A Mechanical Approach to Limit Contrast-Induced Nephropathy: Sentinel at the Gate

Contrast-induced nephropathy (CIN) is a serious complication of coronary angiography and contrast-based procedures. It is a complex syndrome of acute renal failure that occurs after the administration of iodinated radiocontrast not attributable to other causes. Since the initial description of radiocontrast nephrotoxicity in the 1960s, CIN has become the third leading cause of hospital-acquired renal failure (after decreased renal perfusion and nephrotoxic drugs) and accounts for approximately 11% of cases.1 In the majority of patients, this rise occurs within the first 24 hours, peaking 3–5 days after the procedure, and is coupled with a reduction in creatinine clearance.2 Typically, creatinine levels return to baseline within 1–3 weeks post procedure. However, renal function occasionally deteriorates severely enough to lead to short- or even long-term renal replacement therapy. Multiple studies have established that CIN is associated with a significant increase in mortality and myocardial infarction.3 Furthermore, the need for hemodialysis due to CIN after percutaneous coronary intervention is associated with a very poor prognosis, with a 2-year survival rate of From the Department of Medicine (Cardiovascular Medicine), Stony Brook University Medical Center, Stony Brook, New York. The authors report no conflicts of interest regarding the content herein. Address for correspondence: Luis Gruberg, MD, FACC, Director, Cardiovascular Catheterization Laboratories, Professor of Medicine, Division of Cardiology, SUNY - Stony Brook University Medical Center, Health Sciences Center, T-16-080, Stony Brook, NY 11794-8167. E-mail: Luis.Gruberg@stonybrook.edu

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