Nonpharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury
Table 5
Nonpharmacological strategies to prevent contrast-induced acute kidney injury.
Time of referral
Before the examination
Time of examination
After the examination
Elective examination
Identify patients who require measurement of renal function (i) Patients with known eGFR less than 60 mL/min/1.73 m2 determine eGFR (or SCr) after contrast medium administration within 7 days (ii) Patients who will receive intra-arterial contrast media (iii) Age over 70 years (iv) Patients with a history of renal disease renal surgery proteinuria diabetes mellitus hypertension gout (v) Recent nephrotoxic drugs
At-risk patients (i) Consider an alternative imaging method not using iodine-based contrast media (ii) Discuss the need to stop nephrotoxic drugs with the referring physician (iii) Start volume expansion. A suitable protocol is intravenous normal saline, 1.0–1.5 mL/kg/hour, for at least 6 hours before and after contrast media. An alternative protocol is intravenous sodium bicarbonate, 3 mL/kg/h for 1 hour before contrast medium and 1 mL/kg/hour for 6 hours after contrast media
At-risk patients (i) Use low- or isoosmolar contrast media (ii) Use the lowest dose of contrast media consistent with a diagnostic result
At-risk patients (i) Continue volume expansion (ii) Determine eGFR 48–72 hours after contrast media
Emergency examination
Identify at-risk patients (see Table 1) if possible (i) Determine eGFR if the procedure can be deferred until the result is available without harm to the patient (ii) If eGFR cannot be obtained, follow the protocols for patients with eGFR less than 60 mL/min/1.73 m2 for intra-arterial administration and eGFR less than 45 mL/min/1.73 m2 for intravenous administration as closely as clinical circumstances permit
At-risk patients (i) Consider an alternative imaging method not using iodine-based contrast media. (ii) Start volume expansion as early as possible before contrast media administration (see elective examination)
Patients not at increased risk Use the lowest dose of contrast media consistent with a diagnostic result
