Contrast Media, Nephropathy and Prophylaxis

Animal experiments and clinical observations have documented that the contrast material can cause kidney damage leading to decreased kidney function and acute kidney injury (AKI), an entity initially called contrast-induced nephropathy. Because along with the contrast material, other comorbidities and predisposing factors can contribute to the development of AKI, more general terms, such as contrast-associated AKI or post-contrast AKI have been recently adopted. The risk of AKI has been shown to be significantly higher with high-osmolar compared to low- or iso-osmolar contrast media and depends on the volume of contrast administered during the procedure. The most accepted patient-related risk factors have included advanced age, pre-existing renal insufficiency (especially if eGFR <30 mL/min/1.73 m2) and a prolonged history of diabetes mellitus and/or hypertension. In uncomplicated patients with mild renal impairment contrast-associated AKI develops in <3%. As chronic kidney disease progresses, there is a sharp increase in the rates of contrast-associated AKI (>10% in moderate and > 25% in severe). Among a variety of measures that have been attempted to prevent contrast-associated AKI, pre-hydration with crystalloids and the reduction of the volume of contrast media are generally recommended.