Techniques in Vascular & Interventional Radiology
Volume 9, Issue 2 , Pages 42-49 , June 2006

Prevention and Treatment of Contrast-Induced Nephropathy

  • Mohammed Al-Ghonaim, MBBS

      Affiliations

    • Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
    • ,
  • Neesh Pannu, BSc, MD

      Affiliations

    • Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
    • Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
    • Corresponding Author InformationAddress reprint requests to Neesh Pannu, MD, 11-107 Clinical Sciences Bldg., 8440-112 St., Edmonton, Alberta, Canada, T6G 2G3.

References 

  1. Maitino AJ, Levin DC, Parker L, et al. Practice patterns of radiologists and nonradiologists in utilization of noninvasive diagnostic imaging among the Medicare population 1993-1999. Radiology. 2003;228(3):795–801
  2. Toms AP, Cash CJ, Linton SJ, et al. Requests for body computed tomography: increasing workload, increasing indications and increasing age. Eur Radiol. 2001;11(12):2633–2637
  3. Lameire N, Van Biesen W, Vanholder R. The changing epidemiology of acute renal failure. Nat Clin Pract Nephrol. 2006;2(7):364–377
  4. Gleeson TG, Bulugahapitiya S. Contrast-induced nephropathy. AJR Am J Roentgenol. 2004;183(6):1673–1689
  5. 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;47(1):254–261
  6. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997;103(5):368–375
  7. Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality (A cohort analysis). JAMA. 1996;275(19):1489–1494
  8. van Acker BA, Koomen GC, Koopman MG, et al. Creatinine clearance during cimetidine administration for measurement of glomerular filtration rate. Lancet. 1992;340(8831):1326–1329
  9. Andreev E, Koopman M, Arisz L. A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible?. J Intern Med. 1999;246(3):247–252
  10. Hoffmann U, Fischereder M, Kruger B, et al. The value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol. 2004;15(2):407–410
  11. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 suppl 1):S1–S266
  12. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41
  13. Thomas L, Huber AR. Renal function—estimation of glomerular filtration rate. Clin Chem Lab Med. 2006;44(11):1295–1302
  14. Filler G, Foster J, Acker A, et al. The Cockcroft-Gault formula should not be used in children. Kidney Int. 2005;67(6):2321–2324
  15. Poggio ED, Wang X, Greene T, et al. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol. 2005;16(2):459–466
  16. Levey AS. Assessing the effectiveness of therapy to prevent the progression of renal disease. Am J Kidney Dis. 1993;22(1):207–214
  17. Cirillo M, Anastasio P, De Santo NG. Relationship of gender, age, and body mass index to errors in predicted kidney function. Nephrol Dial Transplant. 2005;20(9):1791–1798
  18. Herget-Rosenthal S, Pietruck F, Volbracht L, et al. Serum cystatin C—a superior marker of rapidly reduced glomerular filtration after uninephrectomy in kidney donors compared to creatinine. Clin Nephrol. 2005;64(1):41–446
  19. Wells M, Lipman J. Measurements of glomerular filtration in the intensive care unit are only a rough guide to renal function. S Afr J Surg. 1997;35(1):20–23
  20. Detrenis S, Meschi M, Musini S, et al. Lights and shadows on the pathogenesis of contrast-induced nephropathy: state of the art. Nephrol Dial Transplant. 2005;20(8):1542–1550
  21. Pflueger A, Larson TS, Nath KA, et al. Role of adenosine in contrast media-induced acute renal failure in diabetes mellitus. Mayo Clin Proc. 2000;75(12):1275–1283
  22. Cantley LG, Spokes K, Clark B, et al. Role of endothelin and prostaglandins in radiocontrast-induced renal artery constriction. Kidney Int. 1993;44(6):1217–1223
  23. Agmon Y, Peleg H, Greenfeld Z, et al. Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat. J Clin Invest. 1994;94(3):1069–1075
  24. Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int. 2005;68(1):14–22
  25. Liss P, Aukland K, Carlsson PO, et al. Influence of iothalamate on renal medullary perfusion and oxygenation in the rat. Acta Radiol. 2005;46(8):823–839
  26. Liss P, Persson PB, Hansell P, et al. Renal failure in 57,925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int. 2006;70:1811–1817
  27. Spargias K, Alexopoulos E, Kyrzopoulos S, et al. Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation. 2004;110(18):2837–2842
  28. Lasser EC, Lyon SG, Berry CC. Reports on contrast media reactions: analysis of data from reports to the U.S. Food and Drug Administration. Radiology. 1997;203(3):605–610
  29. Moore RD, Steinberg EP, Powe NR, et al. Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial. Radiology. 1992;182(3):649–655
  30. Mueller C, Seidensticker P, Buettner HJ, et al. Incidence of contrast nephropathy in patients receiving comprehensive intravenous and oral hydration. Swiss Med Wkly. 2005;135(19-20):286–290
  31. 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;44(7):1393–1399
  32. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105(19):2259–2264
  33. Freeman RV, O’Donnell M, Share D, et al. Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. Am J Cardiol. 2002;90(10):1068–1073
  34. Bartholomew BA, Harjai KJ, Dukkipati S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol. 2004;93(12):1515–1519
  35. 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;320(3):143–149
  36. Thomsen HS, Morcos SK ESUR Contrast Media Safety Committee. Contrast media and metformin: guidelines to diminish the risk of lactic acidosis in non-insulin-dependent diabetics after administration of contrast media. Eur Radiol. 1999;9(4):738–740
  37. Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA. 2006;295(23):2765–2779
  38. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993;188(1):171–178
  39. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348(6):491–499
  40. Jo SH, Youn TJ, Koo BK, et al. Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER study: a randomized controlled trial. J Am Coll Cardiol. 2006;48(5):924–930
  41. Chalmers N, Jackson RW. Comparison of iodixanol and iohexol in renal impairment. Br J Radiol. 1999;72(859):701–703
  42. Solomon R. The role of osmolality in the incidence of contrast-induced nephropathy: a systematic review of angiographic contrast media in high risk patients. Kidney Int. 2005;68(5):2256–2263
  43. Barrett BJ, Parfrey PS, McDonald JR, et al. Nonionic low-osmolality versus ionic high-osmolality contrast material for intravenous use in patients perceived to be at high risk: randomized trial. Radiology. 1992;183(1):105–110
  44. Schwab SJ, Hlatky MA, Pieper KS, et al. Contrast nephrotoxicity: a randomized controlled trial of a nonionic and an ionic radiographic contrast agent. N Engl J Med. 1989;320(3):149–153
  45. Harris KG, Smith TP, Cragg AH, et al. Nephrotoxicity from contrast material in renal insufficiency: ionic versus nonionic agents. Radiology. 1991;179(3):849–852
  46. Manske CL, Sprafka JM, Strony JT, et al. Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med. 1990;89(5):615–620
  47. Nikolsky E, Mehran R, Lasic Z, et al. Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int. 2005;67(2):706–713
  48. Cigarroa RG, Lange RA, Williams RH, et al. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med. 1989;86(6 Pt. 1):649–652
  49. Thomsen HS. How to avoid CIN: guidelines from the European Society of Urogenital Radiology. Nephrol Dial Transplant. 2005;20(suppl 1):i18–i22
  50. American College of Radiology. Manual on contrast media, version 5.0 (accessed November 08, 2006). [cited; Available from: https://sso.acr.org]
  51. Canadian Association of Radiologists: Guidelines for the Prevention of Contrast Induced Nephropathy 2006 (accessed November 08, 2006). [cited; Available from: http://www.car.ca]
  52. Panel TCCW. Contrast-induced nephropathy: clinical insights and practical guidance. Am J Cardiol. 2006;98(6):2–77
  53. Bader BD, Berger ED, Heede MB, et al. What is the best hydration regimen to prevent contrast media-induced nephrotoxicity?. Clin Nephrol. 2004;62(1):1–7
  54. Krasuski RA, Beard BM, Geoghagan JD, et al. Optimal timing of hydration to erase contrast-associated nephropathy: the OTHER CAN study. J Invasive Cardiol. 2003;15(12):699–702
  55. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291(19):2328–2334
  56. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329–336
  57. Taylor AJ, Hotchkiss D, Morse RW, et al. PREPARED: Preparation for Angiography in Renal Dysfunction: a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction. Chest. 1998;114(6):1570–1574
  58. Trivedi HS, Moore H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract. 2003;93(1):C29–C34
  59. Stevens MA, McCullough PA, Tobin KJ, et al. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.C.E. Study (Prevention of Radiocontrast Induced Nephropathy Clinical Evaluation). J Am Coll Cardiol. 1999;33(2):403–411
  60. Weinstein JM, Heyman S, Brezis M. Potential deleterious effect of furosemide in radiocontrast nephropathy. Nephron. 1992;62(4):413–415
  61. Solomon R, Werner C, Mann D, et al. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331(21):1416–1420
  62. Dussol B, Morange S, Loundoun A, et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant. 2006;21(8):2120–2126
  63. Gare M, Haviv YS, Ben-Yehuda A, et al. The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography. J Am Coll Cardiol. 1999;34(6):1682–1688
  64. Hans SS, Hans BA, Dhillon R, et al. Effect of dopamine on renal function after arteriography in patients with pre-existing renal insufficiency. Am Surg. 1998;64(5):432–436
  65. Weisberg LS, Kurnik PB, Kurnik BR. Risk of radiocontrast nephropathy in patients with and without diabetes mellitus. Kidney Int. 1994;45(1):259–265
  66. Abizaid AS, Clark CE, Mintz GS, et al. Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency. Am J Cardiol. 1999;83(2):260–263A5
  67. Bakris GL, Lass NA, Glock D. Renal hemodynamics in radiocontrast medium-induced renal dysfunction: a role for dopamine-1 receptors. Kidney Int. 1999;56(1):206–210
  68. Tumlin JA, Wang A, Murray PT, et al. Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: a pilot trial in the prevention of contrast nephropathy. Am Heart J. 2002;143(5):894–903
  69. Stone GW, McCullough PA, Tumlin JA, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA. 2003;290(17):2284–2291
  70. Briguori C, Colombo A, Airoldi F, et al. N-Acetylcysteine versus fenoldopam mesylate to prevent contrast agent-associated nephrotoxicity. J Am Coll Cardiol. 2004;44(4):762–765
  71. Ng TM, Shurmur SW, Silver M, et al. Comparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN). Int J Cardiol. 2006;109(3):322–328
  72. Ix JH, McCulloch CE, Chertow GM. Theophylline for the prevention of radiocontrast nephropathy: a meta-analysis. Nephrol Dial Transplant. 2004;19(11):2747–2753
  73. Erley CM, Duda SH, Schlepckow S, et al. Adenosine antagonist theophylline prevents the reduction of glomerular filtration rate after contrast media application. Kidney Int. 1994;45(5):1425–1431
  74. Erley CM, Duda SH, Rehfuss D, et al. Prevention of radiocontrast-media-induced nephropathy in patients with pre-existing renal insufficiency by hydration in combination with the adenosine antagonist theophylline. Nephrol Dial Transplant. 1999;14(5):1146–1149
  75. Gandhi MR, Brown P, Romanowski CA, et al. The use of theophylline, an adenosine antagonist in the prevention of contrast media induced nephrotoxicity. Br J Radiol. 1992;65(777):838
  76. Huber W, Ilgmann K, Page M, et al. Effect of theophylline on contrast material-nephropathy in patients with chronic renal insufficiency: controlled, randomized, double-blinded study. Radiology. 2002;223(3):772–779
  77. Huber W, Schipek C, Ilgmann K, et al. Effectiveness of theophylline prophylaxis of renal impairment after coronary angiography in patients with chronic renal insufficiency. Am J Cardiol. 2003;91(10):1157–1162
  78. Kapoor A, Kumar S, Gulati S, et al. The role of theophylline in contrast-induced nephropathy: a case-control study. Nephrol Dial Transplant. 2002;17(11):1936–1941
  79. Bagshaw SM, Ghali WA. Theophylline for prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Arch Intern Med. 2005;165(10):1087–1093
  80. Marenzi G, Assanelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006;354(26):2773–2782
  81. Morcos SK, Thomsen HS, Webb JA. Dialysis and contrast media. Eur Radiol. 2002;12(12):3026–3030
  82. Huber W, Jeschke B, Kreymann B, et al. Haemodialysis for the prevention of contrast-induced nephropathy: outcome of 31 patients with severely impaired renal function, comparison with patients at similar risk and review. Invest Radiol. 2002;37(9):471–481
  83. Vogt B, Ferrari P, Schonholzer C, et al. Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful. Am J Med. 2001;111(9):692–698
  84. Frank H, Werner D, Lorusso V, et al. Simultaneous hemodialysis during coronary angiography fails to prevent radiocontrast-induced nephropathy in chronic renal failure. Clin Nephrol. 2003;60(3):176–182
  85. Marenzi G, Bartorelli AL. Hemofiltration in the prevention of radiocontrast agent induced nephropathy. Minerva Anestesiol. 2004;70(4):189–191
  86. Marenzi G, Marana I, Lauri G, et al. The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med. 2003;349(14):1333–1340
  87. Klarenbach SW, Pannu N, Tonelli MA, et al. Cost-effectiveness of hemofiltration to prevent contrast nephropathy in patients with chronic kidney disease. Crit Care Med. 2006;34(4):1044–1051
  88. Elicker BM, Cypel YS, Weinreb JC. IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. AJR Am J Roentgenol. 2006;186(6):1651–1658
  89. Nikolsky E, Aymong ED, Dangas G, et al. Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function. Rev Cardiovasc Med. 2003;4(suppl 1):S7–S14
  90. Tippins RB, Torres WE, Baumgartner BR, et al. Are screening serum creatinine levels necessary prior to outpatient CT examinations?. Radiology. 2000;216(2):481–484
  91. Kerns SR, Hawkins IF. Carbon dioxide digital subtraction angiography: expanding applications and technical evolution. AJR Am J Roentgenol. 1995;164(3):735–741
  92. Kessel DO, Robertson I, Patel JT, et al. Carbon-dioxide-guided vascular interventions: technique and pitfalls. Cardiovasc Intervent Radiol. 2002;25(6):476–483
  93. Spinosa DJ, Matsumoto AH, Angle JF, et al. Renal insufficiency: usefulness of gadodiamide-enhanced renal angiography to supplement CO2-enhanced renal angiography for diagnosis and percutaneous treatment. Radiology. 1999;210(3):663–672
  94. Ergun I, Keven K, Uruc I, et al. The safety of gadolinium in patients with stage 3 and 4 renal failure. Nephrol Dial Transplant. 2006;21(3):697–700

PII: S1089-2516(06)00046-1

doi: 10.1053/j.tvir.2006.12.002

Techniques in Vascular & Interventional Radiology
Volume 9, Issue 2 , Pages 42-49 , June 2006

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