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There is a variety of definitions of RCN, the most common being an increase of serum creatinine greater than 0.5 mg/dl within 24–48 hours following exposure to contrast without other identifiable causes of ARF. RCN is defined by an acute decline in renal function (usually a rise in baseline creatinine of greater than 25% or absolute increase of 0.5 mg/dL) after systemic administration of contrast in the absence of other causes. The time course of contrast-induced renal failure is predictable. It occurs within 24–48 hours after exposure, with a typical peak creatinine after 3–5 days and a return to baseline or near baseline in 1 to 2 weeks .
In patients without risk factors the incidence is 2% , which appears low, but may amount to 600 000 cases per year in industrialized countries, in view of the large number of radiological examinations using iodinated CM. In patients with mild-to- oderate RI and diabetes, the incidence of CIN is reported in the range of 9 to >50% [4,5] and in patients with chronic diabetic azotaemic nephropathy, CIN can occur in 50–90% of the patients.
The commonly used methods for identifying patients at risk include use of patient questionnaires, review of medical history and measurement of serum creatinine levels prior to the administration of CM. Estimation of the glomerular filtration rate (GFR) before CM administration should be encouraged. Risk assessment may be complicated by the presence of multiple risk factors. To simplify this process, Mehran et al.  developed a simple risk score for CIN after PCI for patients with >1 risk factor. Data were obtained from 8357 patients in a prospective interventional cardiology database who underwent PCI and had documented pre- and post-procedural SCr data. Patients requiring dialysis because of preexisting end-stage renal disease (ESRD) were excluded from the analyses as were patients requiring more than one contrast procedure, those receiving PCI after acute MI and those in shock. Each patient was assigned to either a developmental dataset (n¼5571) or a validation dataset (n¼2786). The definition of CIN used in the analysis was an increase of 25% or 0.5 mg/dl in aseline SCr at 48 h after PCI.
Sludging= empantanamiento There is also no clear evidence to guide the choice of the optimal rate and duration of infusion. However, good urine output (150 ml/h) in the 6 h after the procedure has been associated with reduced rates of AKI in 1 study (61). Since not all of intravenously administered isotonic crystalloid remains in the vascular space, in order to achieve a urine flow rate of at least 150 ml/h, 1.0 to 1.5 ml/kg/min of intravenous fluid has to be administered for 3 to 12 h before and 6 to 12 h after contrast exposure. Oral volume expansion may have some benefit, but there is not enough evidence to show that it is as effective as intravenous volume expansion.
Contrastes Iónicos Mono: Ioxitalamato (Telebrix) – HOCM Iónicos Diméricos: Ioxaglato (Hexabrix) – LOCM No Iónicos Mono: Iopamidol (Iopamiron), Iohexol (Omnipaque), Ioversol (Optiray), Iobitridol (Xenetix) – LOCM No Iónicos Diméricos: Iodixanol (Visipaque) - ISOCM
Slide 9: 2007 Focused Update of the ACC/AHA/SCAI (Soc. Americana de Cardiolog. Intervencionista)2005 Guideline Update for PCI and ACC/AHA 2007 Guidelines for Management of Patients With UA/NSTEMI (angina Inestable sin levación del seg.ST) In 2008, the American College of Cardiology/American Heart Association Task Force on Practice Guidelines released the 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for PCI. Based on new data from the RECOVER trial and the McCullough meta-analysis, the new guidelines recommend that patients with CKD or CKD and DM be given isosmolar CM (IOCM) as these are associated with lower rates of contrast-associated acute kidney injury (AKI) compared to low-osmolar CM (LOCM). 1 In addition, the ACC/AHA 2007 Guidelines for management of patients with UA/NSTEMI recommend the use of isosmolar contrast agents for patients with CKD undergoing angiography. 2 References: 1. King SB, Smith SC, Hirshfeld JW, et al. 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation . 2008;117:1-35. 2. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2007;50: e1-e157.