Trombara F, Cosentino N, Pontone G, Marenzi G. Renal replacement therapies in the prevention of contrast-induced acute kidney injury. World J Nephrol 2026; 15(3): 119548 [DOI: 10.5527/wjn.v15.i3.119548]
Corresponding Author of This Article
Nicola Cosentino, MD, PhD, Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, Milan 20138, Lombardy, Italy. nicola.cosentino@cardiologicomonzino.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
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review-article
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Trombara F, Cosentino N, Pontone G, Marenzi G. Renal replacement therapies in the prevention of contrast-induced acute kidney injury. World J Nephrol 2026; 15(3): 119548 [DOI: 10.5527/wjn.v15.i3.119548]
Filippo Trombara, Centro Cardiologico Monzino IRCCS, Milan 20138, Lombardy, Italy
Nicola Cosentino, Gianluca Pontone, Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan 20138, Lombardy, Italy
Gianluca Pontone, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20138, Italy
Giancarlo Marenzi, Intensive Cardiac Care Unit, Centro Cardiologico Monzino IRCCS, Milan 20138, Italy
Author contributions: Trombara F and Cosentino N designed the research study, performed the research, and wrote the manuscript; Pontone G and Marenzi G critically revised the manuscript. All authors have read and approved the final manuscript.
AI contribution statement: AI was used for language polishing and writing assistance of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Nicola Cosentino, MD, PhD, Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, Milan 20138, Lombardy, Italy. nicola.cosentino@cardiologicomonzino.it
Received: February 10, 2026 Revised: February 23, 2026 Accepted: April 2, 2026 Published online: September 25, 2026 Processing time: 195 Days and 11.4 Hours
Abstract
Contrast-associated acute kidney injury (CA-AKI) remains a significant cause of hospital-acquired acute kidney injury, particularly in patients undergoing interventional radiology and cardiology procedures. Despite the implementation of preventive measures, such as intravenous hydration, pharmacologic prophylaxis, and minimization of contrast exposure, CA-AKI continues to be associated with increased morbidity, prolonged hospital stays, elevated mortality rates, and greater healthcare costs. Renal replacement therapies (RRT), including haemodialysis and hemofiltration, have been explored as potential strategies to prevent CA-AKI in high-risk populations. However, the existing evidence is inconclusive. While certain studies report a reduced incidence of CA-AKI with early hemofiltration in select patient groups, others have found no significant advantage over standard hydration protocols. Furthermore, practical concerns, including procedural risks, cost implications, and logistical constraints, limit the routine use of prophylactic RRTs in clinical practice. Current clinical guidelines do not endorse the widespread use of RRTs for CA-AKI prevention, though selective application in very high-risk patients may be considered. Robust, large-scale randomized controlled trials are needed to identify patient subgroups that might derive benefit from this intervention. In the interim, optimized hydration and contrast minimization remain the cornerstone strategies for CA-AKI prevention.
Core Tip: Contrast-associated acute kidney injury remains a major complication in high-risk patients undergoing contrast-based procedures. While standard prevention relies on individualized hydration and contrast minimization, the role of prophylactic renal replacement therapy remains controversial. Evidence consistently shows that hemodialysis does not prevent contrast-associated acute kidney injury, whereas early hemofiltration may offer benefit in carefully selected patients with advanced chronic kidney disease and limited tolerance to fluid expansion. However, inconsistent trial results and logistical constraints preclude routine use. This review critically evaluates current evidence, highlights patient selection and timing considerations, and underscores the need for adequately powered randomized trials.
