Managing CIAKI in CKD Patients Undergoing Coronary Angiography: A Clinical Case Study

Abstract

Contrast-Induced Acute Kidney Injury (CIAKI) is a major concern for patients with chronic kidney disease (CKD) who need diagnostic tests like coronary angiography. This case study looks at how CIAKI was managed in a 67-year-old man with CKD who had coronary angiography. After the procedure, he developed acute kidney injury due to the contrast material used, leading to the use of preventive measures and treatment plans. This case shows how important it is to assess risks, follow hydration guidelines, and closely monitor patients after the procedure to lower the chances of CIAKI. The results emphasize the need for personalized patient care and better awareness among healthcare providers about CIAKI in high-risk groups.

Introduction

Definition of Contrast-Induced Acute Kidney Injury Contrast-Induced Acute Kidney Injury Contrast-Induced Acute Kidney Injury is officially termed as a true decline in renal function that follows exposure to contrast media in the presence of pre-existing renal impairment. Patients with CKD are at risk for severe CIAKI, which impacts their recovery from renal insult. Determination of CIAKI can lead to several consequences, such as lengthened hospital stay, renal replacement therapy, and mortality.

Among the evaluation diagnostic procedures for coronary artery disease, coronagraphy is yet a practice exposing patients to the risk for CIAKI, especially among those with CKD. Preventive measures and good management strategies must be undertaken to prevent this occurrence. This case study provides a kind of insight into how clinical diagnosis should be made by showing exactly what a patient with CKD undergoes in the course of being diagnosed with CIAKI following the procedure.

Patient Information

• Age: 67 years

• Gender: Male

• Medical History: Hypertension (controlled), Type 2 Diabetes Mellitus (well-managed), Stage 3 Chronic Kidney Disease (CKD), previous myocardial infarction two years prior

• Symptoms: The patient, over the past week, presented with worsening dyspnea and chest discomfort; hence, the patient required coronary angiography.

Clinical Findings

Upon admission, the patient exhibited

Vital Signs

• Blood Pressure: 130/80 mmHg

• Heart Rate: 76 bpm

• Respiratory Rate: 18 breaths/min

Physical Examination

• Mild bilateral edema in the lower extremities

• Clear lung fields upon auscultation

• No signs of heart failure

Laboratory Tests

• Serum Creatinine: 1.8 mg/dL (baseline)

• Blood Urea Nitrogen (BUN): 25 mg/dL

• Estimated Glomerular Filtration Rate (eGFR): 45 mL/min

Timeline

Pre-Procedural Assessment

• Date: June 5, 2023

• Findings: The patient's CKD stage was assessed, and risk factors for CIAKI were evaluated.

• Plan: Hydration protocol initiated (IV fluids) before contrast administration.

Coronary Angiography

• Date: June 7, 2023

• Procedure: Left heart catheterization with the administration of iodinated contrast.

• Procedure Outcome: Significant coronary artery stenosis noted; stenting was performed.

Post-Procedure Monitoring

• Date: June 8, 2023

• Initial Post-Procedure Labs:

• Serum Creatinine: 2.5 mg/dL

• BUN: 35 mg/dL

• Assessment: Diagnosis of CIAKI confirmed.

Management of CIAKI

• Date: June 9, 2023

• Interventions: IV hydration continued. Monitoring of renal function daily. Consultation with nephrology for further management.

Follow-Up

• Date: June 14, 2023

• Findings: Renal function began to improve.

Labs

• Serum Creatinine: 1.9 mg/dL

• BUN: 28 mg/dL

Diagnostic Assessment

Pre-Procedure Assessment

Pre-procedure evaluation entailed a review of history, renal function tests, and risk stratification for CIAKI. The patient was ranked as a class for being high-risk since the patient is classified under CKD status.

Post-Procedure Assessment

Laboratory Tests: Serum creatinine and BUN were observed after the procedure for acute change in renal function. Changes of more than 0.3 mg/dL or an absolute rise ≥50% from baseline within 48 hours post-contrast defined CIAKI.

Follow-Up and Outcomes

The patient was closely monitored in the cardiac care unit post-procedure. Initial lab results indicated an acute rise in serum creatinine, thereby confirming CIAKI. Management strategy involved:

• IV Hydration: Continued vigorous hydration with NS at a rate of 150 mL/hr for the first 24 hours post-angiography to dilute contrast agents and promote renal perfusion.

• Renal Monitoring: Serum creatinine and electrolytes were monitored daily.

• Nephrology Consult: The patient is evaluated to assess the renal function and the further management plan if required.

• Medication Review: All nephrotoxic medications are stopped reduced or adjusted in the hospital.

Discussion

CIAKI management, particularly in patients with pre-existing CKD, should be holistic: risk assessment, preventive measures, and close monitoring at the stage post-procedure.

Preventive Measures

• Hydration: The patient should be hydrated before administration of contrast and afterward. IV fluids may be used to support renal perfusion, decreasing the nephrotoxic effect of contrast media.

• Low-Volume Contrast: Administration of the minimal volume of contrast media that can achieve diagnostic quality reduces the risk of CIAKI directly.

• Alternative Imaging: If possible, non-contrast imaging modalities (echocardiography or magnetic resonance imaging) would be useful in high-risk patients.

Post-procedure Care

The renal function in CIAKI must be monitored uninterruptedly post-procedure to catch up early. In this case, the patient's serum creatinine increased enormously after the procedure, and urgent intervention became necessary.

CIAKI requires cooperative care with nephrology for customized treatment, especially in those patients already suffering from CKD.

Long Term Management

A multidisciplinary approach to management is important to discuss how patients with CKD, who have CIAKI risk factors, are at an increased risk for future renal impairment and cardiovascular events. Probably the improvement in lifestyle modification, medication adherence, and regular follow-ups on the management of CKD can improve long-term outcomes.

Takeaway

The case study emphasizes the use of proactive management strategies in preventing and managing CIAKI among patients with CKD who are undergoing coronary angiography. Hydration protocols, regular monitoring, and interdisciplinary collaboration will be found to significantly reduce the occurrence of CIAKI and improve outcomes among patients.

Healthcare providers need to stay vigilant about the risk factors associated with CIAKI in high-risk populations. It reminds providers to stress individualized care to their patients and not forget the permanent need for education on measures of prevention.

Patient’s Perspective

With attentive care provided to the patient during his entire stay in the hospital, the patient felt content. He was relieved knowing that healthcare professionals were monitoring his kidney function, managing risk processes, and giving him focus on his overall well-being throughout the process. While anxious about some complications that may arise early due to the procedure, this proactive approach to hydration and monitoring helped minimize some of these apprehensions.

Post-discharge, the patient showed hopefulness regarding his recovery and expressed that he was committed to following up on follow-up appointments with the care team to manage his CKD. Highly valued education and good communication from his healthcare providers established a long-term relationship on understanding his condition and its preventive measures to protect his kidney health at all costs in the future.

Conclusion

Prevention and management of CIAKI in patients with chronic kidney disease during coronary angiography present a critical care challenge. The case study appropriately identifies methods leading to the prevention and management of CIAKI. Strenuous pre-procedure evaluation, hydration protocols, and post-procedure vigilance present appropriate contexts for the complication to be minimized. Multidisciplinary approaches promoting patient-centered care improve patient outcomes while minimizing complications arising from CIAKI.

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