Prevention of contrast induced nephropathy: Recommendations for the high risk patient undergoing cardiovascular procedures

Abstract

Contrast induced nephropathy (CIN) is the third leading cause of hospital aquired renal failure and is associated with significant morbidity and mortality. Chronic kidney disease is the primary predisposing factor for CIN. As estimated glomerular filtration rate <60 ml/1.73 m 2 represents significant renal dysfunction and defines patients at high risk. Modifiable risk factors for CIN include hydration status, the type and amount of contrast, use of concomitant nephrotoxic agents and recent contrast administration. The cornerstone of CIN prevention, in both the high and low risk patients, is adequate parenteral volume repletion. In the patient at increased risk for CIN it is often appropriate to withhold potentially nephrotoxic medications, and consider the use of n-acetylcysteine. In patients at increased risk for CIN the use of low or iso-osomolar contrast agents should be utilized and strategies employed to minimize contrast volume. In these patients serum creatinine should be obtained forty-eight hours post procedure and it is often appropriate to continue withholding medications such as metformin or non steroidal anti-inflammatories until renal function returns to normal.' 2006 Wiley-Liss, Inc.

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

“…Suboptimal images will require The results from the data collected raise concerns as it is generally assumed that biplane is beneficial to the patient in terms of reducing total radiographic contrast dosage. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] A publication released by Siemens Medical 33 in 2004 evaluating the clinical experiences with the AXIOM Artis BC biplane flat panel detector system stated that ‚the doses of contrast medium and radiation exposure are drastically reduced and the examination is greatly shortened. The findings in this study do not support the statement by Siemens Medical and may highlight a greater risk to patient safety with the utilisation of biplane equipment than previously assumed, particularly as its use is recommended in paediatric and adult catheter laboratories.…”

“…Where single-plane will complete the nine standard projections, biplane will produce ten projections due to 18 and John Muir Health 19 along with others have subsequently assumed that biplane is beneficial to the patient in terms of reducing total radiographic contrast dosage and therefore its use may decrease the risk of CIN in patients. [20][21][22][23][24][25][26][27][28][29][30][31] However, since the concept of biplane imaging was introduced by Rob and Steinberg 32 in 1939 there have been no published data comparing the total contrast load used in single and biplane imaging in patients undergoing diagnostic coronary angiography.…”

“…[20][21][22][23][24][25][26][27][28][29][30][31] However, since the concept of biplane imaging was introduced by Rob and Steinberg 32 in 1939 there have been no published data comparing the total contrast load used in single and biplane imaging in patients undergoing diagnostic coronary angiography.…”

“…Where single-plane will complete the nine standard projections, biplane will produce ten projections due to 18 and John Muir Health 19 along with others have subsequently assumed that biplane is beneficial to the patient in terms of reducing total radiographic contrast dosage and therefore its use may decrease the risk of CIN in patients. [20][21][22][23][24][25][26][27][28][29][30][31] However, since the concept of biplane imaging was introduced by Rob and Steinberg 32 in 1939 there have been no published data comparing the total contrast load used in single and biplane imaging in patients undergoing diagnostic coronary angiography.The aim of this study was to test the hypothesis that biplane imaging in routine diagnostic coronary angiography results in a significant reduction in screening time, procedural time and contrast load within the procedure when compared to single-plane imaging. Additionally the study investigated whether bipolar imaging acquired a greater number of cine angiography runs compared to single-plane imaging.…”

Frequency and risk factors of contrast-induced nephropathy after cardiac catheterization in type II diabetic patients: a study among Egyptian patients

“…Many studies have been conducted to identify the main risk factors for CIN, in fact many score systems have been proposed [7][8][9][10][11][12] and increasing number of guidelines have been suggested in literature 13,14 to help lessen the complication of CIN. The most widely recognized risk predictor of CIN is the elevated serum creatinine or reduced GFR pre-contrast administration.…”