Nephropathy induced by contrast agent: do we know everything?

Authors: M. Berková;  Z. Berka;  E. Topinková
Published in: Geriatrie a Gerontologie 2018, 7, č. 1: 11-16


Continuously increasing number of radiodiagnostic imaging, often associated with therapeutic performance, requires intravascular administration of iodinated contrast medium. In this paper, we want to draw attention to the possible undesirable effect of iodinated contrast media in the form of contrast-induced nephropathy (CIN). Risk factors of the onset, course and precautionary measures to reduce the risk of CIN and the development of newer, less risky iodine contrast agents are analysed. There is also a different view of some authors, who do not consider applying iodinated contrast agent as an independent risk factor for impaired of renal function.

contrast-induced nephropathy – iodinated contrast medium – preventive measures


2. Roy AK, Mc Gorrian C, Treacy C, et al. A Comparison of traditional and novel Definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure. Cardiorenal Med 2013; 3: 26–37.

3. Newhouse JH, Kho D, Rao QA, et al. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol 2008; 191: 376–382.

4. Bruce RJ, Djamali A, Shinki K, et al. Background fluctuation of kidney function versus contrast-induced nephrotoxicity. AJR Am J Roentgenol 2009; 192: 711–718.

5. Sinert R, Brandler E, Subramanian RA, et al. Does the current definition of contrast-induced acute kidney injury reflect a true clinical entity? Acad Emerg Med 2012; 19: 1261–1267.

6. McDonald RJ, McDonald JS, Carter RE, et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology 2014; 273: 714–725.

7. Cely CM, Schein RM, Quartin AA. Risk of contrast induced nephropathy in the critically ill: a prospective, case matched study. Critical care (London, England) 2012; 16: R67.

8. Hinson JS, Ehmann MR, Fine DM, et al. Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med 2017; 69(5): 577–586.

9. Katzberg RW, Halley C. Contrast-induced nephrotoxicity: Clinical lansdscape. Kidney Int 2006; 69 (Suppl 100): S3–S7.

10. Brendan J, Barrett MB, Parfrey PS. Preventing nephropathy induced by contrast medium. N Engl J Med 2006; 354: 379–386.

11. Peer S, Choh NA, Gojwari TA. Incidence of contrast-induced nephropathy a prospective study. J Renal Inj Prev 2017; 6(3): 192–198.

12. McCullough PA. Contrast-induced acute kidney injury. JACC Vol. 51, No. 15, 2008.

13. Solomon R. Preventing contrast-induced nephropathy: problems, challenges and future directions. BMC Medicine 2009; 7: 24.

14. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiography. NEPHRIC Study. N Engl J Med 2003; 348: 491–499.

15. 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; 5; 48(5): 924–30.

16. Botev R, Mallié JP, Wetzels JFM, et al. The clinician and estimation of glomerular filtration rate by creatinine-based formulas: Current limitations and quo vadis. CJASN 2011; 6(4): 937–950.

17. Liu Y, Tan N, Zhou YL, et al. The contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy after primary percutaneous coronary intervention. Int Urol Nephrol 2012; 44: 221–229.

18. Pasternak JJ, Williamson EE. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: A primer for the non-radiologist. Mayo Clin Proc. 2012; 87(4): 390–402.

19. Jurado-Roman A, Hernandez-Hernandez F, Garcia-Tejada J, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol 2015; 115(9): 1174–1178.

20. Chalikias G, Drosos I, Tziakas DN. Prevention of contrast-induced acute kidney injury: an update. Cardiovasc Drugs Ther 2016; 30: 515–524.

21. Mueller C, Buerkle G, Buettner H, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002; 162: 329–336.

22. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical practice guideline for acute kidney injury. Kidney inter, Suppl. 2012; 2(1): 1–138.

23. Zhang B, Liang L, Chen W, et al. The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis. BMJ Open 2015; 5(3): e006989.

24. Jang JS, Jin HY, Seo JS, et al. Sodium bicarbonate therapy for the prevention of contrast-induced acute kidney injury - A systematic review and meta-analysis. Circ J. 2012; 76(9): 2255–2265.

25. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004 May 19; 291(19):2 328–34.

26. Trivedi H, Nadella R, Szabo A. Hydration with sodium bicarbonate for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials. Clin Nephrol 2010; 74: 288–296.

27. Maioli M, Toso A, Leoncini M, et al. Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol 2008; 52: 599–604.

28. 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; 389(10076): 1312–1322.

29. McCullough PA, Zhang J, Ronco C. Volume expansion and contrast-induced acute kidney injury. Lancet 2017; 389: 1277–1278.

30. Raje V, Feldman G, Jovin IS. Diagnosing and treating contrast-induced acute kidney injury in 2017. J Thorac Dis 2017; 9(6): 1443–1445.

31. Dorval JF, Dixon SR, Zelman RB, et al. Feasibility study of the RenalGuard balanced hydration system: a novel strategy for the prevention of contrast-induced nephropathy in high risk patients. Int J Cardiol 2013; 166(2): 482–486.

32. Gu G, Zhang Y, Lu R, et al. Additional furosemide treatment beyond saline hydration for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8(1): 387–394.

33. Duan N, Zhao J, Li Z, et al. Furosemide with saline hydration for prevention of contrast-induced nephropathy in patients undergoing coronary angiography: A meta-analysis of randomized controlled trials. Med Sci Monit 2015; 21: 292–297.

34. Yang B, Xu J, Xu F, et al. Intravascular administration of mannitol for acute kidney injury prevention: A systematic review and meta-analysis. PLoS One 2014; 9(1): e85029.

35. Sang-Ho Jo. N-acetylcysteine for Prevention of Contrast-Induced Nephropathy: A Narrative Review. Korean Circ J 2011; 41(12): 695–702.

36. Dai B, Liu Y, Fu L, et al. Effect of theophylline on prevention of contrast-induced acute kidney injury: a meta-analysis of randomized controlled trials. Am J Kidney Dis 2012; 60(3): 360–370.

37. Marenzi G, Cosentino N, Werba JP, et al. A meta-analysis of randomized controlled trials on statins for the prevention of contrast-induced acute kidney injury in patients with and without acute coronary syndromes. Int J Cardiol 2015; 183: 47–53.

38. Briasoulis A, Mallikethi-Reddy S, Sharma S, et al. 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; 22(6): 158–166.

39. Liu YH, Liu Y, Duan CY, et al. Statins for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography/Percutaneous Interventions: A meta-analysis of randomized controlled trials. J Cardiovasc Pharmacol Ther 2015; 20(2): 181–192.

40. Giacoppo D, Capodanno D, Capranzano P, et al. Meta-analysis of randomized controlled trials of preprocedural statin administration for reducing contrast-induced acute kidney injury in patients undergoing coronary catheterization. Am J Cardiol 2014; 114(4): 541–548.

41. Kawashima S, Takano H, Iino Y, et al. Prophylactic hemodialysis does not prevent contrast-induced nephropathy after cardiac catheterization in patients with chronic renal insufficiency. Circ J 2006; 70(5): 553-558.

42. Vogt B, Ferrari P, Schonholzer C, et al. Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful. Am J Med 2001; 111: 692–698.

43. Ghani AA, Hussain N, Al Helal B. Can continuous venovenous hemofiltration prevent contrast-agent induced nephropathy in patients with advanced chronic kidney disease after coronary angiography? Saudi J Kidney Dis Transpl 2011; 22(1): 54–60.

44. Choi MJ, Yoon JW, Han SJ, et al. The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: a comparison with periprocedural hemofiltration. 2014; 176(3): 941–945.

Geriatrics General practitioner for adults Orthopaedic prosthetics
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account