What are radiologists doing to prevent contrast-induced nephropathy (CIN) compared with measures supported by current evidence? A survey of European radiologists on CIN associated with computed tomography.
BACKGROUND
Contrast-induced nephropathy (CIN) is a serious complication of the use of iodinated contrast media (CM), and is associated with increased morbidity and mortality.


OBJECTIVE
To investigate whether radiologists take sufficient measures to prevent CIN in computed tomography (CT).


METHODS
2005 survey of 509 European radiologists who had > or =3 years' experience and performed > or =50 CT scans/week.


RESULTS
The most common methods used to identify patients at risk of CIN were renal function measurements (64%), clinical judgment (55%), and patient questionnaires (31%); 9% made no routine attempt to identify at-risk patients. The most common preventive protocols used in at-risk patients included: intravenous (i.v.) saline volume repletion (59%) or oral hydration (52%) before/after CT; use of low-osmolar CM (LOCM; 40%) or isosmolar CM (IOCM; 36%); and N-acetylcysteine (20%); 8% used no hydration regimen. While 78% of respondents used < or =100 ml of CM in high-risk patients, 14% used < or =150 ml, and 9% set no volume limit. For 57% of respondents, osmolality was the most important attribute in choosing an iodinated CM in at-risk patients; 41% agreed that CIN risk is lower with IOCM versus LOCM (31% disagreed).


CONCLUSIONS
A European radiologist survey identified a need for increased implementation of evidence-based protocols to improve CIN prevention: routine identification of at-risk patients; withdrawal of nephrotoxic drugs; use of volume repletion regimens; lowest possible volume of CM; and appropriate CM.
Fishman
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Johns Hopkins Hospital, Baltimore, Maryland 21287-0801, USA. efishman@jhmi.edu
Reddan
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D002983:Clinical Competence / Q000706:statistics & numerical data; D002985:Clinical Protocols; D003287:Contrast Media / Q000009:adverse effects*; D004347:Drug Interactions; D005060:Europe; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007600:Judgment / Q000502:physiology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D008297:Male; D009994:Osmolar Concentration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011871:Radiology / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D012965:Sodium Chloride