Research progress in the prevention of contrast-related acute kidney injury

doi:10.11958/20230617

Abstract

Abstract:

Contrast-associated acute kidney injury (CA-AKI) is an important complication caused by the use of contrast medium (CM) in diagnostic or interventional surgery. At present, it has become one of the major causes of acute renal insufficiency in hospitalized patients. Choosing a relatively low toxic CM and reducing the exposure time and dose of CM can prevent CA-AKI occurrence to some extent. Drugs such as statins and postoperative hydration can reduce the risk of CA-AKI. In addition, nanomedicine has shown a benefit in animal models. This paper reviews the current prevention and treatment of CA-AKI to lay the foundation for further study of new interventions and provide a theoretical basis for clinical treatment.

Key words: contrast media, acute kidney injury, hydroxymethylglutaryl-CoA reductase inhibitors, nanoparticles, fluid therapy

CLC Number:

R692

Figures/Tables 2

References 26

[1]	LUN Z, LIU J, LIU L, et al. Association of early and late contrast-associated acute kidney injury and long-term mortality in patients undergoing coronary angiography[J]. J Interv Cardiol, 2021, 2021:6641887. doi:10.1155/2021/6641887.
[2]	MACH F, BAIGENT C, CATAPANO A L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk[J]. Eur Heart J,2020, 41(1):111-188. doi:10.1093/eurheartj/ehz455.
[3]	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[J]. Cardiorenal Med, 2020, 10(5):288-301. doi:10.1159/000506857.
[4]	ZHANG F, LU Z, WANG F. Advances in the pathogenesis and prevention of contrast-induced nephropathy[J]. Life Sci, 2020, 259:118379. doi:10.1016/j.lfs.2020.118379.
[5]	DAVENPORT M S, PERAZELLA M A, YEE J, et al. Use of intravenous iodinated contrast media in patients with kidney disease:consensus statements from the american college of radiology and the national kidney foundation[J]. Radiology, 2020, 294(3):660-668. doi:10.1148/radiol.2019192094.
[6]	KUSIRISIN P, CHATTIPAKORN S C, CHATTIPAKORN N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches[J]. J Transl Med, 2020, 18(1):400. doi:10.1186/s12967-020-02574-8.
[7]	SŮVA M, KALA P, POLOCZEK M, et al. Contrast-induced acute kidney injury and its contemporary prevention[J]. Front Cardiovasc Med, 2022, 9:1073072. doi:10.3389/fcvm.2022.1073072.
[8]	GUPTA A, DOSEKUN A K, KUMAR V. Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy[J]. World J Cardiol, 2020, 12(2):76-90. doi:10.4330/wjc.v12.i2.76.
[9]	HEPBURN M, MULLAGURI N, BATTINENI A, et al. Fatal brain injury following carbon dioxide angiography[J]. J Stroke Cerebrovasc Dis, 2020, 29(12):105350. doi:10.1016/j.jstrokecerebrovasdis.2020.105350.
[10]	WATANABE M, AONUMA K, MUROHARA T, et al. Prevention of contrast-induced nephropathy after cardiovascular catheterization and intervention with high-dose strong statin therapy in Japan - The PREVENT CINC-J Study[J]. Circ J, 2022, 86(9):1455-1463. doi:10.1253/circj.CJ-21-0869.
[11]	MANSOOR K, SULIMAN M, AMRO M, et al. Protective effect of allopurinol in preventing contrast-induced nephropathy among patients undergoing percutaneous coronary intervention:a systematic review and meta-analysis[J]. Arch Med Sci Atheroscler Dis, 2021, 6:e196-e202. doi:10.5114/amsad.2021.112226.
[12]	CORRIDON P R. Still finding ways to augment the existing management of acute and chronic kidney diseases with targeted gene and cell therapies:opportunities and hurdles[J]. Front Med (Lausanne), 2023, 10:1143028. doi:10.3389/fmed.2023.1143028.
[13]	THAI H, KIM K R, HONG K T, et al. Kidney-targeted cytosolic delivery of siRNA using a small-sized mirror DNA tetrahedron for enhanced potency[J]. ACS Cent Sci, 2020, 6(12):2250-2258. doi:10.1021/acscentsci.0c00763.
[14]	GAO J, LIU Y, JIANG B, et al. Phenylenediamine-based carbon nanodots alleviate acute kidney injury via preferential renal accumulation and antioxidant capacity[J]. ACS Appl Mater Interfaces, 2020, 12(28):31745-31756. doi:10.1021/acsami.0c05041.
[15]	ZHANG D Y, TU T, YOUNIS M R, et al. Clinically translatable gold nanozymes with broad spectrum antioxidant and anti-inflammatory activity for alleviating acute kidney injury[J]. Theranostics, 2021, 11(20):9904-9917. doi:10.7150/thno.66518.
[16]	ZHANG D Y, LIU H, RIZWAN Y M, et al. Ultrasmall platinum nanozymes as broad-spectrum antioxidants for theranostic application in acute kidney injury[J]. Chem Eng J, 2021, 421:129963. doi:10.1016/j.cej.2021.129963.
[17]	ZHANG D Y, YOUNIS M R, LIU H, et al. Multi-enzyme mimetic ultrasmall iridium nanozymes as reactive oxygen/nitrogen species scavengers for acute kidney injury management[J]. Biomaterials, 2021, 271:120706. doi:10.1016/j.biomaterials.2021.120706.
[18]	ZHAO Y, PU M, WANG Y, et al. Application of nanotechnology in acute kidney injury: From diagnosis to therapeutic implications[J]. J Control Release, 2021, 336:233-251. doi:10.1016/j.jconrel.2021.06.026.
[19]	MA Y, ZHA L, ZHANG Q, et al. Effect of PCSK9 inhibitor on contrast-induced acute kidney injury in patients with acute myocardial infarction undergoing intervention therapy[J]. Cardiol Res Pract, 2022, 2022:1638209. doi:10.1155/2022/1638209.
[20]	FU H, ZHANG J, ZHANG H, et al. Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency[J]. Perfusion, 2021, 36(6):603-609. doi:10.1177/0267659120957856.
[21]	BOTTINOR W, CHAWLA R, DANYI P, et al. Intravenous fluid therapy is associated with a reduced incidence of contrast-induced nephropathy but not with a reduced long-term incidence of renal dysfunction after cardiac catheterization[J]. Cardiovasc Revasc Med, 2020, 21(1):20-23. doi:10.1016/j.carrev.2019.07.020.
[22]	PIOLI M R, COUTO R M, FRANCISCO J A, et al. Effectiveness of oral hydration in preventing contrast-induced nephropathy in individuals undergoing elective coronary interventions[J]. Arq Bras Cardiol, 2023, 120(2):e20220529. doi:10.36660/abc.20220529.
[23]	BARRETT T, KHWAJA A, CARMONA C, et al. Acute kidney injury:prevention,detection,and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media[J]. Clin Radiol, 2021, 76(3):193-199. doi:10.1016/j.crad.2020.08.039.
[24]	BRIGUORI C, D'AMORE C, De MICCO F, et al. Left ventricular end-diastolic pressure versus urine flow rate-guided hydration in preventing contrast-associated acute kidney injury[J]. JACC Cardiovasc Interv, 2020, 13(17):2065-2074. doi:10.1016/j.jcin.2020.04.051.
[25]	BRAR S S, AHARONIAN V, MANSUKHANI P, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial[J]. Lancet, 2014, 383(9931):1814-1823. doi:10.1016/S0140-6736(14)60689-9.
[26]	MAULER-WITTWER S, SIEVERT H, IOPPOLO A M, et al. Study evaluating the use of RenalGuard to protect patients at high risk of AKI[J]. JACC Cardiovasc Interv, 2022, 15(16):1639-1648. doi:10.1016/j.jcin.2022.05.036.

纳米颗粒类型	特性
壳聚糖纳米颗粒
硫酸化壳聚糖	Fe²⁺螯合能力和抗氧化活性
含有姜黄素的壳聚糖纳米颗粒	姜黄素具有肾保护作用；抑制氧化损伤
负载芒果苷的壳聚糖纳米颗粒	增强药物溶解度，提高生物利用度，清除氧自由基，与过氧化氢酶和过氧化物酶等抗氧化酶协同作用，保护肾上皮细胞免受氟化钠诱导的氧化损伤
SS31^①偶联L-丝氨酸修饰壳聚糖前药	具有肾脏靶性和触发的药物释放，以保护线粒体免受损伤，减少氧化应激、炎症反应和细胞凋亡
负载SS31的pH响应性纳米颗粒	抑制氧化应激、炎症反应，保护线粒体结构；壳聚糖具有pH敏感性，能够在溶酶体中释放SS31，SS31具有线粒体靶向
pH响应性含氮氧化物自由基的纳米颗粒	清除ROS和肾脏保护作用；抑制ROS生成，脂质过氧化和促炎细胞因子生成
无机纳米颗粒
苯二铵基碳纳米点	AKI肾脏特异性被动靶向和通过清除ROS的抗氧化治疗
金纳米颗粒	抗氧化、抗炎和抗血管生成能力
氧化钌纳米颗粒	多酶样抗氧化活性（例如过氧化氢酶、过氧化物酶，超氧化物歧化酶和谷胱甘肽过氧化物酶）
脂质基纳米颗粒
负载地塞米松的唾液酸修饰脂质磷酸钙纳米颗粒	有效积累在AKI损伤的肾脏中；改善肾功能，降低促炎细胞因子水平、氧化应激和细胞凋亡
泼尼松龙负载脂质体	聚集在发炎的肾组织发挥抗炎作用
水凝胶
负载生长因子的注射水凝胶	促进肾小管再生
肿瘤坏死因子-α中和抗体和肝细胞生长因子共载水凝胶	改善血清生物标志物，肾小管再生，减少肾组织中促炎细胞和巨噬细胞浸润

纳米颗粒类型	特性
壳聚糖纳米颗粒
硫酸化壳聚糖	Fe²⁺螯合能力和抗氧化活性
含有姜黄素的壳聚糖纳米颗粒	姜黄素具有肾保护作用；抑制氧化损伤
负载芒果苷的壳聚糖纳米颗粒	增强药物溶解度，提高生物利用度，清除氧自由基，与过氧化氢酶和过氧化物酶等抗氧化酶协同作用，保护肾上皮细胞免受氟化钠诱导的氧化损伤
SS31^①偶联L-丝氨酸修饰壳聚糖前药	具有肾脏靶性和触发的药物释放，以保护线粒体免受损伤，减少氧化应激、炎症反应和细胞凋亡
负载SS31的pH响应性纳米颗粒	抑制氧化应激、炎症反应，保护线粒体结构；壳聚糖具有pH敏感性，能够在溶酶体中释放SS31，SS31具有线粒体靶向
pH响应性含氮氧化物自由基的纳米颗粒	清除ROS和肾脏保护作用；抑制ROS生成，脂质过氧化和促炎细胞因子生成
无机纳米颗粒
苯二铵基碳纳米点	AKI肾脏特异性被动靶向和通过清除ROS的抗氧化治疗
金纳米颗粒	抗氧化、抗炎和抗血管生成能力
氧化钌纳米颗粒	多酶样抗氧化活性（例如过氧化氢酶、过氧化物酶，超氧化物歧化酶和谷胱甘肽过氧化物酶）
脂质基纳米颗粒
负载地塞米松的唾液酸修饰脂质磷酸钙纳米颗粒	有效积累在AKI损伤的肾脏中；改善肾功能，降低促炎细胞因子水平、氧化应激和细胞凋亡
泼尼松龙负载脂质体	聚集在发炎的肾组织发挥抗炎作用
水凝胶
负载生长因子的注射水凝胶	促进肾小管再生
肿瘤坏死因子-α中和抗体和肝细胞生长因子共载水凝胶	改善血清生物标志物，肾小管再生，减少肾组织中促炎细胞和巨噬细胞浸润