Navigating nephrotoxic waters: A comprehensive overview of contrast-induced acute kidney injury prevention

Table 1 Clinical pearls for contrast-induced acute kidney injury in every day clinical practice

Risk factors-complications

Serum creatinine elevation occurs within 48-72 hours after the injection of the CM, with the first 24 hours post-exposure are crucial to the development of CI-AKI

Patients with preexisting CKD, elderly, and renal transplant recipients are at increased risk for CI-AKI development

Renal function via serum creatinine and eGFR calculation should be evaluated in high-risk patients before exposure to CM for CI-AKI risk assessment

Other notable complications of CM exposure: Myocardial infarction, shock, stroke, death, longer in-hospital stays

Prevention

CM considerations: Apply non-ionic, hypo-osmolar CM at lowest dose, prewarm at 37 °C

Discontinue nephrotoxic drugs: Non-steroidal anti-inflammatory drugs, aminoglycosides, metformin

Periprocedural hydration with normal saline in patients at risk:

Three mL/kg/hour 1 hour before to 4 hours after the procedure

One mL/kg/hour 12 hours before to 12 hours after the procedure

Individualized use of specialized systems (RenalGuard/DyeVert) in coronary procedures

CI-AKI: Contrast-induced acute kidney injury; CM: Contrast medium; CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate.