AKI After PCI: Optimizing Contrast Selection for Real‑World Prevention-Slides: Preventing AKI Before and During PCI/PVI, Dr. Seto

Slides: Preventing AKI Before and During PCI/PVI, Dr. Seto

Pdf Summary

This presentation reviews practical ways to prevent acute kidney injury (AKI) before and during PCI/PVI, especially in high-risk patients with chronic kidney disease, heart failure, diabetes, shock, or urgent procedures. Key recommendations include screening for AKI risk, giving periprocedural hydration, and limiting contrast volume. Risk can be estimated using tools such as the Mehran and NCDR risk scores.<br /><br />A major emphasis is placed on contrast minimization. Operators should set a contrast limit in advance, ideally around 1× the patient’s GFR and no more than 3× to 3.7× GFR. The procedure “time-out” should include creatinine, GFR, and the contrast cap. Practical strategies include using radial access when possible, ultrasound-guided femoral access, IVUS or saline OCT, physiologic assessment (FFR/NHPR), smaller diagnostic catheters, diluted contrast, and staging PCI when appropriate. Avoiding LV gram and using prior imaging or biplane rooms can also reduce risk.<br /><br />Hydration remains the most effective preventive measure. The talk reviews standard saline and bicarbonate protocols, as well as the POSEIDON strategy, which adjusts fluid rates based on LVEDP to balance renal protection with heart failure risk. In emergent cases, a saline bolus before the procedure is suggested when time allows.<br /><br />Other measures discussed include high-dose statins, holding ACE inhibitors/ARBs/NSAIDs, and correcting anemia, hypotension, and hyperglycemia. The PRESERVE trial found no benefit from sodium bicarbonate or N-acetylcysteine. Newer technologies such as CT-guided PCI planning, improved imaging systems, automated injectors, and ultralow-contrast techniques may further reduce renal injury.<br /><br />A case example showed successful ultra-low-contrast coronary angiography in a patient with advanced CKD using 23 mL of contrast and careful hydration, with creatinine improving afterward.

Keywords

acute kidney injury

AKI prevention

PCI

PVI

contrast minimization

hydration therapy

chronic kidney disease

Mehran risk score

NCDR risk score

ultra-low contrast angiography