Background: Contrast-induced nephropathy, also termed contrast-associated acute kidney injury, is an important complication after coronary angiography and PCI, especially in patients with chronic kidney disease, diabetes, elderly age, heart failure, and high contrast exposure.

Objective: To evaluate the effectiveness of pharmacological preventive strategies for contrast-induced nephropathy among high-risk patients undergoing coronary procedures.

Methods: A prospective observational study was conducted among 480 patients undergoing coronary angiography or PCI. Patients received standard hydration with or without pharmacological prophylaxis including high-dose statins, N-acetylcysteine, sodium bicarbonate, and antioxidant therapy. The primary endpoint was development of CIN within 48–72 hours after contrast exposure.

Results: CIN occurred in 9.8% of patients overall. The lowest incidence was observed in patients receiving hydration plus high-dose statin therapy. N-acetylcysteine showed modest benefit but inconsistent effect. Sodium bicarbonate was comparable to isotonic saline hydration. Advanced CKD, diabetes, contrast volume >120 mL, and baseline eGFR <45 mL/min/1.73m² were independent predictors of CIN.

Conclusion: Pharmacological prevention of CIN should be risk-based. Adequate hydration and contrast minimization remain the foundation, while high-dose statin loading appears to offer the most consistent pharmacological benefit. Evidence for N-acetylcysteine and sodium bicarbonate remains mixed. Recent reviews continue to emphasize hydration, risk stratification, and avoidance of nephrotoxins as core preventive measures. (Medscape)