Canadian Association of Radiologists Consensus Guidelines for the Prevention of Contrast-Induced Nephropathy: Update 2012

Abstract

A serum creatinine level (SCr) should be obtained, and an estimated glomerular filtration rate (eGFR) should be calculated within 6 months in the outpatient who is stable and within 1 week for inpatients and patients who are not stable. Patients with an eGFR of ≥ 60 mL/min have an extremely low risk of CIN. The risk of CIN after intra-arterial CM administration appears be at least twice that after intravenous administration. Fluid volume loading remains the single most important measure, and hydration regimens that use sodium bicarbonate or normal saline solution should be considered for all patients with GFR < 60 mL/min who receive intra-arterial contrast and when GFR < 45 mL/min in patients who receive intravenous contrast. Patients are most at risk for CIN when eGFR < 30 mL/min. Additional preventative measures include the following: avoid dehydration, avoid CM when appropriate, minimize CM volume and frequency, avoid high osmolar CM, and discontinue nephrotoxic medications 48 hours before administration of CM.

Sodium bicarbonate infusion for prevention of acute kidney injury: No evidence for superior benefit, but risk for harm?

“…To the contrary, there is overwhelming evidence that this common practice has no additional benefit (compared to saline), but adds to in-hospital mortality and mortality. These conclusions contradict recently published renal [5] or radiological [47] guidelines recommending intravenous administration of sodium bicarbonate for prevention of AKI.…”

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

“…A significantly increased risk of CIN has also been demonstrated among patients who received a second dose of contrast media within 48 hours. 13 The most important risk marker for nephropathy after exposure to iodinated contrast media is pre-existing renal impairment and diabetes mellitus. Other markers associated with an increased risk of contrast induced nephropathy (CIN) include nephrotoxic drugs, anemia, age older than 70 years, pre-procedural hemodynamic instability, volume depletion, congestive heart failure (CHF) and hypoalbuminaemia.…”

Comparison of the Effects of Iodixanol and Iopamidol on Urine Flow, Urine Viscosity, and Glomerular Filtration in Rats

“…Today, we can choose between iodixanol, the only IOCM presently approved for intravascular administration, and an array of LOCM, such as the widely used iopamidol. Current guidelines leave this choice to the physician [1,[6][7][8], because the results of prospective clinical head-to-head comparisons concerning the renal safety of iodixanol versus LOCM have been contradictory [2,[9][10][11][12]. One major reason behind this lack of consistent results is that the vast majority of clinical studies have been relying on serum creatinine concentration (SCrea) as the sole end point [2,9,11,12].…”