title: Canadian Association of Radiologists consensus guidelines for the prevention of contrast-induced nephropathy: update 2012.
abstract: OBJECTIVE
  Contrast-induced acute kidney injury or contrast-induced nephropathy (CIN) is a significant complication of intravascular contrast medium (CM). These guidelines are intended as a practical approach to risk stratification and prevention. The major risk factor that predicts CIN is pre-existing chronic kidney disease.
  
  
  METHODS
  Members of the committee represent radiologists and nephrologists across Canada. The previous guidelines were reviewed, and an in-depth up-to-date literature review was carried out.
  
  
  RESULTS
  A serum creatinine level (SCr) should be obtained, and an estimated glomerular filtration rate (eGFR) should be calculated within 6 months in the outpatient who is stable and within 1 week for inpatients and patients who are not stable. Patients with an eGFR of ≥ 60 mL/min have an extremely low risk of CIN. The risk of CIN after intra-arterial CM administration appears be at least twice that after intravenous administration. Fluid volume loading remains the single most important measure, and hydration regimens that use sodium bicarbonate or normal saline solution should be considered for all patients with GFR < 60 mL/min who receive intra-arterial contrast and when GFR < 45 mL/min in patients who receive intravenous contrast. Patients are most at risk for CIN when eGFR < 30 mL/min. Additional preventative measures include the following: avoid dehydration, avoid CM when appropriate, minimize CM volume and frequency, avoid high osmolar CM, and discontinue nephrotoxic medications 48 hours before administration of CM.
authors.affiliation: Radiology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: drrichardowen@tbwifi.ca.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Owen
authors.affiliation: Nephrology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Hiremath
authors.affiliation: Radiology, Lakeridge Health, Oshawa, Ontario, Canada.
authors.forename: Andy
authors.initials: A
authors.lastname: Myers
authors.affiliation: Radiology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fraser-Hill
authors.affiliation: Nephrology, Memorial University of Newfoundland, St Johns, Newfoundland, Canada.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Barrett
mesh_terms: D002170:Canada; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D007677:Kidney Function Tests; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical
chemical_list: D003287:Contrast Media
keywords: Acute renal failure; Chronic kidney disease; Contrast-induced acute kidney injury; Contrast-induced nephropathy; Metformin; N-Acetylcysteine