AKI After PCI: Optimizing Contrast Selection for Real‑World Prevention-Slides: Post PCI and PVI Management for Reduced AKI Risk, Dr. Altin

Slides: Post PCI and PVI Management for Reduced AKI Risk, Dr. Altin

Pdf Summary

This presentation reviews how to reduce acute kidney injury (AKI) risk after PCI and peripheral vascular intervention (PVI). It emphasizes early identification of at-risk patients using tools such as the Mehran score, SCAI risk assessment, and the NCDR AKI calculator. Important risk factors include chronic kidney disease, diabetes, hypertension, anemia, hypotension, and high contrast volume.<br /><br />Key prevention strategies include pre-procedure planning, such as documenting creatinine, eGFR, and estimating a maximum contrast dose during the procedural time-out. The risk of contrast-induced AKI rises with increasing contrast volume, especially when contrast use exceeds the maximal acceptable contrast dose.<br /><br />Hydration is highlighted as one of the most effective preventive measures. The POSEIDON trial showed that LVEDP-guided hydration significantly reduced contrast-induced AKI compared with standard hydration. The protocol adjusts fluid rates based on LVEDP measurements.<br /><br />The talk also reviews procedural techniques to reduce AKI risk: correcting modifiable factors like hypovolemia and hypotension, holding nephrotoxic medications when appropriate, using smaller catheters, limiting contrast injections, using automated injectors, staging complex PCI, using IVUS, and favoring radial access when feasible to reduce bleeding-related complications. For PVI, contrast-sparing approaches are especially important in patients with PAD and CKD, including diluted contrast, pressure injectors, and CO2 angiography when iodinated contrast should be avoided.<br /><br />Post-procedure surveillance is also important. High-risk patients should have creatinine checked at 24 hours and ideally again at 48–72 hours. The presentation concludes that cath labs should track contrast use, AKI rates, and outcomes as part of quality monitoring, and that same-day discharge should be avoided in patients at high AKI risk.

Keywords

acute kidney injury

AKI prevention

PCI

peripheral vascular intervention

contrast-induced nephropathy

Mehran score

hydration therapy

LVEDP-guided hydration

contrast volume

CO2 angiography