Contrast Associated Acute Kidney Injury - Dr Hiremath (Ottawa, Canada)

Dr. Swapnil Hiremath, who is nephrologist and Associated Professor at the Faculty of Medicine, University of Ottawa, discusses pathophysiology, incidence and prevention of contrast-associated acute kidney injury. The interview was recorded on February 2th, 2022. Moderators: Priv. Doz. Dr. Andreas Kronbichler (Innsbruck, Austria / Cambridge, UK), Dr. Martin Windpessl (Wels, Austria) and Prof. Dr. Gunnar Heine (Frankfurt / Homburg, Germany). Articles discussed: Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med. 2019 doi: 10.1056/NEJMra1805256. Bruce RJ et al. Background fluctuation of kidney function versus contrast-induced nephrotoxicity. AJR Am J Roentgenol 2009 doi: 10.2214/AJR.08.1413 Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006 doi: 10.1056/NEJMcp050801. KDIGO Clinical Practice Guideline for Acute Kidney Injury Kidney Int 2012 doi:10.1038/kisup.2011.32 Weisbord SD et al.; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med. 2018 Nijssen EC et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. 2017 Gonzales DA et al. A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity. BMC Med. 2007 Shishikura D et al. The Extent of Aortic Atherosclerosis Predicts the Occurrence, Severity, and Recovery of Acute Kidney Injury After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv. 2018 Coca SG et al. Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials. J Am Soc Nephrol. 2016 Liu C et al. Postangiography Increases in Serum Creatinine and Biomarkers of Injury and Repair. Clin J Am Soc Nephrol. 2020 Tepel M et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000 Hoffmann U et al. The value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol. 2004 Solomon R et al. Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994 Hiremath S et al. Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence. PLoS One. 2013 Davenport MS et al. Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med. 2020 Owen RJ et al. Canadian Association of Radiologists consensus guidelines for the prevention of contrast-induced nephropathy: update 2012. Can Assoc Radiol J. 2014 ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011 Cichowitz C, Fenves AZ. Contrast-associated acute kidney injury in a patient with lower respiratory tract infection. Lancet 2021 Oloko A et al. Does Iodinated Contrast Affect Residual Renal Function in Dialysis Patients? A Systematic Review and Meta-Analysis. Nephron. 2020 Timal RJ et al. Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease: The Kompas Randomized Clinical Trial. JAMA Intern Med. 2020 Brar SS et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014 Merten GJ et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004 Mehran R 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 Tsai TT et al. Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J Am Heart Assoc. 2014 Rosenstock JL et al. The effect of withdrawal of ACE inhibitors or angiotensin receptor blockers prior to coronary angiography on the incidence of contrast-induced nephropathy. Int Urol Nephrol. 2008