Contrast-induced acute kidney injury – A review focusing on prophylactic strategies

Contrast-induced acute kidney injury is the third leading cause of intrahospital acute kidney disease, accounting for 11% of all cases. It is associated with a worse prognosis on the short- and long-term, as well as with extended hospital stay and increase in health-care costs. As the number of diagnostic and interventional angiographies and computerized tomography increases in clinical practice and higher doses of contrast media are administered to sicker and older patients, contrast-induced acute kidney injury is an increasing problem. Contrast-induced acute kidney injury is a unique form of acute kidney injury in that its risk factors are known and its timing predictable. This makes room for the implementation of prophylactic measures in patients at risk.

Several articles were searched in nephrology journals (“American Journal of Kidney Disease”, “Journal of the American Society of Nephrology”, “Clinical Journal of the American Society of Nephrology”, “Kidney International” and “Nephrology Dialysis Transplantation”) for a global view on contrast-induced acute kidney injury and prophylactic strategies. Subsequently, individual searches were made on MEDLINE^® database for randomized controlled trials and meta-analyses on each prophylactic strategy encountered.

Several approaches to contrast-induced acute kidney injury prevention have been reported, of which vigorous hydration and the use of non-ionic contrast media are the most important. The administration of oral N-acetylcysteine is also a popular strategy in virtue of its favorable risk/benefit profile. Statins have also been reported as protective against contrast-induced acute kidney injury. The authors review the disease and studied prophylactic interventions, presenting a practical approach to the prevention of contrast-induced acute kidney injury.