Intravenous fluids for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography and cardiac catheterization

ABSTRACT

Introduction: Contrast-induced nephropathy is a known complication that can occur after intravascular administration of iodinated contrast medium. Its consequences can range from a mild worsening of the renal function to renal failure requiring renal replacement therapy. There is no known effective treatment for contrast-induced nephropathy, and thus, efforts have focused on its prevention. Many approaches have been studied, but the most common strategy in use at the present time is prophylactic intravenous isotonic saline.

Areas covered: This article reviews the data supporting the current practice of prophylactic periprocedural intravenous isotonic saline for lowering the incidence of contrast-induced nephropathy. We reviewed PubMed to search primarily for the latest clinical trials and meta-analyses pertaining to contrast-induced nephropathy and the use of prophylactic measures, specifically intravenous infusion of isotonic saline.

Expert commentary: Currently, there are no universally accepted methods for the prevention of contrast-induced nephropathy. The best evidence for contrast-induced nephropathy prophylaxis is the administration of intravenous isotonic saline. Our review article provides an overview of the current knowledge, latest research, and current practice on contrast-induced nephropathy prophylaxis using intravenous isotonic saline administration.

KEYWORDS:

• Contrast-induced nephropathy
• intravenous fluid therapy
• normal saline
• coronary angiography
• cardiac catheterization

Article highlights

• Contrast-induced nephropathy is an iatrogenic cause of acute kidney injury and one of the most frequent causes of deteriorating renal function in hospitalized inpatients.

• There is no cure for contrast-induced nephropathy and so the emphasis is on preventing it.

• Of all the strategies employed for prevention, infusion of IVIS is the most consistently shown to be effective.

• Several new studies have refined our understanding regarding the patient population that may benefit the most, the guidance of hemodynamic measurements and the utility of IVIS infusion to prevent contrast-induced nephropathy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.