Recent advances in the prevention of radiocontrast-induced nephropathy

Research output: Contribution to journalArticle

Abstract

Purpose of review: Radiocontrast nephropathy is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal failure. The optimal strategy to prevent radiocontrast nephropathy has not been established. This article reviews recent clinical researches concerning new developments in the prevention of radiocontrast nephropathy and analyzes unresolved issues. Recent findings: Among all prophylactic measures that have been proposed, periprocedural hydration with isotonic saline has demonstrated effectiveness in the prevention of radiocontrast nephropathy. Thus, it remains the most frequently applied measure in clinical practice. Recently, additional benefit has been shown to derive from the infusion of isotonic alkalizing (sodium bicarbonate), instead of isotonic (sodium chloride) solutions. The use of nonionic low-osmolar and, more recently, nonionic iso-osmolar contrast agents has been demonstrated to significantly reduce the risk of radiocontrast nephropathy in patients with renal impairment, in comparison with hyperosmolar contrast media. Recently, periprocedural hemofiltration has emerged as a safe and very effective strategy to prevent radiocontrast nephropathy and to reduce its associated poor outcome in patients with severe chronic renal failure. In the past few years, several trials with acetylcysteine have shown conflicting results. Nevertheless, most of them indicated that acetylcysteine, particularly when associated with adequate hydration, might be useful in preventing radiocontrast nephropathy in patients with renal impairment. A possible dose-dependent protective effect has been suggested by more recent trials that included patients undergoing coronary interventional procedures requiring large contrast volume. Summary: Adequate prophylaxis is needed to reduce the high morbidity and mortality associated with radiocontrast nephropathy in high-risk patients. By reviewing the available evidence from clinical trials, this article provides an overview of current strategies and unresolved issues concerning the prevention of radiocontrast nephropathy.

Original languageEnglish
Pages (from-to)505-509
Number of pages5
JournalCurrent Opinion in Critical Care
Volume10
Issue number6
Publication statusPublished - Dec 2004

Fingerprint

Acetylcysteine
Contrast Media
Chronic Kidney Failure
Morbidity
Kidney
Hemofiltration
Sodium Bicarbonate
Mortality
Sodium Chloride
Clinical Trials
Research

Keywords

  • Acetylcysteine
  • Chronic renal failure
  • Hemofiltration
  • Intravenous hydration
  • Radiocontrast-induced nephropathy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Recent advances in the prevention of radiocontrast-induced nephropathy. / Marenzi, Giancarlo; Bartorelli, Antonio L.

In: Current Opinion in Critical Care, Vol. 10, No. 6, 12.2004, p. 505-509.

Research output: Contribution to journalArticle

@article{16ff527673734b64a75e79e019f4c48b,
title = "Recent advances in the prevention of radiocontrast-induced nephropathy",
abstract = "Purpose of review: Radiocontrast nephropathy is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal failure. The optimal strategy to prevent radiocontrast nephropathy has not been established. This article reviews recent clinical researches concerning new developments in the prevention of radiocontrast nephropathy and analyzes unresolved issues. Recent findings: Among all prophylactic measures that have been proposed, periprocedural hydration with isotonic saline has demonstrated effectiveness in the prevention of radiocontrast nephropathy. Thus, it remains the most frequently applied measure in clinical practice. Recently, additional benefit has been shown to derive from the infusion of isotonic alkalizing (sodium bicarbonate), instead of isotonic (sodium chloride) solutions. The use of nonionic low-osmolar and, more recently, nonionic iso-osmolar contrast agents has been demonstrated to significantly reduce the risk of radiocontrast nephropathy in patients with renal impairment, in comparison with hyperosmolar contrast media. Recently, periprocedural hemofiltration has emerged as a safe and very effective strategy to prevent radiocontrast nephropathy and to reduce its associated poor outcome in patients with severe chronic renal failure. In the past few years, several trials with acetylcysteine have shown conflicting results. Nevertheless, most of them indicated that acetylcysteine, particularly when associated with adequate hydration, might be useful in preventing radiocontrast nephropathy in patients with renal impairment. A possible dose-dependent protective effect has been suggested by more recent trials that included patients undergoing coronary interventional procedures requiring large contrast volume. Summary: Adequate prophylaxis is needed to reduce the high morbidity and mortality associated with radiocontrast nephropathy in high-risk patients. By reviewing the available evidence from clinical trials, this article provides an overview of current strategies and unresolved issues concerning the prevention of radiocontrast nephropathy.",
keywords = "Acetylcysteine, Chronic renal failure, Hemofiltration, Intravenous hydration, Radiocontrast-induced nephropathy",
author = "Giancarlo Marenzi and Bartorelli, {Antonio L.}",
year = "2004",
month = "12",
language = "English",
volume = "10",
pages = "505--509",
journal = "Current Opinion in Critical Care",
issn = "1070-5295",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Recent advances in the prevention of radiocontrast-induced nephropathy

AU - Marenzi, Giancarlo

AU - Bartorelli, Antonio L.

PY - 2004/12

Y1 - 2004/12

N2 - Purpose of review: Radiocontrast nephropathy is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal failure. The optimal strategy to prevent radiocontrast nephropathy has not been established. This article reviews recent clinical researches concerning new developments in the prevention of radiocontrast nephropathy and analyzes unresolved issues. Recent findings: Among all prophylactic measures that have been proposed, periprocedural hydration with isotonic saline has demonstrated effectiveness in the prevention of radiocontrast nephropathy. Thus, it remains the most frequently applied measure in clinical practice. Recently, additional benefit has been shown to derive from the infusion of isotonic alkalizing (sodium bicarbonate), instead of isotonic (sodium chloride) solutions. The use of nonionic low-osmolar and, more recently, nonionic iso-osmolar contrast agents has been demonstrated to significantly reduce the risk of radiocontrast nephropathy in patients with renal impairment, in comparison with hyperosmolar contrast media. Recently, periprocedural hemofiltration has emerged as a safe and very effective strategy to prevent radiocontrast nephropathy and to reduce its associated poor outcome in patients with severe chronic renal failure. In the past few years, several trials with acetylcysteine have shown conflicting results. Nevertheless, most of them indicated that acetylcysteine, particularly when associated with adequate hydration, might be useful in preventing radiocontrast nephropathy in patients with renal impairment. A possible dose-dependent protective effect has been suggested by more recent trials that included patients undergoing coronary interventional procedures requiring large contrast volume. Summary: Adequate prophylaxis is needed to reduce the high morbidity and mortality associated with radiocontrast nephropathy in high-risk patients. By reviewing the available evidence from clinical trials, this article provides an overview of current strategies and unresolved issues concerning the prevention of radiocontrast nephropathy.

AB - Purpose of review: Radiocontrast nephropathy is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal failure. The optimal strategy to prevent radiocontrast nephropathy has not been established. This article reviews recent clinical researches concerning new developments in the prevention of radiocontrast nephropathy and analyzes unresolved issues. Recent findings: Among all prophylactic measures that have been proposed, periprocedural hydration with isotonic saline has demonstrated effectiveness in the prevention of radiocontrast nephropathy. Thus, it remains the most frequently applied measure in clinical practice. Recently, additional benefit has been shown to derive from the infusion of isotonic alkalizing (sodium bicarbonate), instead of isotonic (sodium chloride) solutions. The use of nonionic low-osmolar and, more recently, nonionic iso-osmolar contrast agents has been demonstrated to significantly reduce the risk of radiocontrast nephropathy in patients with renal impairment, in comparison with hyperosmolar contrast media. Recently, periprocedural hemofiltration has emerged as a safe and very effective strategy to prevent radiocontrast nephropathy and to reduce its associated poor outcome in patients with severe chronic renal failure. In the past few years, several trials with acetylcysteine have shown conflicting results. Nevertheless, most of them indicated that acetylcysteine, particularly when associated with adequate hydration, might be useful in preventing radiocontrast nephropathy in patients with renal impairment. A possible dose-dependent protective effect has been suggested by more recent trials that included patients undergoing coronary interventional procedures requiring large contrast volume. Summary: Adequate prophylaxis is needed to reduce the high morbidity and mortality associated with radiocontrast nephropathy in high-risk patients. By reviewing the available evidence from clinical trials, this article provides an overview of current strategies and unresolved issues concerning the prevention of radiocontrast nephropathy.

KW - Acetylcysteine

KW - Chronic renal failure

KW - Hemofiltration

KW - Intravenous hydration

KW - Radiocontrast-induced nephropathy

UR - http://www.scopus.com/inward/record.url?scp=10244229649&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10244229649&partnerID=8YFLogxK

M3 - Article

C2 - 15616393

AN - SCOPUS:10244229649

VL - 10

SP - 505

EP - 509

JO - Current Opinion in Critical Care

JF - Current Opinion in Critical Care

SN - 1070-5295

IS - 6

ER -