Risk Prediction of Contrast-Induced Nephropathy
Section snippets
Consensus statement 2
The risk of CIN is elevated and of clinical importance in patients with chronic kidney disease (particularly when diabetes is also present), recognized by an estimated glomerular filtration rate <60 mL/min/1.73 m2.
Consensus statement 5
The presence of multiple CIN risk factors in the same patient or high-risk clinical scenarios can create a very high risk for CIN (∼50%) and acute renal failure (∼15%) requiring dialysis after contrast exposure.
Overview of Major Risk Markers
Table 1 summarizes the main risk predictors for CIN that have been reported in the literature, with impaired renal function and diabetes cited consistently. The CIN Consensus Working Panel preferred the use of the term risk marker to risk factor because many of these indicators are nonmodifiable patient characteristics that are not necessarily directly causative.
Additive risk
The effect of risk factors is additive, and the likelihood of CIN rises sharply as number of risk factors increases. This was first documented by Cochran and colleagues29 in a study of renal angiography that showed that the risk of CIN was 50% in patients with 5 risk factors. Others have consistently shown a relation between multiple risk factors and an increased risk of CIN, both in peripheral angiography4, 22, 23 and in PCI.12, 16, 17 One study in patients undergoing angiography for
Review of main scoring schemes
A risk model combines ≥2 characteristics to help clinicians to make predictions about future health outcomes. The identification of major risk markers for CIN and quantification of the effect of these baseline and periprocedural characteristics on the likelihood of a CIN event among patients undergoing various radiologic procedures have allowed the development of risk models. The predictors used in published risk models are summarized in Table 2.12, 16, 17, 19, 39, 79 As already discussed, the
Practical approaches to risk prediction
The consensus view of the Panel was that the most appropriate approach to risk prediction is a simple one that focuses on renal dysfunction and diabetes as the most important risk markers. Figure 2 shows the result of modeling the risk of CIN according to the eGFR for the total population and according to the presence or absence of diabetes.9, 15, 47, 49, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111,
References (119)
- et al.
Acute renal failure following high dose excretory urography in dehydrated patients
J Urol
(1971) - et al.
Renal failure following major angiography
Am J Med
(1978) - et al.
Causes of acute renal dysfunction after percutaneous coronary intervention and comparison of late mortality rates with postprocedure rise of creatine kinase-MB versus rise of serum creatinine
Am J Cardiol
(2004) - et al.
Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions
Kidney Int
(2005) - 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) - et al.
Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables
Am J Cardiol
(2005) - et al.
Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention
Am J Cardiol
(2004) - et al.
Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality
Am J Med
(1997) - et al.
Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification
Am J Cardiol
(2004) - et al.
Contrast medium-induced acute renal failure and cholesterol embolism after radiological procedures: incidence, risk factors, and compliance with recommendations
Eur J Intern Med
(2003)
Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose
Am J Cardiol
Nephrotoxicity from angiographic contrast material: a prospective study
Am J Med
A randomized comparison of the nephrotoxicity of iopamidol and diatrizoate in high risk patients undergoing cardiac angiography
J Am Coll Cardiol
Reduction in renal function after renal arteriography and after renal artery angioplasty
Eur J Vasc Endovasc Surg
Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trialThe Iohexol Cooperative Study
Kidney Int
Acetylcysteine for prevention of contrast nephropathy: meta-analysis
Lancet
Uric acid and chronic renal disease: possible implication of hyperuricemia on progression of renal disease
Semin Nephrol
Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
Prognostic significance of renal insufficiency in patients presenting with acute coronary syndrome (the Prospective Multicenter SYCOMORE study)
Am J Cardiol
Slowing the progression of diabetic nephropathy and its cardiovascular consequences
Am Heart J
Statin therapy reduces contrast-induced nephropathy: an analysis of contemporary percutaneous interventions
Am J Med
Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam
Am J Cardiol
Cisplatin nephrotoxicity
Semin Nephrol
Chronic cisplatin nephropathy, contrast media, and creatinine
Acad Radiol
Effect of high-dose intravenous immunoglobulin therapy on blood rheology
Lancet
Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency
Am J Cardiol
A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study
J Am Coll Cardiol
Acetylcysteine and contrast agent-associated nephrotoxicity
J Am Coll Cardiol
Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial)
Am J Cardiol
The effect of N-acetylcysteine on renal function, nitric oxide, and oxidative stress after angiography
Kidney Int
Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial
Am J Kidney Dis
Effectiveness of theophylline prophylaxis of renal impairment after coronary angiography in patients with chronic renal insufficiency
Am J Cardiol
N-acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up
Am Heart J
Epidemiology and prognostic implications of contrast-induced nephropathy
Am J Cardiol
Acute renal failure (ARF) induced by radiographic contrast material
Clin Res
Acute renal failure: association with administration of radiographic contrast material
JAMA
Acute renal failure following intravenous use of radiographic contrast dyes in patients with diabetes mellitus
Diabetes
Nephrotoxicity of conventional and low osmolality radiocontrast media
J Nephrol
Contrast medium use
Am J Cardiol
Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention
Circulation
Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention
J Invasive Cardiol
Female sex and risk of contrast nephropathy after percutaneous coronary intervention
Can J Cardiol
Radiocontrast-associated renal dysfunction: incidence and risk factors
AJR Am J Roentgenol
Renal dysfunction after angiography: a risk factor analysis in patients with peripheral vascular disease
J Cardiovasc Surg (Torino)
Acute renal dysfunction after major arteriography
AJR Am J Roentgenol
Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older: a prospective study
Arch Intern Med
Predicting angiography-induced acute renal function impairment: clinical risk model
AJR Am J Roentgenol
Nephrotoxicity of low osmolality contrast media versus high osmolality media
Invest Radiol
Cardiovascular and renal toxicity of a nonionic radiographic contrast agent after cardiac catheterization: a prospective trial
Ann Intern Med
Renal function impairment caused by intravenous urography: a prospective study
Arch Intern Med
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