Renal replacement therapies in the prevention of contrast-induced acute kidney injury

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.