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STATE-OF-THE-ART PAPER

Contrast-Induced Acute Kidney Injury

Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Michigan.

Manuscript received August 29, 2007; revised manuscript received December 10, 2007, accepted December 10, 2007.

^_* Reprint requests and correspondence: Dr. Peter A. McCullough, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, Michigan 48073. (Email: pmc975{at}yahoo.com).

Cardiac angiography and coronary/vascular interventions depend on iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired renal failure, with adverse effects on prognosis and health care costs. The epidemiology and pathogenesis of contrast-induced AKI, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use, and preventive strategies are discussed in this report. An advanced algorithm is suggested for the risk stratification and management of contrast-induced AKI as it relates to patients undergoing cardiovascular procedures. Contrast-induced AKI is likely to remain a significant challenge for cardiologists in the future because the patient population is aging and chronic kidney disease and diabetes are becoming more common.

Abbreviations and Acronyms   AKI = acute kidney injury   CIN = contrast-induced nephropathy   CKD = chronic kidney disease   CK-MB = creatine kinase-myocardial band   Cr = creatinine   DM = diabetes mellitus   eGFR = estimated glomerular filtration rate   HOCM = high-osmolal contrast media   IOCM = iso-osmolal contrast media   LOCM = low-osmolal contrast media   MI = myocardial infarction   NAC = N-acetylcysteine   PCI = percutaneous coronary intervention