Guidelines for the Prevention of Contrast Induced Nephropathy: Intravenous Contrast
Sparrow
Andrew B. MacKersie, M.D.
February 19, 2013
1 of 2
General Guidelines for all patients with GFR <= 40 mL/min:
• Consider alternative imaging studies not requiring iodinated contrast medium (CM).
• Contrast volume is minimized per standard protocols.
• Avoid repeat contrast studies within 24 hours. Follow-up GFR prior to repeat contrast injection.
***Following guidelines assume stable GFR. Patients with acute renal insufficiency are at high risk for CIN.***
GFR < 30 mL/min
High risk for CIN
• Consider alternative study
• IV 0.9% Saline Hydration
• Follow-up GFR in 48 hours
• Physician Approval Only
GFR 30-40mL/min
Low to Moderate risk for CIN
• Inpatient - IV 0.9% Saline
• Outpatient• IV 0.9% Saline or
• Oral hydration
GFR > 40 mL/min
Very Low risk for CIN
• Proceed with examination.
Peri-Procedural Fluid Administration Protocols
Intravenous:
Inpatients: IV 0.9% saline at 100 ml/hr 6 to 12 hours before and continuing 4 to 12 hours after CM.
Outpatients: IV 0.9% saline at 100 ml/hr 6 hours prior to CM. Liberal oral fluids immediately following CM.
Oral hydration: Liberal fluids the day before and up to 2 hours before CM and immediately following CM.
***Salty foods the day before the examination to encourage volume expansion.***
Guidelines for the Prevention of Contrast Induced Nephropathy: Intravenous Contrast
Sparrow
Andrew B. MacKersie, M.D.
February 19, 2013
2 of 2
Indications for GFR determination prior to IV Iodinated Contrast Media:
• Kidney problems
• Kidney disease
• Renal insufficiency/failure
• Kidney surgery or kidney transplant
• Kidney injury
• Diabetes (treated with insulin or other medication)
• Certain diseases: (e.g. multiple myeloma or systemic lupus erythematosa)
• Potentially Nephrotoxic Medications, e.g.:
• chronic or high-dose NSAID therapy
• aminoglycoside antibiotics
• Cardiovascular disease:
• History of congestive heart failure and hypertension requiring medication
• Peripheral vascular disease – all CTA runoff examinations
• 70 years of age or older
• Inpatients and emergency department patients
• Note: GFR results are required within 30 days for outpatients