title: Contrast medium use.
abstract: Various properties of iodinated contrast media (osmolality, ionic versus nonionic, and viscosity) may contribute to contrast-induced nephropathy (CIN). Therefore, the choice of contrast medium affects the risk for CIN. There is good evidence that low-osmolar contrast media are less nephrotoxic than high-osmolar contrast media in patients at increased risk for CIN who receive intra-arterial iodinated contrast. Current evidence suggests that nonionic isosmolar contrast presents the lowest risk for CIN in patients with chronic kidney disease (CKD), particularly in those patients with diabetes mellitus. Intra-arterial administration of contrast media may be associated with a greater risk for CIN above that observed with intravenous administration. The use of gadolinium or CO(2) as alternative contrast media to avoid the risk of nephrotoxicity cannot be substantiated by clinical trials and therefore cannot be recommended. Most studies show that, within a class, higher volumes (>100 mL) of iodinated contrast medium are associated with a higher risk for CIN. However, in patients at high risk, such as those with CKD and diabetes, even small volumes of contrast medium can have adverse effects on renal function.
authors.affiliation: Northwestern Memorial Hospital, Chicago, Illinois 60611, USA. cdavidson@nmh.org
authors.forename: Charles
authors.initials: C
authors.lastname: Davidson
authors.forename: Fulvio
authors.initials: F
authors.lastname: Stacul
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: James
authors.initials: J
authors.lastname: Tumlin
authors.forename: Andy
authors.initials: A
authors.lastname: Adam
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Becker
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control; D002245:Carbon Dioxide / Q000008:administration & dosage; D003245:Consensus Statements as Topic; D003287:Contrast Media / Q000494:pharmacology*; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D009994:Osmolar Concentration; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide; D019786:Gadolinium DTPA