Strategies to reduce the risk of contrast-induced nephropathy.
In view of the clinical importance of contrast-induced nephropathy (CIN), numerous potential risk-reduction strategies have been evaluated. Adequate intravenous volume expansion with isotonic crystalloid (1.0-1.5 mL/kg per hr) for 3-12 hours before the procedure and continued for 6-24 hours afterward can lessen the probability of CIN in patients at risk. There are insufficient data on oral fluids (as opposed to intravenous volume expansion) as a CIN-prevention strategy. No adjunctive medical or mechanical treatment has been proved to be efficacious in reducing risk for CIN. Prophylactic hemodialysis and hemofiltration have not been validated as effective strategies. The CIN Consensus Working Panel considered that, of the pharmacologic agents that have been evaluated, theophylline, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), ascorbic acid, and prostaglandin E(1) deserve further evaluation. N-acetylcysteine is not consistently effective in reducing the risk for CIN. Fenoldopam, dopamine, calcium channel blockers, atrial natriuretic peptide, and l-arginine have not been shown to be effective. Use of furosemide, mannitol, or an endothelin receptor antagonist is potentially detrimental. Nephrotoxic drugs should be withdrawn before contrast administration in patients at risk for CIN.
Stacul
Fulvio
F
Department of Radiology, University of Trieste, Trieste, Italy. fulvio.stacul@aots.sanita.fvg.it
Adam
Andy
A
Becker
Christoph R
CR
Davidson
Charles
C
Lameire
Norbert
N
McCullough
Peter A
PA
Tumlin
James
J
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D003245:Consensus Statements as Topic; D003287:Contrast Media / Q000009:adverse effects*; D004630:Emergencies; D005440:Fluid Therapy; D006440:Hemofiltration; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008687:Metformin / Q000009:adverse effects; D006435:Renal Dialysis
D003287:Contrast Media; D007004:Hypoglycemic Agents; D008687:Metformin