Type:
Educational Exhibit
Keywords:
Contrast agents, Kidney, CT, Contrast agent-intravenous, Diagnostic procedure, Drugs / Reactions, Toxicity
Authors:
E. Blanco Pérez, E. Cascón Sánchez, A. González-Cruz Soler, R. Garcia Garcia, M. L. Peris Pérez, L. A. Escobar; Valencia/ES
DOI:
10.1594/ecr2013/C-2148
Conclusion
CONCLUSIONS
The best index of kidney function is the GFR which can be estimated using the MDRM formula.
The measure that has shown greater efficiency is intravenous hydration,
no drug provides consistent protection against the NFC,
studies on acetylcysteine show inconclusive results,
although it tends to his administration
Patients with near-normal renal function are at little risk and few precautions are necessary other than avoidance of volume depletion.
In those patients who are at high risk of contrast nephropathy,
more effective preventive measures,
are as follows:
-Use,
if possible an alternative technique without radiocontrast agents.
-Not using high osmolal agents (1400 to 1800 mosmol/kg) (Grade 1A). Preferably iodixanol or nonionic low osmolal agents such as iopamidol or ioversol rather than iohexol (Grade 1B).
-Use lower doses of contrast and avoid repetitive,
closely spaced studies.
-Avoid volume depletion and nephrotoxic drugs.
-Volume expansion with isotonic intravenous fluids prior to and posterior to contrast administration (Grade 1B).
-Acetylcysteine the day before and the day of the procedure (1200 mg orally twice daily rather than 600 mg twice daily the day before and the day of the procedure) (Grade 2B).
-Among patients with stage 3 and 4 CKD,
it is not necessary to perform prophylactic hemofiltration or hemodialysis after contrast exposure (Grade 1B).
-Among patients with stage 5 CKD,
prophylactic hemodialysis can be done after contrast exposure if there is already a functioning hemodialysis access (Grade 2C).
Although the benefit is questionable.