In high-risk patients, use of an iso-osmolar CM or one of the low-osmolar CM with a documented low incidence of CIN is recommended. At this time,
iodixanol and iopamidol
appear to be the contrast agents of choice to reduce renal risk.
Does hydration prevent contrast-induced nephropathy?
The recent AMACING study compared hydration versus no hydration, and found that
hydration did not prevent contrast-induced nephropathy
but did lead to complications and higher costs. The latest 2017 guideline recommends hydration only for patients with eGFR < 30 ml/min/1.73 m2.
How can contrast induced nephropathy be prevented?
The cornerstone of prevention of CIN is appropriate risk stratification, intravenous hydration with normal saline or sodium bicarbonate, appropriate withholding of nephrotoxic medications, use of
low or iso-osmolar contrast media
, and various intraprocedural methods for iodinated contrast
Does dialysis prevent contrast nephropathy?
Conclusions:
Data provide no hint that haemodialysis prevents contrast-induced nephropathy
. Therefore, postprocedural dialysis should be restricted to patients participating in clinical studies.
What is contrast-induced nephropathy?
Contrast-induced nephropathy (CIN) is defined as
the impairment of kidney function
—measured as either a 25% increase in serum creatinine (SCr) from baseline or a 0.5 mg/dL (44 μmol/L) increase in absolute SCr value—within 48-72 hours after intravenous contrast administration.
What increases the risk of contrast nephropathy?
The most common risk factors for developing CIN are (1)
a high total dose of CM
[72] ; (2) a high osmolality of the CM [13] ; (3) a high ionic content of the CM [33, 73] ; Page 9 Toprak /Cirit Kidney Blood Press Res 2006;29:84–93 92 (4) a high viscosity of the CM [11, 12, 74] ; (5) intra-arte- rial administration of …
Can contrast induced nephropathy be reversed?
Treatment.
There is no definitive treatment available for established
CIN; therefore, the benefit for CM-based diagnostic studies or interventional procedures should always be weighed against the risk of CIN. In addition, repeated exposure to CM within a short period of time should be avoided whenever possible.
How can we prevent CIN?
The cornerstone of prevention of CIN is appropriate risk stratification,
intravenous hydration with normal saline or sodium bicarbonate
, appropriate withholding of nephrotoxic medications, use of low or iso-osmolar contrast media, and various intraprocedural methods for iodinated contrast dose reduction.
When should athletes consume fluids?
The athlete should drink 7-12 ounces of cold fluid
about 15-30 minutes before workouts
. If the workout is prolonged, add carbohydrates to the beverage at a 6-8 percent concentration. Drink 4-8 ounces of cold fluid during exercise at 15-20 minute intervals.
Can oral contrast cause Aki?
A very important unwanted effect of the use of contrast drugs is acute kidney injury (AKI), ie, a sudden decrease of renal function due to renal damage. 7 AKI secondary to contrast drugs is called contrast-induced AKI (CI-AKI; or contrast-induced nephropathy [CIN]); it is actually an iatrogenic AKI.
Does dialysis clear contrast?
Contrast media can be efficiently removed from blood by hemodialysis
(HD). Since most contrast media are middle-sized molecules, the main factors potentially influencing their removal by HD are blood flow, membrane surface area, molecular size, transmembrane pressure, and dialysis time.
Does dialysis remove contrast?
Peritoneal dialysis is also
effective in removing contrast agents from the body
but takes longer than HD. Dialysis immediately after radiographic contrast studies has been suggested for two groups of patients. Those on chronic HD and those at very high risk for contrast nephropathy.
When do you need dialysis after contrast?
Based on this, for anuric patients on chronic HD it is OK to administer IV contrast with the general recommendation that the patient should undergo dialysis
within 24-48 hours
to reduce the intravascular volume load. As above, there is no need for more urgent dialysis and this is concordant with our current policy.
What are symptoms of contrast induced nephropathy?
CIN is associated with a sharp decrease in kidney function over a period of 48-72 hours. The symptoms can be similar to those of kidney disease, which include
feeling more tired, poor appetite, swelling in the feet and ankles, puffiness around the eyes, or dry and itchy skin
.
How do you protect your kidneys from contrast dye?
The inexpensive drug, called
N-acetylcysteine
, can prevent serious kidney damage that can be caused by the iodine-containing “dyes” that doctors use to enhance the quality of such scans. That “dye,” called contrast agent, is usually given intravenously before a CT scan, angiogram or other test.
Should you stop metformin before contrast?
Metformin medications should be
stopped at the time of or prior to CT studies with IV Contrast
, AND withheld for 48 hours after the procedure.
