Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Strategies for Renal Protection in Cardiovascular Interventions

  • Ziad A. Ali (The Heart Center, St. Francis Hospital) ;
  • Javier Escaned (Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid) ;
  • Dariusz Dudek (Institute of Cardiology, Jagiellonian University) ;
  • Jai Radhakrishnan (Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University) ;
  • Keyvan Karimi Galougahi (Heart Research Institute)
  • Received : 2022.03.24
  • Accepted : 2022.05.13
  • Published : 2022.07.01
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Abstract

Coronary artery disease is highly prevalent in chronic kidney disease (CKD) and is a risk factor for contrast-associated acute kidney injury (CA-AKI), a complication of cardiovascular procedures that require contrast administration (e.g., coronary angiography, percutaneous coronary intervention [PCI]). CA-AKI has a major impact on morbidity, mortality, and healthcare resource utilization. The incidence of CA-AKI is particularly high in patients with pre-existing CKD, advanced age and comorbidities that increase the likelihood of CKD. The focus of the present review is to provide a brief overview on the assessment of the risk for and prevention of CA-AKI in patients undergoing angiography and PCI, including recognition of the important patient- and procedure-related factors that may contribute to CA-AKI. Preventive and treatment strategies, the mainstay of which is volume repletion by normal saline, are briefly discussed. The main focus of the review is placed on technical details of contrast minimization techniques, including ultra-low contrast angiography and zerocontrast PCI. Operator competence in such techniques is important to ensure that procedural challenges in patients with CKD, like vessel calcification, multivessel disease and complex anatomical subsets, are effectively addressed by PCI while minimizing the risk of CA-AKI.

Keywords

Acknowledgement

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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