Kontrastmittelinduziertes Nierenversagen

ZUSAMMENFASSUNG

Ein akutes Nierenschädigungsereignis bedeutet für Patienten ein erhöhtes Mortalitätsrisiko, Morbiditätsrisiko sowie ein erhöhtes Risiko für eine chronische Nierenerkrankung. Daher stellt sich im klinischen Alltag stets die Frage, wie eine akute Nierenschädigung nicht nur behandelt, sondern v. a. auch präventiv vermieden werden kann. In erster Linie gilt es, Patienten durch diagnostische und therapeutische Maßnahmen nicht mehr zu schaden als zu helfen. Die wahrscheinlich am häufigsten genutzte Diagnostik im medizinischen Alltag stellt sicher die Bildgebung und die damit häufig verbundene Gabe von Kontrastmittel (KM) dar, dessen Einfluss auf die Nierenfunktion durchaus kontrovers ist. Dieser Artikel gibt einen Überblick über die aktuelle Datenlage und den wissenschaftlichen Diskurs bzgl. des kontrastmittelinduzierten Nierenversagens (KIN).

Publication History

Article published online:
14 March 2022

• Literaturverzeichnis

• 1 Tsai TT, Patel UD, Chang TI. et al Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J Am Heart Assoc 2014; 03: e001380
• 2 Nijssen EC, Rennenberg RJ, Nelemans PJ. et al Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet 2017; 389: 1312-1322
• 3 Weinreb JC, Rodby RA, Yee J. et al Use of Intravenous Gadolinium-Based Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020; 03: 142-150
• 4 Newhouse JH, Kho D, Rao QA. et al Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol 2008; 191: 376-382
• 5 Lee YC, Hsieh CC, Chang TT. et al Contrast-Induced Acute Kidney Injury Among Patients With Chronic Kidney Disease Undergoing Imaging Studies: A Meta-Analysis. AJR Am J Roentgenol 2019; 213: 728-735
• 6 McDonald JS, McDonald RJ, Comin J. et al Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology 2013; 267: 119-128
• 7 McDonald RJ, McDonald JS, Bida JP. et al Intravenous contrast material-induced nephropathy: causal or coincident phenomenon?. Radiology 2013; 267: 106-118
• 8 Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol 1999; 09: 1602-1613
• 9 Thakar CV, Christianson A, Freyberg R. et al Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med 2009; 37: 2552-2558
• 10 Latus J, Schwenger V, Schlieper G. et al Kontrastmittelinduzierte akute Nierenschädigung – Konsensuspapier der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. und der Deutschen Gesellschaft für Nephrologie e. V. Kardiologe 2020; 14: 494-504
• 11 Venturi G, Pighi M, Lunardi M. et al Contrast-Induced Nephropathy in Patients Undergoing Staged Versus Concomitant Transcatheter Aortic Valve Implantation and Coronary Procedures. J Am Heart Assoc 2021; 10: e020599
• 12 Humes HD, Hunt DA, White MD. Direct toxic effect of the radiocontrast agent diatrizoate on renal proximal tubule cells. Am J Physiol 1987; 252: F246-F255
• 13 Dickenmann M, Oettl T, Mihatsch MJ. Osmotic nephrosis: acute kidney injury with accumulation of proximal tubular lysosomes due to administration of exogenous solutes. Am J Kidney Dis 2008; 51: 491-503
• 14 Persson PB, Tepel M. Contrast medium-induced nephropathy: the pathophysiology. Kidney Int Suppl 2006; 69: S8-S10
• 15 Seeliger E, Becker K, Ladwig M. et al Up to 50-fold increase in urine viscosity with iso-osmolar contrast media in the rat. Radiology 2010; 256: 406-414
• 16 Seeliger E, Flemming B, Wronski T. et al Viscosity of contrast media perturbs renal hemodynamics. J Am Soc Nephrol 2007; 18: 2912-2920
• 17 Sendeski M, Patzak A, Pallone TL. et al Iodixanol, constriction of medullary descending vasa recta, and risk for contrast medium-induced nephropathy. Radiology 2009; 251: 697-704
• 18 Liss P. Effects of contrast media on renal microcirculation and oxygen tension. An experimental study in the rat. Acta Radiol Suppl 1997; 409: 1-29
• 19 Bainey KR, Rahim S, Etherington K. et al Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization: Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Cardiac Catheterization (CAPTAIN) trial. Am Heart J 2015; 170: 110-116
• 20 Weisbord SD, Gallagher M, Palevsky PM. Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med 2018; 378: 1749
• 21 Li H, Wang C, Liu C, Li R, Zou M, Cheng G. Efficacy of Short-Term Statin Treatment for the Prevention of Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography/Percutaneous Coronary Intervention: A Meta-Analysis of 21 Randomized Controlled Trials. Am J Cardiovasc Drugs 2016; 16: 201-219
• 22 Leoncini M, Toso A, Maioli M. et al Early high-dose rosuvastatin for contrast-induced nephropathy prevention in acute coronary syndrome: Results from the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome). J Am Coll Cardiol 2014; 63: 71-79
• 23 Toso A, Leoncini M, Maioli M. et al A Prospective, Randomized, Open-Label Trial of Atorvastatin versus Rosuvastatin in the Prevention of Contrast-Induced Acute Kidney Injury, Worsened Renal Function at 30 Days, and Clinical Events After Acute Coronary Angiography: the PRATO-ACS-2 Study. Cardiorenal Med 2020; 10: 288-301
• 24 Klima T, Christ A, Marana I. et al Sodium chloride vs. sodium bicarbonate for the prevention of contrast medium-induced nephropathy: a randomized controlled trial. Eur Heart J 2012; 33: 2071-2079
• 25 Nijssen EC, Nelemans PJ, Rennenberg RJ. et al Evaluation of Safety Guidelines on the Use of Iodinated Contrast Material: Conundrum Continued. Invest Radiol 2018; 53: 616-622
• 26 Barbanti M, Gulino S, Capranzano P. et al Acute Kidney Injury With the RenalGuard System in Patients Undergoing Transcatheter Aortic Valve Replacement: The PROTECT-TAVI Trial (PROphylactic effecT of furosEmide-induCed diuresis with matched isotonic intravenous hydraTion in Transcatheter Aortic Valve Implantation). JACC Cardiovasc Interv 2015; 08: 1595-1604
• 27 Marenzi G, Ferrari C, Marana I. et al Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv 2012; 05: 90-97
• 28 Moon SS, Bäck SE, Kurkus J. et al Hemodialysis for elimination of the nonionic contrast medium iohexol after angiography in patients with impaired renal function. Nephron 1995; 70: 430-437
• 29 Reinecke H, Fobker M, Wellmann J. et al A randomized controlled trial comparing hydration therapy to additional hemodialysis or N-acetylcysteine for the prevention of contrast medium-induced nephropathy: the Dialysis-versus-Diuresis (DVD) Trial. Clin Res Cardiol 2007; 96: 130-139
• 30 Cruz DN, Goh CY, Marenzi G. et al Renal replacement therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Med 2012; 125: 66-78e3
• 31 Marenzi G, Lauri G, Campodonico J. et al Comparison of two hemofiltration protocols for prevention of contrast-induced nephropathy in high-risk patients. Am J Med 2006; 119: 155-162
• 32 Oloko A, Talreja H, Davis A. et al Does Iodinated Contrast Affect Residual Renal Function in Dialysis Patients? A Systematic Review and Meta-Analysis. Nephron 2020; 144: 176-184
• 33 Morcos R, Kucharik M, Bansal P. et al Contrast-Induced Acute Kidney Injury: Review and Practical Update. Clin Med Insights Cardiol 2019; 13: 1179546819878680