PCI complications: renal failure
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PCI complications: renal failure On the Web
American Roentgen Ray Society Images of PCI complications: renal failure
Editors-In-Chief: Alexandra Almonacid M.D., Jeffrey J.Popma M.D.
Acute kidney injury (AKI) occurs in approximately 7% of patients undergoing PCI, of whom 3% develop AKI that requires dialysis. Increased occurrence of AKI among patients undergoing PCI is associated with the presence of STEMI, preexisting baseline renal failure and cardiogenic shock. The occurrence of AKI following PCI is associated with increased in-hospital mortality.
- Contrast Induced Nephropathy
- The risk of CIN is dependent on the dose of the contrast agents used, hydration status at the time of the procedure, pre-existing renal function of the patient, age, hemodynamic stability, anemia, and diabetes, and the risk for cholesterol embolization syndrome relates to catheter manipulation in an ascending or descending atherosclerotic aorta that releases cholesterol crystals.
- While the risk of hemodialysis is less than 3 percent in cases of uncomplicated CIN, the in-hospital mortality in the setting of hemodialysis exceeds 30 percent.
- Prior renal insufficiency
- Diabetes Mellitus
- Dehydration before the procedure
- Congestive Heart Failure
- Larger volumes of contrast material
- Nephrotoxic drugs
- Recent (<48 hour) contrast exposure.
Natural History, Complications and Prognosis
- The morbidity and mortality associated with PCI relates directly to the extent of baseline renal disease.
- Patients with evidence of mild renal dysfunction have a 20 percent higher risk of death a one year following PCI than patients with preserved renal function.
- Mild renal dysfunction following PCI may increase the risk of death up to four fold at one year following PCI compared with patients with preserved renal function.
- Worsening of renal function may occur after contrast agent administration in 13 to 20% of patients.
- 5% patient will have a 1 mg/dl increase of creatinine following angiography.
- <1% chronic dialysis.
Toxicities Associated with Radiocontrast Agents
- Allergic (anaphylactoid) reactions
- Cardiovascular toxicity
2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)
Contrast-Induced Acute Kidney Injury (DO NOT EDIT)
|"1. Patients should be assessed for risk of contrast-induced acute kidney injury before PCI. (Level of Evidence: C)"|
|"2. Patients undergoing cardiac catheterization with contrast media should receive adequate preparatory hydration. (Level of Evidence: B)"|
|"3. In patients with chronic kidney disease (CKD) (creatinine clearance ≤60 mL/min), the volume of contrast media should be minimized. (Level of Evidence: B)"|
|Class III (No Benefit)|
|"1. Administration of N-acetyl-L-cysteine is not useful for the prevention of contrast-induced acute kidney injury.  (Level of Evidence: A)"|
PCI in Chronic Kidney Disease (DO NOT EDIT)
|"1. In patients undergoing PCI, the glomerular filtration rate should be estimated and the dosage of renally cleared medications should be adjusted. (Level of Evidence: B)"|
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