Mahgoub Mohammed, Fan Jerry, Concepcion Luis, Tanner Stephan B, Adams Kadilee, Widmer Robert J
Division of Nephrology, Baylor University Medical Center, Dallas, Texas, USA.
Division of Cardiology, Baylor Scott and White Medical Center - Temple, Temple, Texas, USA.
Proc (Bayl Univ Med Cent). 2024 Aug 29;37(6):938-944. doi: 10.1080/08998280.2024.2395765. eCollection 2024.
Contrast-associated acute kidney injury (CA-AKI) is an abrupt decline in kidney function occurring after a recent exposure to iodinated radiocontrast media. CA-AKI presents as elevated serum creatinine level or decreased urine output. CA-AKI is the third leading cause of inpatient AKI. The incidence of CA-AKI varies according to patient population characteristics, ranging from 5% in the general population to as high as 30% in special populations with preexisting comorbidities such as diabetes mellitus, cardiovascular disease, and chronic kidney disease. The development of CA-AKI places a heavy toll on patients and the healthcare system secondary to increased patient morbidity, mortality, hospital length of stay, readmission risk, and healthcare cost. Patients undergoing cardiac catheterization are of special interest, since they have higher risk of developing CA-AKI and its associated complications. The recognition, prevention, and management of CA-AKI has improved over the past few years with the introduction of fluid management guidelines, using less nephrotoxic radiocontrast media, and preprocedural CA-AKI risk assessment. Future advancements in patients' CA-AKI risk stratification and early detection will facilitate prompt initiation of mitigation treatment plans and decrease associated complications.
造影剂相关急性肾损伤(CA-AKI)是指近期接触含碘造影剂后肾功能突然下降。CA-AKI表现为血清肌酐水平升高或尿量减少。CA-AKI是住院患者急性肾损伤的第三大主要原因。CA-AKI的发生率因患者人群特征而异,在普通人群中为5%,在患有糖尿病、心血管疾病和慢性肾病等合并症的特殊人群中高达30%。CA-AKI的发生给患者和医疗系统带来了沉重负担,这是由于患者发病率、死亡率、住院时间、再入院风险和医疗成本增加所致。接受心脏导管插入术的患者尤其值得关注,因为他们发生CA-AKI及其相关并发症的风险更高。在过去几年中,随着液体管理指南的引入、使用肾毒性较小的造影剂以及术前CA-AKI风险评估,CA-AKI的识别、预防和管理有了改善。患者CA-AKI风险分层和早期检测方面的未来进展将有助于及时启动缓解治疗计划并减少相关并发症。