Methods to reduce the rate of contrast-induced acute kidney injury after percutaneous coronary interventions
Contrast-induced acute kidney injury (CI-AKI) is an iatrogenic injury of kidney parenchyma occurring after the administration of iodinated radiocontrast agent (RCA). The number of patients who receive high-technology cardiologic care increases annually, the consumption of RCA also increases. The result is a higher rate of CI-AKI after coronary angiography and percutaneous coronary interventions. CI-AKI increases the rate and number of cardiovascular complications, the length of in-hospital stay, and the need in renal replacement therapy and is also associated with a 5-fold increase in the hospital mortality rate. CI-AKI is more common in patients with chronic kidney disease. Preventive and treatment strategies for CI-AKI involve minimization of RCA via the reduction of its volume or the use of specific equipment (e.g., intravascular ultrasound or optical coherence tomography). Various additional measures to reduce the risk of CI-AKI can be applied as well, i.e., radial approach, ischemic preconditioning, hemodynamic support in high-risk patients. The authors review the methods for CI-AKI prevention and analyze technical aspects to improve the quality of medical care in patients with high risk of CI-AKI after percutaneous coronary interventions.