Prevention of Contrast Induced Nephropathy

Summarized by: Prasaanthan Gopee-Ramanan, M.D.

Original publication details

Authors: Richard J Owen, Swapnil Hiremath, Andy Myers, Margaret Fraser-Hill, Brendan J Barrett

DOI: https://doi.org/10.1016/j.carj.2012.11.002

Reference: Owen, R. J., Hiremath, S., Myers, A., Fraser-Hill, M., & Barrett, B. J. (2014). Canadian Association of Radiologists consensus guidelines for the prevention of contrast-induced nephropathy: update 2012. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes, 65(2), 96–105.

Serum creatinine and eGFR:

Within 6 months for a stable outpatient prior to CT with contrast

Within 1 week for in-patients and patients with unstable or acute renal disease

Main risk factors for renal dysfunction

DM, renal disease/solitary kidney, sepsis or acute hypotension, dehydration or volume contraction, age >70y, previous chemotherapy, organ transplant, vascular disease

eGFR

eGFR ≥ 60 mL/min: extremely low risk of contrast-induced nephropathy (CIN) - no preventative measures or follow up

eGFR ≤ 60 mL/min: preventative measures recommended

Greatest risk eGFR ≤ 30 mL/min

Preventative measures

  • Avoid dehydration

  • Consider alternatives without contrast media (CM)

  • Minimize CM volume and frequency

  • Avoid high osmolar CM

  • Discontinue nephrotoxic medications

  • Load fluid volume - IV 

  • Metformin discontinued on day of CM administration and restarted 48 hours later

IV hydration protocol

For in-patients

0.9% NaCl at 1mL/kg/hr for 12 hours pre-procedure and 12 hours post-procedure

If same day

Isotonic NaCl or NaHCO3 at 3 mL/kg/hr a minimum of 1 hour before procedure and 6 hours following procedure

Accounting for patient’s weight, at least 300-500 mL of IV hydration recommended prior to CM administration

Citation

Owen, R. J., Hiremath, S., Myers, A., Fraser-Hill, M., & Barrett, B. J. (2014). Canadian Association of Radiologists consensus guidelines for the prevention of contrast-induced nephropathy: update 2012. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes, 65(2), 96–105. https://doi.org/10.1016/j.carj.2012.11.002