Clinical inquiries. What interventions reduce the risk of contrast nephropathy for high-risk patients?
Several interventions may reduce the risk of contrast nephropathy for high-risk patients; however, most evidence uses surrogate markers for clinically relevant outcomes. Because dehydration is a risk factor for developing contrast nephropathy, periprocedural hydration is routinely recommended (strength of recommendation [SOR]: C, expert opinion). Single studies have suggested that isotonic saline is associated with less risk than half-normal saline, and hydration with fluids containing sodium bicarbonate is more efficacious than those containing isotonic saline (SOR: B, single randomized controlled trial [RCT]). Oral acetylcysteine lowers the risk of postcontrast elevations in creatinine if taken more than 24 hours before contrast administration (SOR: A, RCTs). Acetylcysteine's low cost and favorable side effect profile make it an appealing option. Hypo-osmolar contrast media are less likely to induce contrast nephropathy than hyper-osmolar media (SOR: A, RCTs). Finally, hemofiltration might be considered for patients with extremely high risk of developing contrast nephropathy (SOR: B, single RCT).
Grossman
Paul D
PD
Del Norte Community Health Center, Crescent City, CA, USA. pdgrossman@yahoo.com
Burroughs
Martha
M
Guthmann
Richard A
RA
D000111:Acetylcysteine / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D006440:Hemofiltration; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D009994:Osmolar Concentration; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage
D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D000111:Acetylcysteine