0) CT computed tomography aActual osmolality bNot approved for intravascular administration Invasive diagnostic imaging including cardiac angiography or percutaneous catheter intervention Does CKD increase the risk for developing CIN after CAG? Answer: 1. It is highly likely that CKD (GFR <60 mL/min/1.73 m2) increases the risk for developing CIN after CAG.

The risk for developing CIN increases find more as kidney function decreases.   2. We recommend that physicians explain CIN to patients with an eGFR of <60 mL/min/1.73 m2 who are going to undergo CAG, and that they take appropriate preventive measures such as fluid therapy before and after CAG.   Recently, CAG and catheter-based revascularization have become common procedures,

and the use of contrast media has increased substantially. It has been reported that in patients with CKD the risk of CIN increases as kidney function (GFR) decreases (Fig. 1) [8]. In 2001, Shiraki et al. [73] reported that 61 of 1,920 patients (3.2 %) who underwent CAG developed CIN, and 1 of them (0.05 %) required hemodialysis. In Idasanutlin in vitro another study, Fujisaki et al. [74] reported that CIN SAHA purchase developed in 12 of 267 patients (4.5 %) who underwent CAG, and hemodialysis was required in 2 patients (0.7 %). In a report from the Mayo Clinic in 2002, CIN developed in 254 of 7,586 (3.3 %) patients who underwent CAG, and 20 (7.9 %) of these required hemodialysis [4]. Mortality at 1 and 5 years were 12.1 and 44.6 %, respectively, in patients with CIN, which were significantly higher than those in patients without CIN (3.7 and 14.5 %, respectively). Montelukast Sodium In a study reported in 2009, Abe et al. [75] reported that the incidence of CIN within 5 days after

CAG was 4.0 % in 1,157 consecutive patients who underwent CAG, and risk factors for CIN included a baseline SCr level of ≥1.2 mg/dL and the use of a large volume (≥200 mL) of contrast media. In the earlier-mentioned studies, CIN was defined as an increase in SCr levels by ≥0.5 mg/dL. The risk of CIN after CAG was 3.0–5.0 %, and CIN developed mainly in high-risk patients such as those with diabetes, anemia, dehydration, or an underlying kidney diseases, and/or those who were elderly or were receiving nephrotoxic agents [50]. It is recommended that patients with CKD should receive appropriate preventive treatment such as fluid therapy and be closely monitored for kidney function after CAG. Fig. 1 Risk for developing CIN according to baseline kidney function. The incidence of CIN is higher in patients with lower baseline eGFR, and is higher in patients with diabetes than in those without diabetes. CIN contrast-induced nephropathy, eGFR estimated glomerular filtration rate. Adapted from J Am Coll Cardiol. 2008;51:1419–1428 [8], with permission from Elsevier Inc.