Prevention of contrast induced nephropathy: recommendations for the high risk patient undergoing cardiovascular procedures.
Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired 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 m2 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.
Schweiger
Marc J
MJ
Division of Cardiology, Baystate Medical Center, Springfield, MA 01199, USA. marc.schweiger@bhs.org
Chambers
Charles E
CE
Davidson
Charles J
CJ
Zhang
Shaoheng
S
Blankenship
James
J
Bhalla
Narinder P
NP
Block
Peter C
PC
Dervan
John P
JP
Gasperetti
Christine
C
Gerber
Lowell
L
Kleiman
Neal S
NS
Krone
Ronald J
RJ
Phillips
William J
WJ
Siegel
Robert M
RM
Uretsky
Barry F
BF
Laskey
Warren K
WK
D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D005440:Fluid Therapy; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D011292:Premedication; D015641:Radiography, Interventional; D012307:Risk Factors
D003287:Contrast Media