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Prevention of contrast induced nephropathy: Recommendations for the high risk patient undergoing cardiovascular procedures
Author(s) -
Schweiger Marc J.,
Chambers Charles E.,
Davidson Charles J.,
Zhang Shaoheng,
Blankenship James,
Bhalla Narinder P.,
Block Peter C.,
Dervan John P.,
Gasperetti Christine,
Gerber Lowell,
Kleiman Neal S.,
Krone Ronald J.,
Phillips William J.,
Siegel Robert M.,
Uretsky Barry F.,
Laskey Warren K.
Publication year - 2007
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20964
Subject(s) - medicine , nephrotoxicity , renal function , contrast induced nephropathy , nephropathy , kidney disease , creatinine , risk factor , urology , concomitant , intensive care medicine , surgery , kidney , endocrinology , diabetes mellitus
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 m 2 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. © 2006 Wiley‐Liss, Inc.