<b>Background:</b><b> </b>Contrast-induced acute kidney injury (CI-AKI) is the third most common cause of AKI in hospitalized patients. Contrast agents mainly cause acute kidney injury through hypoxic damage to renal parenchyma and toxic effects on renal capillaries and tubules. Patients with CI-AKI are more likely to experience adverse events, including longer hospital stay and costs, longer ICU stay, and higher mortality rates. This article elaborates on the definition, epidemiology, risk factors, pathogenesis, and prevention strategies of CI-AKI. <b>Methods:</b><b> </b>We conducted an extensive literature search using contrast agents and AKI as keywords to identify relevant studies on CI-AKI. <b>C</b><b>onclusion</b><b>:</b><b> </b>CI-AKI is a significant clinical challenge that requires a multifaceted approach to prevention and management. Understanding the risk factors, pathophysiology, and current best practices is essential for healthcare providers to optimize patient care and improve outcomes in those undergoing contrast-enhanced imaging procedures. Hydration therapy is currently the main prevention method, but antioxidants may also become a new strategy.
Subramanian, S., Tumlin, J., Bapat, B. and Zyczynski, T. (2007) Economic Burden of Contrast-Induced Nephropathy: Implications for Prevention Strategies. Journal of Medical Economics , 10, 119-134.
Mehran, R. and Nikolsky, E. (2006) Contrast-Induced Nephropathy: Definition, Epidemiology, and Patients at Risk. Kidney International Supplements , 69, S11-S15. https://doi.org/10.1038/sj.ki.5000368
Khwaja, A. (2012) KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clinical Practice , 120, C179-C184. https://doi.org/10.1159/000339789
Nash, K., Hafeez, A. and Hou, S. (2002) Hospital-Acquired Renal Insufficiency. American Journal of Kidney Diseases , 39, 930-936. https://doi.org/10.1053/ajkd.2002.32766
Chandiramani, R., Cao, D., Nicolas, J. and Mehran, R. (2020) Contrast-Induced Acute Kidney Injury. Cardiovascular Intervention and Therapeutics , 35, 209-217. https://doi.org/10.1007/s12928-020-00660-8
McCullough, P.A. (2008) Acute Kidney Injury with Iodinated Contrast. Critical Care Medicine , 36, S204-S211. https://doi.org/10.1097/CCM.0b013e318168cdc3
Rudnick, M.R., Kesselheim, A. and Goldfarb, S. (2006) Contrast-Induced Nephropathy: How It Develops, How to Prevent It. Cleveland Clinic Journal of Medicine , 73, 75-80, 83-87. https://doi.org/10.3949/ccjm.73.1.75
Rihal, C.S., Textor, S.C., Grill, D.E., Berger, P.B., Ting, H.H., Best, P.J., Singh, M., Bell, M.R., Barsness, G.W., Mathew, V., Garratt, K.N. and Holmes, D.R. (2002) Incidence and Prognostic Importance of Acute Renal Failure after Percutaneous Coronary Intervention. Circulation , 105, 2259-2264. https://doi.org/10.1161/01.CIR.0000016043.87291.33
Hogstrom, B. and Ikei, N. (2015) Physicochemical Properties of Radiographic Contrast Media, Potential Nephrotoxicity and Prophylaxis. Clinical and Experimental Pharmacology and Physiology , 42, 1251-1257. https://doi.org/10.1111/1440-1681.12487
Palli, E., Makris, D., Papanikolaou, J., Garoufalis, G. and Zakynthinos, E. (2014) Contrast-Induced Nephropathy in Aged Critically Ill Patients. Oxidative Medicine and Cellular Longevity , 2014, Article ID: 756469. https://doi.org/10.1155/2014/756469
Kane, G.C., Doyle, B.J., Lerman, A., Barsness, G.W., Best, P.J. and Rihal, C.S. (2008) Ultra-Low Contrast Volumes Reduce Rates of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease Undergoing Coronary Angiography. Journal of the American College of Cardiology , 51, 89-90. https://doi.org/10.1016/j.jacc.2007.09.019
Freeman, R.V., O’Donnell, M., Share, D., Meengs, W.L., Kline-Rogers, E., Clark, V.L., DeFranco, A.C., Eagle, K.A., McGinnity, J.G., Patel, K., Maxwell-Eward, A., Bondie, D., Moscucci, M. and Blue Cross-Blue Shield of Michigan Cardiovascular Consortium (BMC2) (2002) Nephropathy Requiring Dialysis after Percutaneous Coronary Intervention and the Critical Role of an Adjusted Contrast Dose. Amer i can Journal of Cardiology , 90, 1068-1073. https://doi.org/10.1016/S0002-9149(02)02771-6
Pistolesi, V., Regolisti, G., Morabito, S., Gandolfini, I., Corrado, S., Piotti, G. and Fiaccadori, E. (2018) Contrast Medium Induced Acute Kidney Injury: A Narrative Review. Journal of Nephrology , 31, 797-812. https://doi.org/10.1007/s40620-018-0498-y
Gupta, R.K. and Bang, T.J. (2010) Prevention of Contrast-Induced Nephropathy (CIN) in Interventional Radiology Practice. Seminars in Interventional Radiology , 27, 348-359. https://doi.org/10.1055/s-0030-1267860
Li, Y. and Ren, K. (2020) The Mechanism of Contrast-Induced Acute Kidney Injury and Its Association with Diabetes Mellitus. Contrast Media & Molecular Imaging , 2020, Article ID: 3295176. https://doi.org/10.1155/2020/3295176
Ortega-Loubon, C., Martínez-Paz, P., García-Morán, E., Tamayo-Velasco, Á., López-Hernández, F.J., Jorge-Monjas, P. and Tamayo, E. (2021) Genetic Susceptibility to Acute Kidney Injury. Journal of Clinical Medicine , 10, Article No. 3039. https://doi.org/10.3390/jcm10143039
Michael, A., Faga, T., Pisani, A., Riccio, E., Bramanti, P., Sabbatini, M., Navarra, M. and Andreucci, M. (2014) Molecular Mechanisms of Renal Cellular Nephrotoxicity Due to Radiocontrast Media. BioMed Research International , 2014, Article ID: 249810. https://doi.org/10.1155/2014/249810
Persson, P.B., Ansell, P. and Kiss, P. (2005) Pathophysiology of Contrast Medium-Induced Nephropathy. Kidney International , 68, 14-22. https://doi.org/10.1111/j.1523-1755.2005.00377.x
Caiazzas, A., Russo, L., Sabbatin, M. and Russo, D. (2014) Hemodynamic and Tubular Changes Induced by Contrast Media. BioMed Research International , 2014, Article ID: 578974. https://doi.org/10.1155/2014/578974
Sendeskia, M.M. (2011) Pathophysiology of Renal Tissue Damage by Iodinated Contrast Media. Clinical and Experimental Pharmacology and Physiology , 38, 292-299. https://doi.org/10.1111/j.1440-1681.2011.05503.x
Yang, D. and Yang, D. (2013) Role of Intracellular Ca 2 and Na /Ca 2 Exchanger in the Pathogenesis of Contrast-Induced Acute Kidney Injury. BioMed Research I n ternational , 2013, Article ID: 678456. https://doi.org/10.1155/2013/678456
Farrar, A. (2018) Acute Kidney Injury. Nursing Clinics of North America , 53, 499-510. https://doi.org/10.1016/j.cnur.2018.07.001
Shams, E. and Mayrovitz, H.N. (2021) Contrast-Induced Nephropathy: A Review of Mechanisms and Risks. Cureus , 13, E14842. https://doi.org/10.7759/cureus.14842
Budhiraja, P., Chen, Z. and Popovtzer, M. (2009) Sodium Bicarbonate versus Normal Saline for Protection against Contrast Nephropathy. Renal Failure , 31, 118-123. https://doi.org/10.1080/08860220802599239
Zapata-Chica, C.A., Bello Marquez, D., Serna-Higuita, L.M., Nieto-Ríos, J.F., Casas-Arroyave, F.D. and Donado-Gómez, J.H. (2015) Sodium Bicarbonate versus Isotonic Saline Solution to Prevent Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis. Colombia Médica ( Cali ), 46, 90-103. https://doi.org/10.25100/cm.v46i3.1925
Shalansky, S.J., Pate, G.E., Levin, A. and Webb, J.G. (2005) N-Acetylcysteine for Prevention of Radiocontrast Induced Nephrotoxicity: The Importance of Dose and Route of Administration. Heart , 91, 997-999. https://doi.org/10.1136/hrt.2004.053579
Subramaniam, R.M., Suarez-Cuervo, C., Wilson, R.F., Turban, S., Zhang, A., Sherrod, C., Aboagye, J., Eng, J., Choi, M.J., Hutfless, S. and Bass, E.B. (2016) Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis. Annals of Internal Medicine , 164, 406-416. https://doi.org/10.7326/M15-1456
Zhao, S.J., Zhong, Z.S., Qi, G.X. and Tian, W. (2016) The Efficacy of N-Acetylcysteine plus Sodium Bicarbonate in the Prevention of Contrast-Induced Nephropathy after Cardiac Catheterization and Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials. International Journal of Cardiology , 221, 251-259. https://doi.org/10.1016/j.ijcard.2016.07.086
Xu, R., Tao, A., Bai, Y., Deng, Y. and Chen, G. (2016) Effectiveness of N-Acetylcysteine for the Prevention of Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of the American Heart Association , 5, E003968. https://doi.org/10.1161/JAHA.116.003968
Wang, N., Qian, P., Kumar, S., Yan, T.D. and Phan, K. (2016) The Effect of N-Acetylcysteine on the Incidence of Contrast-Induced Kidney Injury: A Systematic Review and Trial Sequential Analysis. International Journal of Cardiology , 209, 319-327. https://doi.org/10.1016/j.ijcard.2016.02.083
Kang, X., Hu, D.Y., Li, C.B., Ai, Z.S. and Peng, A. (2015) N-Acetylcysteine for the Prevention of Contrast-Induced Nephropathy in Patients with Pre-Existing Renal Insufficiency or Diabetes: A Systematic Review and Meta-Analysis. Renal Failure , 37, 297-303. https://doi.org/10.3109/0886022X.2015.1012985
Oudemans-Van Straaten, H.M., Spoelstra-De Man, A.M. and De Waard, M.C. (2014) Vitamin C Revisited. Critical Care , 18, Article No. 460. https://doi.org/10.1186/s13054-014-0460-x
Abd-El-Fattah, A.A., El-Sawalhi, M.M., Rashed, E.R. and El-Ghazaly, M.A. (2010) Possible Role of Vitamin E, Coenzyme Q10 and Rutin in Protection against Cerebral Ischemia/Reperfusion Injury in Irradiated Rats. International Journal of Radi a tion Biology , 86, 1070-1078. https://doi.org/10.3109/09553002.2010.501844
Spargias, K., Alexopoulos, E., Kyrzopoulos, S., Iokovis, P., Greenwood, D.C., Manginas, A., Voudris, V., Pavlides, G., Buller, C.E., Kremastinos, D. and Cokkinos, D.V. (2004) Ascorbic Acid Prevents Contrast-Mediated Nephropathy in Patients with Renal Dysfunction Undergoing Coronary Angiography or Intervention. Circulation , 110, 2837-2842. https://doi.org/10.1161/01.CIR.0000146396.19081.73
Khaledifar, A., Momeni, A., Ebrahimi, A., Kheiri, S. and Mokhtari, A. (2015) Comparison of N-Acetylcysteine, Ascorbic Acid, and Normal Saline Effect in Prevention of Contrast-Induced Nephropathy. ARYA Atherosclerosis , 11, 228-232.
Dvoršak, B., Kanič, V., Ekart, R., Bevc, S. and Hojs, R. (2013) Ascorbic Acid for the Prevention of Contrast-Induced Nephropathy after Coronary Angiography in Patients with Chronic Renal Impairment: A Randomized Controlled Trial. Therape u tic Apheresis and Dialysis , 17, 384-390. https://doi.org/10.1111/1744-9987.12083
Albabtaina, M.A., Almasoods, A., Alshurafahi, H., Alamria, H. and Tarim, H. (2013) Efficacy of Ascorbic Acid, N-Acetylcysteine, or Combination of both on Top of Saline Hydration versus Saline Hydration Alone on Prevention of Contrast-Induced Nephropathy: A Prospective Randomized Study. Journal of Interve n tional Cardiology , 26, 90-96. https://doi.org/10.1111/j.1540-8183.2012.00767.x
Tasanarong, A., Vohakiat, A., Hutayanon, P. and Piyayotai, D. (2013) New Strategy of α -and γ -Tocopherol to Prevent Contrast-Induced Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Elective Coronary Procedures. Nep h rology Dialysis Tran splantation , 28, 337-344. https://doi.org/10.1093/ndt/gfs525
Rezaei, Y., Khademvatani, K., Rahimi, B., Khoshfetrat, M., Arjmand, N. and Seyyed-Mohammadzad, M.H. (2016) Short-Term High-Dose Vitamin E to Prevent Contrast Medium-Induced Acute Kidney Injury in Patients with Chronic Kidney Disease Undergoing Elective Coronary Angiography: A Randomized Placebo-Controlled Trial. Journal of the American Heart Association , 5, E002919. https://doi.org/10.1161/JAHA.115.002919
Tasanarong, A., Piyayotai, D. and Thitiarchakul, S. (2009) Protection of Radiocontrast Induced Nephropathy by Vitamin E (Alpha Tocopherol): A Randomized Controlled Pilot Study. Journal of the Medical Association of Thailand , 92, 1273-1281.
Kitzler, T.M., Jaberi, A., Sendlhofer, G., Rehak, P., Binder, C., Petnehazy, E., Stacher, R. and Kotanko, P. (2012) Efficacy of Vitamin E and N-Acetylcysteine in the Prevention of Contrast Induced Kidney Injury in Patients with Chronic Kidney Disease: A Double Blind, Randomized Controlled Trial. Wiener Klinische Wochenschrift , 124, 312-319. https://doi.org/10.1007/s00508-012-0169-2
Xu, Y., Zheng, X., Liang, B., Gao, J. and Gu, Z. (2018) Vitamins for Prevention of Contrast-Induced Acute Kidney Injury: A Systematic Review and Trial Sequential Analysis. American Journal of Cardiovascular Drugs , 18, 373-386. https://doi.org/10.1007/s40256-018-0274-3
John, S., Schneider, M.P., Delles, C., Jacobi, J. and Schmieder, R.E. (2005) Lipid-Independent Effects of Statins on Endothelial Function and Bioavailability of Nitric Oxide in Hypercholesterolemic Patients. American Heart Journal , 149, 473.e1-473.e10. https://doi.org/10.1016/j.ahj.2004.06.027
Liberale, L., Carbone, F., Montecucco, F. and Sahebkar, A. (2020) Statins Reduce Vascular Inflammation in Atherogenesis: A Review of Underlying Molecular Mechanisms. The International Journal of Biochemistry & Cell Biology , 122, Article ID: 105735. https://doi.org/10.1016/j.biocel.2020.105735
Li, H., Wang, C., Liu, C., Li, R., Zou, M. and Cheng, G. (2016) Efficacy of Short-Term Statin Treatment for the Prevention of Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography/Percutaneous Coronary Intervention: A Meta-Analysis of 21 Randomized Controlled Trials. American Journal of Cardiovascular Drugs , 16, 201-219. https://doi.org/10.1007/s40256-016-0164-5
Wang, N., Qian, P., Yan, T.D. and Phan, K. (2016) Periprocedural Effects of Statins on the Incidence of Contrast-Induced Acute Kidney Injury: A Systematic Review and Trial Sequential Analysis. International Journal of Cardiology , 206, 143-152. https://doi.org/10.1016/j.ijcard.2016.01.004
Cruz, D.N., Perazella, M.A., Bellomo, R., Corradi, V., De Cal, M., Kuang, D., Ocampo, C., Nalesso, F. and Ronco, C. (2006) Extracorporeal Blood Purification Therapies for Prevention of Radiocontrast-Induced Nephropathy: A Systematic Review. American Journal of Kidney Diseases , 48, 361-371. https://doi.org/10.1053/j.ajkd.2006.05.023
Ellis, J.H. and Cohan, R.H. (2009) Prevention of Contrast-Induced Nephropathy: An Overview. Radiologic Clinics of North America , 47, 801-811. https://doi.org/10.1016/j.rcl.2009.06.003
Gassanov, N., Nia, A.M., Caglayan, E. and Er, F. (2014) Remote Ischemic Preconditioning and Renoprotection: From Myth to a Novel Therapeutic Option? Journal of the American Society of Nephrology , 25, 216-224. https://doi.org/10.1681/ASN.2013070708
Atanda, A.C. and Olafiranye, O. (2017) Contrast-Induced Acute Kidney Injury in Interventional Cardiology: Emerging Evidence and Unifying Mechanisms of Protection by Remote Ischemic Conditioning. Cardiovascular Revascularization Medicine , 18, 549-553. https://doi.org/10.1016/j.carrev.2017.06.001
Ghaemian, A., Yazdani, J., Azizi, S., Farsavian, A.A., Nabati, M., Malekrah, A., Dabirian, M., Espahbodi, F., Mirjani, B., Mohsenipouya, H. and Heshmatian, J. (2018) Remote Ischemic Preconditioning to Reduce Contrast-Induced Acute Kidney Injury in Chronic Kidney Disease: A Randomized Controlled Trial. BMC Nephrology , 19, Article No. 373. https://doi.org/10.1186/s12882-018-1169-x
Bafna, A.A. and Shah, H.C. (2020) Remote Ischemic Preconditioning for Prevention of Contrast-Induced Nephropathy—A Randomized Control Trial. Indian Heart Journal , 72, 244-247. https://doi.org/10.1016/j.ihj.2020.04.010
Deng, J., Lu, Y., Ou, J., Shao, X., Wang, X. and Xie, H. (2020) Remote Ischemic Preconditioning Reduces the Risk of Contrast-Induced Nephropathy in Patients with Moderate Renal Impairment Undergoing Percutaneous Coronary Angiography: A Meta-Analysis. Kidney and Blood Pressure Research , 45, 549-564. https://doi.org/10.1159/000507330
Bei, W.J., Duan, C.Y., Chen, J.Y., Wang, K., Liu, Y.H., Liu, Y. and Tan, N. (2016) Remote Ischemic Conditioning for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions/Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials. Journal of Cardiova s cular Pharmacology and Therapeutics , 21, 53-63. https://doi.org/10.1177/1074248415590197
Pranata, R., Tondas, A.E., Vania, R., Toruan, M.P.L., Lukito, A.A. and Siswanto, B.B. (2020) Remote Ischemic Preconditioning Reduces the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography/Intervention: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Catheterization and Cardiovascular Interve ntions , 96, 1200-1212. https://doi.org/10.1002/ccd.28709