Prevention of contrast induced nephropathy: Recommendations for the high risk patient undergoing cardiovascular procedures

Marc J. Schweiger*, Charles E. Chambers, Charles J. Davidson, Shaoheng Zhang, James Blankenship, Narinder P. Bhalla, Peter C. Block, John P. Dervan, Christine Gasperetti, Lowell Gerber, Neal S. Kleiman, Ronald J. Krone, William J. Phillips, Robert M. Siegel, Barry F. Uretsky, Warren K. Laskey

*Corresponding author for this work

Research output: Contribution to journalReview article

124 Scopus citations

Abstract

Contrast induced nephropathy (CIN) is the third leading cause of hospital aquired 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 mm2 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.

Original languageEnglish (US)
Pages (from-to)135-140
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume69
Issue number1
DOIs
StatePublished - Jan 2007

Keywords

  • Contrast induced nephropathy
  • Hydration
  • Radiographic contrast media
  • Renal failure

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Schweiger, M. J., Chambers, C. E., Davidson, C. J., Zhang, S., Blankenship, J., Bhalla, N. P., Block, P. C., Dervan, J. P., Gasperetti, C., Gerber, L., Kleiman, N. S., Krone, R. J., Phillips, W. J., Siegel, R. M., Uretsky, B. F., & Laskey, W. K. (2007). Prevention of contrast induced nephropathy: Recommendations for the high risk patient undergoing cardiovascular procedures. Catheterization and Cardiovascular Interventions, 69(1), 135-140. https://doi.org/10.1002/ccd.20964