jacc.2007.09.019
Open DOI Search in Google Scholar Back to article
Gurm HS, Seth M, Dixon SR, et al. Contemporary use of and outcomes associated with ultra-low contrast volume in patients undergoing percutaneous coronary interventions. Catheter Cardiovasc Interv. 2019 Feb 1;93(2):222-230. doi: 10.1002/ccd.27819
Open DOI Search in Google Scholar Back to article
Seeliger E, Sendeski M, Rihal CS, Persson PB. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J. 2012 Aug;33(16):2007-15. doi: 10.1093/eurheartj/ehr494
Open DOI Search in Google Scholar Back to article
Gurm HS, Seth M, Kooiman J, Share D. A novel tool for reliable and accurate prediction of renal complications in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2013 Jun 4;61(22):2242-8. doi: 10.1016/j.jacc.2013.03.026
Open DOI Search in Google Scholar Back to article
Sgura FA, Bertelli L, Monopoli D, et al. Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv. 2010 Oct;3(5):491-8. doi: 10.1161/CIRCINTERVENTIONS.110.955310
Open DOI Search in Google Scholar Back to article
Mehran R, Owen R, Chiarito M, et al. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet. 2021 Nov 27;398(10315):1974-1983. doi: 10.1016/S0140-6736(21)02326-6
Open DOI Search in Google Scholar Back to article
Chandiramani R, Cao D, Nicolas J, Mehran R. Contrast-induced acute kidney injury. Cardiovasc Interv Ther. 2020 Jul;35(3):209-217. doi: 10.1007/s12928-020-00660-8
Open DOI Search in Google Scholar Back to article
Almendarez M, Gurm HS, Mariani J, et al. JACC Cardiovasc Interv. 2019 Oct 14;12(19):1877-1888. doi: 10.1016/j.jcin.2019.04.055
Open DOI Search in Google Scholar Back to article
Brar SS, Aharonian V, Mansukhani P, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014 May 24;383(9931):1814-23. doi: 10.1016/S0140-6736(14)60689-9
Open DOI Search in Google Scholar Back to article
Qian G, Fu Z, Guo J, Cao F, Chen Y. Prevention of Contrast-Induced Nephropathy by Central Venous Pressure-Guided Fluid Administration in Chronic Kidney Disease and Congestive Heart Failure Patients. JACC Cardiovasc Interv. 2016 Jan 11;9(1):89-96. doi: 10.1016/j.jcin.2015.09.026
Open DOI Search in Google Scholar Back to article
Diaz-Sandoval LJ, Kosowsky BD, Losordo DW. Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol. 2002 Feb 1;89(3):356-8. doi: 10.1016/s0002-9149(01)02243-3
Open DOI Search in Google Scholar Back to article
ClinicalTrials.gov [Internet]. Bethesda, MD: National Library of Medicine; c2022. Evaluation of the National Randomized Proton Pump Inhibitor De-prescribing (RaPPID) Program (RaPPID); 2022 Mar 21 [cited 2022 Aug 1]. Available from: https://clinicaltrials.gov/ct2/show/NCT03719170
Search in Google Scholar Back to article
Solomon R, Werner C, Mann D, D’Elia J, Silva P. Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994 Nov 24;331(21):1416-20. doi: 10.1056/NEJM199411243312104
Open DOI Search in Google Scholar Back to article
Weisbord SD, Gallagher M, Jneid H, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med. 2018 Feb 15;378(7):603-614. doi: 10.1056/NEJMoa1710933
Open DOI Search in Google Scholar Back to article
Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ehy394
Open DOI Search in Google Scholar Back to article
Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011 Dec 6;58(24):e44-122. doi: 10.1016/j.jacc.2011.08.007. Epub 2011 Nov 7
Open DOI Search in Google Scholar Back to article
Briguori C, Visconti G, Focaccio A, et al. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): RenalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation. 2011 Sep 13;124(11):1260-9. doi: 10.1161/CIRCULATIONAHA.111.030759
Open DOI Search in Google Scholar Back to article
Briguori C, D’Amore C, De Micco F, et al. Left ventricular end-diastolic pressure versus urine flow rate–guided hydration in preventing contrast-associated acute kidney injury. JACC Cardiovasc Interv. 2020 Sep 14;13(17):2065-2074. doi: 10.1016/j.jcin.2020.04.051
Open DOI Search in Google Scholar Back to article
Leoncini M, Toso A, Maioli M, et al. Early high-dose rosuvastatin and cardioprotection in the protective effect of rosuvastatin and antiplatelet therapy on contrast-induced acute kidney injury and myocardial damage in patients with acute coronary syndrome (PRATO-ACS) study. Am Heart J. 2014 Nov;168(5):792-7. doi: 10.1016/j.ahj.2014.08.005
Open DOI Search in Google Scholar Back to article
Patti G, Ricottini E, Nusca A, et al. Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN [atorvastatin for reduction of myocardial damage during angioplasty--contrast-induced nephropathy] trial. Am J Cardiol. 2011 Jul 1;108(1):1-7. doi: 10.1016/j.amjcard.2011.03.001
Open DOI Search in Google Scholar Back to article
Gami AS, Garovic VD. Contrast nephropathy after coronary angiography. Mayo Clin Proc. 2004 Feb;79(2):211-9. doi: 10.4065/79.2.211
Open DOI Search in Google Scholar Back to article
Brown JR, Robb JF, Block CA, et al. Does safe dosing of iodinated contrast prevent contrast-induced acute kidney injury? Circ Cardiovasc Interv. 2010 Aug;3(4):346-50. doi: 10.1161/CIRCINTERVENTIONS.109.910638
Open DOI Search in Google Scholar Back to article
Ali ZA, Karimi Galougahi K, Nazif T, et al. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study. Eur Heart J. 2016 Oct 21;37(40):3090-3095. doi: 10.1093/eurheartj/ehw078
Open DOI Search in Google Scholar Back to article
Rahim H, Flattery E, Gkargkoulas F, et al. TCT-32 clinical outcomes of imaging-and physiology-guided PCI without contrast administration in advanced renal failure. J Am Coll Cardiol. 2019 Oct;74(13_Supplement):B32. doi: 10.1016/j.jacc.2019.08.059
Open DOI Search in Google Scholar Back to article
Shibata K, Wakabayashi K, Ishinaga T, et al. Feasibility, Safety, and Long-Term Outcomes of Zero-Contrast Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease. Circ J. 2022 Apr 25;86(5):787-796. doi: 10.1253/circj.CJ-21-0905
Open DOI Search in Google Scholar Back to article
Pandya B, Chalhoub JM, Parikh V, et al. Contrast media use in patients with chronic kidney disease undergoing coronary angiography: A systematic review and meta-analysis of randomized trials. Int J Cardiol. 2017 Feb 1;228:137-144. doi: 10.1016/j.ijcard.2016.11.170
Open DOI Search in Google Scholar Back to article
Azzalini L, Vilca LM, Lombardo F, et al. Incidence of contrast-induced acute kidney injury in a large cohort of all-comers undergoing percutaneous coronary intervention: Comparison of five contrast media. Int J Cardiol. 2018 Dec 15;273:69-73. doi: 10.1016/j.ijcard.2018.08.097
Open DOI Search in Google Scholar Back to article
Minsinger KD, Kassis HM, Block CA, Sidhu M, Brown JR. Meta-analysis of the effect of automated contrast injection devices versus manual injection and contrast volume on risk of contrast-induced nephropathy. Am J Cardiol. 2014 Jan 1;113(1):49-53. doi: 10.1016/j.amjcard.2013.08.040
Open DOI Search in Google Scholar Back to article
Gurm HS, Mavromatis K, Bertolet B, et al. Minimizing radiographic contrast administration during coronary angiography using a novel contrast reduction system: A multicenter observational study of the DyeVert™ plus contrast reduction system. Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1228-1235. doi: 10.1002/ccd.27935
Open DOI Search in Google Scholar Back to article
Mariani J, Guedes C, Soares P, et al. Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial. JACC Cardiovasc Interv. 2014 Nov;7(11):1287-93. doi: 10.1016/j.jcin.2014.05.024
Open DOI Search in Google Scholar Back to article
Flaherty MP, Pant S, Patel SV, et al. Hemodynamic Support With a Microaxial Percutaneous Left Ventricular Assist Device (Impella) Protects Against Acute Kidney Injury in Patients Undergoing High-Risk Percutaneous Coronary Intervention. Circ Res. 2017 Feb 17;120(4):692-700. doi: 10.1161/CIRCRESAHA.116.309738
Open DOI Search in Google Scholar Back to article
Flaherty MP, Moses JW, Westenfeld R, et al. Impella support and acute kidney injury during high-risk percutaneous coronary intervention: The Global cVAD Renal Protection Study. Catheter Cardiovasc Interv. 2020 May 1;95(6):1111-1121. doi: 10.1002/ccd.28400
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.14797/mdcvj.1136 | Journal eISSN: 1947-6108

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Language: English

Page range: 73 - 85

Submitted on: May 13, 2022

Accepted on: Aug 1, 2022

Published on: Sep 6, 2022

Published by: Houston Methodist DeBakey Heart & Vascular Center

In partnership with: Paradigm Publishing Services

Keywords:

coronary artery disease,

contrast induced nephropathy,

acute kidney injury,

contrast associated kidney injury,

percutaneous coronary intervention,

cardiogenic shock

© 2022 Isaac Tea, Salima Gilani, Neal S. Kleiman, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 18 (2022): Issue 4