Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.
Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):443-450. doi: 10.1002/ccd.28740. Epub 2020 Jan 22.
Contrast-induced acute kidney injury (CI-AKI) represents a common but serious complication of percutaneous coronary interventions (PCI)-and in general of all those examinations requiring iodinated contrast injection-which affects not only renal function but also long-term prognosis. While several prophylactic approaches were designed in order to prevent CI-AKI, most failed to demonstrate clear benefits in randomized trials, and their implementation is therefore discouraged in clinical practice. The most notorious examples include pre-procedural bicarbonate or N-acetylcysteine, and preprocedural withdrawal of ACE inhibitors/Angiotensin receptor blockers. Those strategies that were instead demonstrated effective include the appropriate use of preprocedural hydration, reduction in contrast volume utilization, adoption of techniques for zero- or ultra-low-contrast procedures, and pharmacological treatments with statins. In this brief review, we summarize the main preventive strategies into brief and pragmatic recommendations designed to improve everyday clinical practice.
对比剂诱导的急性肾损伤（CI-AKI）是经皮冠状动脉介入治疗（PCI）——以及一般所有需要碘造影剂注射的检查——的常见但严重的并发症，它不仅会影响肾功能，还会影响长期预后。尽管已经设计了几种预防方法来预防 CI-AKI，但大多数方法在随机试验中并未显示出明显的益处，因此在临床实践中不鼓励使用。最著名的例子包括术前碳酸氢盐或 N-乙酰半胱氨酸，以及术前停用 ACE 抑制剂/血管紧张素受体阻滞剂。而被证明有效的策略包括适当使用术前水化、减少造影剂用量、采用零或超低对比技术，以及使用他汀类药物进行药物治疗。在这篇简要的综述中，我们将主要的预防策略总结为简短而实用的建议，旨在改善日常临床实践。
