With a decrease in GFR, there is also a parallel decrease in the number of nephrons. Thus, a lower GFR means contrast remains for a longer period of time in the circulation. Contrast is freely filtered and its half-life increases as GFR decreases. This is consistent with the guideline recommendations to stratify risk based on baseline kidney function. To make the calculation of a maximum dose relevant to the individual patient, the majority of the proposed equations use baseline kidney function as a key factor. It is this latter determination of AKI risk that has been the subject of multiple studies.

However, during the procedure, it is also necessary to track how much contrast has been administered and have a MACD that represents the dose at which the risk of AKI increases significantly in that individual. For the most part, these approaches can be established in advance of the procedure and protocolized. Ī number of techniques and devices have been developed to limit the exposure of the kidney to contrast, including avoidance of unnecessary LV grams, use of intravascular ultrasound, automated contrast injectors, pressure sensitive diverters, coronary sinus aspiration, use of the radial artery approach with small-bore catheters, and staging complex procedures. Sampling of cardiologist’s practices reveals a very large spectrum of contrast use for PCI reflecting differing patterns of adherence to this third guideline. The third arm of the prevention strategy is to limit the amount of contrast given for the procedure. A second preventative approach is to ensure that patients get “adequate hydration.” Although this is not defined further, most cardiologists and nephrologists take this to mean correction of any preexisting volume depletion by administering isotonic saline intravenously before, during and after the procedure and promoting a vigorous urine output to dilute out the contrast in the urinary space. There are a number of risk assessment tools, but all rely on knowledge of baseline kidney function and most include the amount of contrast media administered. First is to assess individual patient risk of developing AKI. Current guidelines from the primary cardiology societies (AHA, ACC, and SCAI) recommend a 3-pronged approach to the prevention of AKI.

As there is no effective therapeutic to reverse the injury once it occurs, prevention is the cornerstone of managing patients. Acute renal injury following coronary interventions remains a serious adverse event that is associated with long-term worsening of kidney function and cardiovascular morbidity and mortality. We have organized the links on this page to help staff members more quickly identify and access that content.In this issue of the journal, a group from Boston reassesses the maximum amount of contrast dose (MACD) at which the risk of acute kidney injury (AKI) increases in patients undergoing coronary interventions. These are links to the content on the eGuidelines+ that are especially relevant to staff members performing cardiac catherization procedures, whether in an OR, cath lab, or ambulatory surgery center.

Cardiac cath guideliner