Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Patients treated by the interventional cardiologist are now older and more frequently have coexistent renal insufficiency than in the past. Exacerbation of renal function can be a serious, morbid complication of cardiac catheterization or intervention and efforts to avoid this untoward event are important to acknowledge.The incidence of contrast-induced nephropathy (CIN) ranges from 2% in patients with normal baseline renal function to as high as 20% to 30% in patients with a baseline creatinine u003e2 mg/dL.1,2 The most commonly used definition of CIN is an absolute rise in serum creatinine (SCr) of 0.5 mg/dL or a 25% increase from the baseline value, assessed within 48 hours after the procedure.3Most CIN risk factors can be accessed from clinical history, physical examination, and common laboratory tests. Preexisting chronic kidney disease is probably the most important preprocedural risk factor for CIN. Because an estimated glomerular filtration rate 75 years, advanced heart failure, left ventricular systolic function u003c45%, and anemia.5,6 Different scoring schemes have been proposed to predict the risk for CIN, but none has been adequately validated. When at-risk patients are identified, various measures can be offered to reduce CIN occurrence. Withdrawal of Potentially Nephrotoxic MedicationsPatients should be advised to withhold all nonessential medications that may be nephrotoxic for 24 hours before the procedure (Table). Although there has been controversy as to whether angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may predispose to nephrotoxicity, a recent study demonstrated no such effect.7 Accordingly, it is reasonable to …