Contrast material-induced renal failure: an overview.

The administration of iodinated contrast media (CM) is integral to many cardiovascular procedures. While it is clear that CM provide significant diagnostic benefit, there is some risk of contrast medium-related adverse events in a small percentage of patients. Potentially the most serious complication associated with the use of iodinated contrast agents is contrast-induced nephropathy (CIN). Most patients undergoing contrast-enhanced radiographic procedures are not at risk for CIN, however subjects with pre-existing renal insufficiency, diabetes mellitus, or cardiovascular disease receiving intra-arterial administrations of contrast material are at increased risk. Typically, patients with CIN will experience changes in serum creatinine 1-5 days following contrast exposure. While decrements in renal function are generally small and transient, some patients experience a more prolonged decrease and, in rare cases, require dialysis. More importantly, there is substantial literature documenting that patients with CIN after cardiac intervention experience greater morbidity (including prolonged hospitalization) and acute and 1-year mortality. The present article aims to briefly review the pathogenesis of CIN and reviews current opinion on how best to prevent CIN and manage at-risk patients.