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      Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

      review-article
      Author(s): 1 , , 2
      Publication date (Electronic):
      Journal: Critical Care
      Publisher: BioMed Central

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          Abstract

          Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever international multidisciplinary clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. Two topics, contrast-induced AKI and management of renal replacement therapy, deserve special attention because of the frequency in which they are encountered and the availability of evidence. Recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided. This review is an abridged version of the guideline and provides additional rationale and commentary for those recommendation statements that most directly impact the practice of critical care.

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          A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

          Roxana Mehran, Eve Aymong, Eugenia Nikolsky … (2004)
          We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown. A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase >or=25% and/or >or=0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value 75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient. The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [ or=16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively). The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.
          Article 0 comments Cited 487 times – based on 0 reviews     Review now
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            Contrast-induced acute kidney injury.

            Peter A. McCullough (2008)
            Cardiac angiography and coronary/vascular interventions depend on iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired renal failure, with adverse effects on prognosis and health care costs. The epidemiology and pathogenesis of contrast-induced AKI, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use, and preventive strategies are discussed in this report. An advanced algorithm is suggested for the risk stratification and management of contrast-induced AKI as it relates to patients undergoing cardiovascular procedures. Contrast-induced AKI is likely to remain a significant challenge for cardiologists in the future because the patient population is aging and chronic kidney disease and diabetes are becoming more common.
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              Clinical practice guidelines for vascular access.

              (2006)
              Article 0 comments Cited 179 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Norbert Lameire
                John A Kellum
                Journal
                Journal ID (nlm-ta): Crit Care
                Journal ID (iso-abbrev): Crit Care
                Title: Critical Care
                Publisher: BioMed Central
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2013
                Publication date (Electronic): 4 February 2013
                Publication date PMC-release: 4 February 2014
                Volume: 17
                Issue: 1
                Page: 205
                Affiliations
                [1 ]Ghent University Hospital, De Pintelaan 185, Ghent B9000, Belgium
                [2 ]The CRISMA Center, Department of Critical Care Medicine, 604 Scaife Hall, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
                [3 ]KDIGO AKI Guideline Work Group: John A Kellum (Work Group Co-Chair), University of Pittsburgh, PA, USA; Norbert Lameire (Work Group Co-Chair), University of Ghent, Belgium; Peter Aspelin, Karolinska Institute, Sweden; Rashad S Barsoum, Cairo University, Egypt; Emmanuel A Burdmann, University of São Paulo, Brazil; Stuart L Goldstein, Cincinnati Children's Hospital Medical Center, OH, USA; Charles A Herzog, Hennepin County Medical Center, MN, USA; Michael Joannidis, Medical University Innsbruck, Austria; Andreas Kribben, University of Duisburg-Essen, Germany; Andrew S Levey, Tufts University, MA, USA; Alison M Macleod, University of Aberdeen, UK; Ravindra L Mehta, University of California, San Diego, CA, USA; Patrick T Murray, University College Dublin, Ireland; Saraladevi Naicker, University of the Witwatersrand, South Africa; Steven M Opal, Brown University, RI, USA; Franz Schaefer, Heidelberg University Hospital, Germany; Miet Schetz, University of Leuven, Belgium; and Shigehiko Uchino, Jikei University School of Medicine, Japan
                Author notes
                for the KDIGO AKI Guideline Work Group
                Article
                Publisher ID: cc11455
                DOI: 10.1186/cc11455
                PMC ID: 4056805
                PubMed ID: 23394215
                SO-VID: 11acd221-21e5-4460-a81d-a3b5fdef0648
                Copyright © Copyright © 2013 BioMed Central Ltd
                History
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                Subject: Review

                ScienceOpen disciplines: Emergency medicine & Trauma
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                ScienceOpen disciplines: Emergency medicine & Trauma

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