Guidelines For Clinical Practice
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World J Cardiol. May 26, 2012; 4(5): 157-172
Published online May 26, 2012. doi: 10.4330/wjc.v4.i5.157
Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography
Yao-Min Hung, Shoa-Lin Lin, Shih-Yuan Hung, Wei-Chun Huang, Paul Yung-Pou Wang
Yao-Min Hung, Division of Nephrology, Jiannren Hospital, Kaohsiung 813, Taiwan, China
Shoa-Lin Lin, Wei-Chun Huang, Division of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, China
Shoa-Lin Lin, Wei-Chun Huang, National Yang-Ming University, Taipei 112, Taiwan, China
Shoa-Lin Lin, Division of Cardiology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung 802, Taiwan, China
Shih-Yuan Hung, Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, 824, Taiwan, China
Shih-Yuan Hung, Department of Health Management, I-Shou University, Kaohsiung 824, Taiwan, China
Paul Yung-Pou Wang, Division of Nephrology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA 91706, United States
Author contributions: Hung YM and Lin SL developed the plan of the article and were the primary writers; Hung SY and Huang WC contributed to the data collection and writing the Tables of the manuscript; Wang PYP assisted in critical reviewing and advisement of this article.
Supported by The Kaohsiung Veterans General Hospital, Grant No. VGHKS100-032 (in part)
Correspondence to: Shoa-Lin Lin, MD, Division of Cardiology, Department of Internal Medicine, Yuan’s General Hospital, No. 162, Chen-Kung 1st road, Ling-Ya District, Kaohsiung 802, Taiwan, China. lingoodman@yahoo.com.tw
Telephone: +886-77352884 Fax: +886-72691506
Received: October 28, 2011
Revised: March 16, 2012
Accepted: March 23, 2012
Published online: May 26, 2012
Abstract

Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

Keywords: Acute kidney injury, Contrast media, Coronary angiography, N-acetylcysteine, Radiocontrast-induced nephropathy