Contrast-Induced Nephropathy Questions & Answers

1. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006 Apr. 120 (4):S11-5. [QxMD MEDLINE Link]. [Full Text].

2. Shams E, Mayrovitz HN. Contrast-Induced Nephropathy: A Review of Mechanisms and Risks. Cureus. 2021 May 4. 13 (5):e14842. [QxMD MEDLINE Link]. [Full Text].

3. From AM, Bartholmai BJ, Williams AW, Cha SS, McDonald FS. Mortality associated with nephropathy after radiographic contrast exposure. Mayo Clin Proc. 2008 Oct. 83(10):1095-100. [QxMD MEDLINE Link].

4. Gundlach PJ, van Beek-Peeters JA, Ruissen J, Verberk-Jonkers IJ. [Contrast-induced nephropathy and mortality after contrast-based investigation]. Ned Tijdschr Geneeskd. 2015. 159:A8501. [QxMD MEDLINE Link].

5. Konen E, Konen O, Katz M, Levy Y, Rozenman J, Hertz M. Are referring clinicians aware of patients at risk from intravenous injection of iodinated contrast media?. Clin Radiol. 2002 Feb. 57(2):132-5. [QxMD MEDLINE Link].

6. Lakhal K, Ehrmann S, Chaari A, et al. Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: incidence and outcome. J Crit Care. 2011 Dec. 26(6):593-9. [QxMD MEDLINE Link].

7. Hinson JS, Ehmann MR, Fine DM, et al. Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med. 2017 May. 69(5):577-586.e4. [QxMD MEDLINE Link].

8. Droppa M, Desch S, Blase P, et al. Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty. Clin Res Cardiol. 2011 Nov. 100(11):1037-43. [QxMD MEDLINE Link].

9. Ren L, Ji J, Fang Y, et al. Assessment of urinary N-acetyl-β-glucosaminidase as an early marker of contrast-induced nephropathy. J Int Med Res. 2011. 39(2):647-53. [QxMD MEDLINE Link].

10. Lameier NH. Contrast-induced nephropathy--prevention and risk reduction. Nephrol Dial Transplant. 2006 Jun. 21(6):i11-23. [QxMD MEDLINE Link].

11. [Guideline] Department of Veterans Affairs, Department of Defense. VA/DoD clinical practice guideline for the management of chronic kidney disease in primary care. Available at https://www.healthquality.va.gov/guidelines/CD/ckd/VADoDCKDCPG.pdf. December 2014; Accessed: February 21, 2020.

12. Wong GT, Irwin MG. Contrast-induced nephropathy. Br J Anaesth. 2007 Oct. 99(4):474-83. [QxMD MEDLINE Link].

13. Guastoni C, De Servi S, D'Amico M. The role of dialysis in contrast-induced nephropathy: doubts and certainties. J Cardiovasc Med (Hagerstown). 2007 Aug. 8(8):549-57. [QxMD MEDLINE Link].

14. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993 Jul. 188(1):171-8. [QxMD MEDLINE Link].

15. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003 Feb 6. 348(6):491-9. [QxMD MEDLINE Link].

16. Baker CS, Wragg A, Kumar S, et al. A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study. J Am Coll Cardiol. 2003 Jun 18. 41(12):2114-8. [QxMD MEDLINE Link].

17. Bartorelli AL, Marenzi G. Contrast-induced nephropathy. J Interv Cardiol. 2008 Feb. 21(1):74-85. [QxMD MEDLINE Link].

18. Jo SH, Youn TJ, Koo BK, et al. Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER study: a randomized controlled trial. J Am Coll Cardiol. 2006 Sep 5. 48(5):924-30. [QxMD MEDLINE Link].

19. Shin DH, Choi DJ, Youn TJ, et al. Comparison of contrast-induced nephrotoxicity of iodixanol and iopromide in patients with renal insufficiency undergoing coronary angiography. Am J Cardiol. 2011 Jul 15. 108(2):189-94. [QxMD MEDLINE Link].

20. Toprak O. Risk markers for contrast-induced nephropathy. Am J Med Sci. 2007 Oct. 334(4):283-90. [QxMD MEDLINE Link].

21. Mehta RL, Pascual MT, Soroko S, et al, for the Program to Improve Care in Acute Renal Disease. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct. 66(4):1613-21. [QxMD MEDLINE Link].

22. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997 Nov. 103(5):368-75. [QxMD MEDLINE Link].

23. Grossman PM, Ali SS, Aronow HD, et al. Contrast-induced nephropathy in patients undergoing endovascular peripheral vascular intervention: Incidence, risk factors, and outcomes as observed in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. J Interv Cardiol. 2017 Jun. 30(3):274-80. [QxMD MEDLINE Link].

24. Maioli M, Toso A, Leoncini M, Gallopin M, Musilli N, Bellandi F. Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation. 2012 Jun 26. 125(25):3099-107. [QxMD MEDLINE Link].

25. Abe M, Morimoto T, Akao M, et al. Relation of contrast-induced nephropathy to long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2014 Aug 1. 114(3):362-8. [QxMD MEDLINE Link].

26. Briguori C, Colombo A, Airoldi F, et al. Gadolinium-based contrast agents and nephrotoxicity in patients undergoing coronary artery procedures. Catheter Cardiovasc Interv. 2006 Feb. 67(2):175-80. [QxMD MEDLINE Link].

27. Mehran R, Aymong ED, Nikolsky E, 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 Oct 6. 44(7):1393-9. [QxMD MEDLINE Link].

28. Bartholomew BA, Harjai KJ, Dukkipati S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol. 2004 Jun 15. 93(12):1515-9. [QxMD MEDLINE Link].

29. Lin KY, Zheng WP, Bei WJ, et al. A novel risk score model for prediction of contrast-induced nephropathy after emergent percutaneous coronary intervention. Int J Cardiol. 2017 Mar 1. 230:402-12. [QxMD MEDLINE Link].

30. Moreau JF, Noel LH, Droz D. Proximal renal tubular vacuolization induced by iodinated contrast media, or so-called "osmotic nephrosis". Invest Radiol. 1993 Feb. 28(2):187-90. [QxMD MEDLINE Link].

31. Xu Y, Zheng X, Liang B, Gao J, Gu Z. Vitamins for prevention of contrast-induced acute kidney injury: a systematic review and trial sequential analysis. Am J Cardiovasc Drugs. 2018 Oct. 18(5):373-86. [QxMD MEDLINE Link].

32. Liu X, Hang Y, Shen L, et al. Prevention of contrast-induced nephropathy with prostaglandin E1 in patients undergoing percutaneous coronary procedures: A meta-analysis of 24 randomized controlled trials
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33. Subramaniam RM, Suarez-Cuervo C, Wilson RF, et al. Effectiveness of prevention strategies for contrast-induced nephropathy: a systematic review and meta-analysis. Ann Intern Med. 2016 Mar 15. 164(6):406-16. [QxMD MEDLINE Link].

34. Solomon R. Radiocontrast-induced nephropathy. Semin Nephrol. 1998 Sep. 18(5):551-7. [QxMD MEDLINE Link].

35. Mueller C. Prevention of contrast-induced nephropathy with volume supplementation. Kidney Int Suppl. 2006 Apr. S16-9. [QxMD MEDLINE Link].

36. Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA. 2006 Jun 21. 295(23):2765-79. [QxMD MEDLINE Link].

37. Nijssen EC, Rennenberg RJ, Nelemans PJ, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. 2017 Apr 1. 389(10076):1312-22. [QxMD MEDLINE Link].

38. Putzu A, Boscolo Berto M, Belletti A, et al. Prevention of contrast-induced acute kidney injury by furosemide with matched hydration in patients undergoing interventional procedures: a systematic review and meta-analysis of randomized trials. JACC Cardiovasc Interv. 2017 Feb 27. 10(4):355-63. [QxMD MEDLINE Link].

39. Friedewald VE, Goldfarb S, Laskey WK, et al. The editor's roundtable: contrast-induced nephropathy. Am J Cardiol. 2007 Aug 1. 100(3):544-51. [QxMD MEDLINE Link].

40. Qian G, Liu CF, Guo J, Dong W, Wang J, Chen YD. Prevention of contrast-induced nephropathy by adequate hydration combined with isosorbide dinitrate for patients with renal insufficiency and Congestive Heart Failure. Clin Cardiol. 2018 Jul 27. [QxMD MEDLINE Link]. [Full Text].

41. Yan Y, Ye M, Dong X, Chen Q, Hong H, Chen L, et al. Prevention of Contrast-Induced Nephropathy by Inferior Vena Cava Ultrasonography-Guided Hydration in Chronic Heart Failure Patients. Cardiology. 2021. 146 (2):187-194. [QxMD MEDLINE Link].

42. Pappy R, Stavrakis S, Hennebry TA, Abu-Fadel MS. Effect of statin therapy on contrast-induced nephropathy after coronary angiography: a meta-analysis. Int J Cardiol. 2011 Sep 15. 151(3):348-53. [QxMD MEDLINE Link].

43. Briasoulis A, Mallikethi-Reddy S, Sharma S, Briasouli AA, Afonso L. 3-Hydroxy-3-methylglutaryl-CoA reductase enzyme inhibitors for prevention of contrast-induced nephropathy: a meta-analysis of prospective randomized controlled studies. Am J Ther. 2015 Nov-Dec. 22(6):e158-66. [QxMD MEDLINE Link].

44. Barbieri L, Verdoia M, Schaffer A, Nardin M, Marino P, De Luca G. The role of statins in the prevention of contrast induced nephropathy: a meta-analysis of 8 randomized trials. J Thromb Thrombolysis. 2014 Nov. 38(4):493-502. [QxMD MEDLINE Link].

45. Yang Y, Wu YX, Hu YZ. Rosuvastatin treatment for preventing contrast-induced acute kidney injury after cardiac catheterization: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2015 Jul. 94(30):e1226. [QxMD MEDLINE Link].

46. From AM, Bartholmai BJ, Williams AW, et al. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: a retrospective cohort study of 7977 patients at Mayo Clinic. Clin J Am Soc Nephrol. 2008 Jan. 3(1):10-8. [QxMD MEDLINE Link].

47. Solomon R, Gordon P, Manoukian SV, et al for the BOSS Trial Investigators. Randomized trial of bicarbonate or saline study for the prevention of contrast-induced nephropathy in patients with CKD. Clin J Am Soc Nephrol. 2015 Sep 4. 10(9):1519-24. [QxMD MEDLINE Link].

48. Ali-Hassan-Sayegh S, Mirhosseini SJ, Rahimizadeh E, et al. Current status of sodium bicarbonate in coronary angiography: an updated comprehensive meta-analysis and systematic review. Cardiol Res Pract. 2015. 2015:690308. [QxMD MEDLINE Link]. [Full Text].

49. Timal RJ, Kooiman J, Sijpkens YWJ, de Vries JPM, Verberk-Jonkers IJAM, Brulez HFH, et al. Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease: The Kompas Randomized Clinical Trial. JAMA Intern Med. 2020 Feb 17. [QxMD MEDLINE Link].

50. Xu R, Tao A, Bai Y, Deng Y, Chen G. Effectiveness of N-acetylcysteine for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2016 Sep 23. 5(9):[QxMD MEDLINE Link]. [Full Text].

51. Van Praet JT, De Vriese AS. Prevention of contrast-induced nephropathy: a critical review. Curr Opin Nephrol Hypertens. 2007 Jul. 16(4):336-47. [QxMD MEDLINE Link].

52. Hoffmann U, Fischereder M, Kruger B, et al. The value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol. 2004 Feb. 15(2):407-10. [QxMD MEDLINE Link].

53. Haase M, Haase-Fielitz A, Ratnaike S, et al. N-Acetylcysteine does not artifactually lower plasma creatinine concentration. Nephrol Dial Transplant. 2008 May. 23(5):1581-7. [QxMD MEDLINE Link].

54. Rodby RA. Preventing complications of radiographic contrast media: is there a role for dialysis?. Semin Dial. 2007 Jan-Feb. 20(1):19-23. [QxMD MEDLINE Link].

55. Cruz DN, Perazella MA, Bellomo R, et al. Extracorporeal blood purification therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Kidney Dis. 2006 Sep. 48(3):361-71. [QxMD MEDLINE Link].

56. Lee PT, Chou KJ, Liu CP, et al. Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis. A randomized controlled trial. J Am Coll Cardiol. 2007 Sep 11. 50(11):1015-20. [QxMD MEDLINE Link].

57. Marenzi G, Lauri G, Campodonico J, et al. Comparison of two hemofiltration protocols for prevention of contrast-induced nephropathy in high-risk patients. Am J Med. 2006 Feb. 119(2):155-62. [QxMD MEDLINE Link].

58. Frank H, Werner D, Lorusso V, et al. Simultaneous hemodialysis during coronary angiography fails to prevent radiocontrast-induced nephropathy in chronic renal failure. Clin Nephrol. 2003 Sep. 60(3):176-82. [QxMD MEDLINE Link].

59. Spargias K, Alexopoulos E, Kyrzopoulos S, et al. Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation. 2004 Nov 2. 110(18):2837-42. [QxMD MEDLINE Link].

60. Silver SA, Shah PM, Chertow GM, Harel S, Wald R, Harel Z. Risk prediction models for contrast induced nephropathy: systematic review. BMJ. 2015 Aug 27. 351:h4395. [QxMD MEDLINE Link]. [Full Text].

61. Soulez G, Bloomgarden DC, Rofsky NM, et al. Prospective cohort study of nephrogenic systemic fibrosis in patients with stage 3-5 chronic kidney disease undergoing MRI with injected gadobenate dimeglumine or gadoteridol. AJR Am J Roentgenol. 2015 Sep. 205(3):469-78. [QxMD MEDLINE Link].

62. Becker BA, Yeich T, Jaffe JT, Sun S, Chen Y, Rebert T, et al. Impact of creatinine screening on contrast-induced nephropathy following computerized tomography for stroke. Am J Emerg Med. 2021 Jul. 45:420-425. [QxMD MEDLINE Link].

63. Cigarroa RG, Lange RA, Williams RH, et al. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med. 1989 Jun. 86(6 Pt 1):649-52. [QxMD MEDLINE Link].

64. Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol. 1999. 9(8):1602-13. [QxMD MEDLINE Link].

65. Onuigbo MA, Onuigbo NT. Worsening renal failure in older chronic kidney disease patients with renal artery stenosis concurrently on renin angiotensin aldosterone system blockade: a prospective 50-month Mayo-Health-System clinic analysis. QJM. 2008 Jul. 101(7):519-27. [QxMD MEDLINE Link].

66. Kaplan AA, Kohn OF. Fractional excretion of urea as a guide to renal dysfunction. Am J Nephrol. 1992. 12(1-2):49-54. [QxMD MEDLINE Link].

67. Bainey KR, Rahim S, Etherington K, et al, for the CAPTAIN Investigators. Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization: Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Cardiac Catheterization (CAPTAIN) trial. Am Heart J. 2015 Jul. 170(1):110-6. [QxMD MEDLINE Link].

68. Finn WF. The clinical and renal consequences of contrast-induced nephropathy. Nephrol Dial Transplant. 2006 Jun. 21(6):i2-10. [QxMD MEDLINE Link].

69. [Guideline] Stacul F, van der Molen AJ, Reimer P, et al, for the Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011 Dec. 21(12):2527-41. [QxMD MEDLINE Link]. [Full Text].

70. Wacker-Gussmann A, Buhren K, Schultheiss C, et al. Prediction of contrast-induced nephropathy in patients with serum creatinine levels in the upper normal range by cystatin C: a prospective study in 374 patients. AJR Am J Roentgenol. 2014 Feb. 202(2):452-8. [QxMD MEDLINE Link].

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72. McDonald JS, McDonald RJ, Comin J, et al. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 2013 Apr. 267(1):119-28. [QxMD MEDLINE Link].

73. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002 Feb 11. 162(3):329-36. [QxMD MEDLINE Link].

74. Klima T, Christ A, Marana I, te al. Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J. 2012 Aug. 33(16):2071-9. [QxMD MEDLINE Link].

Anita Basu, MD, FACP Assistant Professor of Medicine, University of Mississippi School of Medicine; Staff Nephrologist, GV (Sonny) Montgomery Veterans Affairs Medical Center

Anita Basu, MD, FACP is a member of the following medical societies: American College of Physicians, National Kidney Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology<br/>Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc.

Vecihi Batuman, MD, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Interim Chair, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Renu Bansal, MD Resident Physician, Department of Internal Medicine, University of Connecticut School of Medicine

Disclosure: Nothing to disclose.

Andre A Kaplan, MD, FACP, FASN Professor of Medicine, University of Connecticut School of Medicine; Director of Dialysis Program, Chief of Blood Purification, John Dempsey Hospital; Medical Director, UConn Dialysis Center; Medical Director, McDougal Correctional Institution Dialysis Unit

Andre A Kaplan, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society for Artificial Internal Organs, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, New York Academy of Medicine, American Society for Apheresis, Renal Physicians Association

Disclosure: Nothing to disclose.

Fabio Aglieco, DO Nephrologist and Internal Medicine Primary Care Provider, Nephrology Leaders and Associates; Medical Director, Brazoria County Dialysis Center

Fabio Aglieco, DO is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

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