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Contrast-associated acute kidney injury: An update of risk factors, risk factor scores, and preventive measures

  • Yi Wang
    Affiliations
    Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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  • Kaixiang Liu
    Affiliations
    Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, China

    Department of Nephrology, Sichuan Provincial People’s Hospital, University of Electronic Scienceand Technology of China, Chengdu, China
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  • Xisheng Xie
    Correspondence
    Correspondence to: X. Xie, Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), 97 Renmin South Road, Shunqing District, Nanchong, Sichuan, China.
    Affiliations
    Department of Nephrology, Sichuan Provincial People’s Hospital, University of Electronic Scienceand Technology of China, Chengdu, China
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  • Bin Song
    Correspondence
    Correspondence to: B. Song, Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, China.
    Affiliations
    Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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      Highlights

      • Clinicians use different criteria to diagnose CA-AKI. Standardization is needed.
      • CA-AKI is associated with many risk factors, some of which are modifiable.
      • A scale can be used to estimate risk and guide prevention strategies.
      • Appropriate hydration is the key to prevention of CA-AKI.

      Abstract

      As lifespans lengthen, age-related diseases such as cardiovascular disease and diabetes are becoming more prevalent. Correspondingly, the use of contrast agents for medical imaging is also becoming more common, and there is increasing awareness of contrast-associated acute kidney injury (CA-AKI). There is no specific treatment for CA-AKI, and clinicians currently focus on prevention, interventions that alter its pathogenesis, and identification of risk factors. Although the incidence of CA-AKI is low in the general population, the risk of CA-AKI can reach 20% to 30% in patients with multiple risk factors. Many models have been applied in the clinic to assess the risk factors for CA-AKI, enable identification of high-risk groups, and improve clinical management. Hypotonic or isotonic contrast media are recommended to prevent CA-AKI in high-risk patients. Patients with risk factors should avoid using contrast media multiple times within a short period of time. All nephrotoxic drugs should be stopped at least 24 h before the administration of contrast media in high-risk populations, and adequate hydration is recommended for all patients. This review summarizes the pathophysiology of CA-AKI and the progress in diagnosis and differential diagnosis; updates the risk factors and risk factor scoring systems; reviews the latest advances related to prevention and treatment; discusses current problems in epidemiological studies; and highlights the importance of identifying high-risk subjects to control modifiable risk factors and use of a rating scale to estimate the risk and implement appropriate prevention strategies.

      Keywords

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