Protocol Development for Preventing Contrast-Induced Nephropathy
Keywords:Nephropathy, hydration, radiographic contrast, dialysis, renal perfusion
Contrast-induced nephropathy (CIN) is related to substantial economic and clinical consequences, including extended hospitalization, the necessity for dialysis, and an amplified risk of death. As radiographic diagnostic testing becomes commonplace, a significant concern among practitioners is the prevention of radiographic contrast-induced nephropathy. Radiographic contrast agents are used most often in tests such as coronary angiography, percutaneous coronary angioplasty, atherectomy, and stent placement, computer-aided tomography (CAT) scanning, and magnetic resonance imaging (MRI). 1 Administration of these contrast agents often cause acute changes in renal function ranging from an acute reduction of renal function to the transient need for hemodialysis.
Early studies assessing the renal effects of radiocontrast administration in dogs proved a reduction in renal perfusion lasting up to 20 hours after radiocontrast administration. 8 Although no randomized controlled trial (RCT) has studied the benefits of hydration alone, it appears reasonable that sufficient hydration may offset some of the presumed hemodynamic effects that could lead to contrast-induced nephropathy. Various preventative strategies have been studied with mixed results.
This paper constitutes reviewing current and old practices and developing a tentative simple protocol for prevention of Contrast induced nephropathy in nearby hospitals.
Mokhtari V, Afsharian P, et al. A Review on Various Uses of N-Acetylcysteine. Cell J. 2017;19 (1): 11-17.
Li Jing-Xiu, Jin En-Ze, et al. Oral N-acetylcysteine for prophylaxis of contrast-induced nephropathy in patients following coronary angioplasty: A meta-analysis. Experimental and therapeutic medicine. 2017; 14: 1568-1576.
Merten G, et al. Prevention of Contrast-Induced Nephropathy with Sodium Bicarbonate. A Randomized controlled Trial. JAMA. 2004; 291:2328-2334.
Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of two hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162:329-36.
Morcos SK et al. Prevention of contrast media nephrotoxicity-the story so far. Clin Radiology 2004; 54:381-389.
Tepel M van der Giet M, Schwarzfeld C, et al. Prevention of radiographic contrast-agent-induced reductions in renal fuction by acetylcysteine. N Eng J Med 2000; 343: 180-184.
Lin J, Bonventre JV. Prevention of radiocontrast nephropathy. Curr Opin Nephrol Hypertens 14: 105-110.
Goic Joana B, Koenigshof Amy M, et al. A retrospective evaluation of contrast-induced kidney injury in dogs. Journal of Veterinary Emergency and Critical Care 2016;26 (5) 713-719.
Meyer M, LeWinter M, Bell Stephen P, et al. N-Acetylcysteine enhanced contrast provides cardio-renal protection. JACC 2009; 2:215-221.
Filho Luiz D, Saad K, et al. Effect of N-acetylcysteine in hearts of rats submitted to controlled hemorrhagic shock. Braz J Cardiovasc Surg 2015;30 (2): 173-81.
Safirstein R, Andrade L, Vieira JM. Acetylcysteine and nephrotoxic effects of radiographic contrast agentsâ€”a new use for an old drug. N Engl J Med. 2000; 343:210-212.
Azmus AD, Gottschall C, Manica A, et al. Effectiveness of acetylcysteine in prevention of contrast nephropathy. J Invasive Cardiol. 2005; 17:80-84.
Baker CS, Wragg A, Kumar S, De Palma R, Baker LR, Knight CJ. A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study. J Am Coll Cardiol. 2003; 41:2114-2118.
. Briguori C, Manganelli F, Scarpato P, et al. Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol. 2002;40:298-303.
Diaz-Sandoval LJ, Kosowsky BD, Losordo DW. Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol. 2002; 89: 356-358.
Drager LF, Andrade L, Barros de Toledo JF, Laurindo FR, Machado Cesar LA, Seguro AC. Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stressmediated renal tubular injury. Nephrol Dial Transplant. 2004; 19:1803-1807.
Durham JD, Caputo C, Dokko J, et al. A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int. 2002; 62:2202-2207.
Efrati S, Dishy V, Averbukh M, et al. The effect of N-acetylcysteine on renal function, nitric oxide, and oxidative stress after angiography. Kidney Int. 2003; 64:2182-2187.
Fung JW, Szeto CC, Chan WW, et al. Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial. Am J Kidney Dis. 2004; 43: 801-808.
Goldenberg I, Shechter M, Matetzky S, et al.Oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy following coronary angiography: a randomized controlled trial and review of the current literature. Eur Heart J. 2004; 25:212-218.
Gomes VO, Poli de Figueredo CE, Caramori P, et al. N-acetylcysteine does not prevent contrast induced nephropathy after cardiac catheterisation with an ionic low osmolality contrast medium: a multicentre clinical trial. Heart. 2005; 91:774-778.
Gulel O, Keles T, Eraslan H, Aydogdu S, Diker E, Ulusoy V. Prophylactic acetylcysteine usage for prevention of contrast nephropathy after coronary angiography. J Cardiovasc Pharmacol. 2005; 46:464-467.
. Kay J, Chow WH, Chan TM, et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial. JAMA. 2003; 289:553-558.
Kotlyar E, Keogh AM, Thavapalachandran S, et al. Prehydration alone is sufficient to prevent contrastinduced nephropathy after day-only angiography procedures- a randomised controlled trial. Heart Lung Circ. 2005; 14:245-251.
MacNeill BD, Harding SA, Bazari H, et al. Prophylaxis of contrast-induced nephropathy in patients undergoing coronary angiography. Catheter Cardiovasc Interv. 2003; 60:458-461.
Miner SE, Dzavik V, Nguyen-Ho P, et al. N-acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up. Am Heart J. 2004; 148:690-695.
Ochoa A, Pellizzon G, Addala S, et al. Abbreviated dosing of N-acetylcysteine prevents contrast-induced nephropathy after elective and urgent coronary angiography and intervention. J Interv Cardiol. 2004; 17:159-165.
Oldemeyer JB, Biddle WP, Wurdeman RL, Mooss AN, Cichowski E, Hilleman DE. Acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography. Am Heart J. 2003; 146:E23.
Rashid ST, Salman M, Myint F, et al. Prevention of contrast-induced nephropathy in vascular patient undergoing angiography: a randomized controlled trial of intravenous N-acetylcysteine. J Vasc Surg. 2004; 40: 1136-1141.
Shyu KG, Cheng JJ, Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol. 2002; 40:1383-1388.
Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographiccontrast- agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000; 343:180-184.
Webb JG, Pate GE, Humphries KH, et al. A randomized controlled trial of intravenous
N-acetylcysteine for the prevention of contrastinduced nephropathy after cardiac catheterization: lack of effect. Am Heart J. 2004; 148:422-429.
Briguori C, Colombo A, Violante A, et al. Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J. 2004; 25:206-211.
Aspelin P, Aubry P, Fransson SG, Strasser R,Willenbrock R, Berg KJ. Nephrotoxic effects in high-risk patients undergoing angiography.NEngl JMed. 2003; 348:491-499.
Andreucci M, Faga T, Serra R, et al. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf. 2017; 9:25-37.
How to Cite
- Papers must be submitted on the understanding that they have not been published elsewhere (except in the form of an abstract or as part of a published lecture, review, or thesis) and are not currently under consideration by another journal published by any other publisher.
- It is also the authors responsibility to ensure that the articles emanating from a particular source are submitted with the necessary approval.
- The authors warrant that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required.
- The authors ensure that all the references carefully and they are accurate in the text as well as in the list of references (and vice versa).
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Attribution-NonCommercial 4.0 International that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author.