Page 1 of 3
Policy # Rad2065 Guidelines: Recommendations for Safe Administration of Iodinated Contrast Administration
in Patients with Diminished Renal Function
UMass Memorial Medical Center
Department of Radiology
Policies/Procedures and or Clinical Guidelines
Policy # Rad2065 Guidelines: Recommendations for Safe Administration of
Iodinated Contrast Administration in Patients with Diminished Renal
Function
Developed By:
Byron Chen MD
Matthew Hoimes MD
Steven Baccei, MD Director, Radiology
Quality, Patient Safety, and Process
Improvement
Effective Date: 7/1/2014
Applicability:
Rescission: Supersedes policy dated: 9/2008,
7/2009
Approved by: _________________________
Max Rosen, MD Radiology Chair
Approved by: __________________________
Kathryn Green, Sr. Director Radiology
Keywords:
I.
Policy:
To standardize departmental practice with regard to iodinated intravenous contrast and
preservation of renal function. For the purpose of this policy, renal function will be
measured by estimated GFR.
II.
Definitions:
N/A
III.
General Procedure:
RENAL FUNCTION SCREENING:
In the outpatient setting, the following patient population will require renal function
screening within 30 days of contrast administration:
 Age >65 years
 History of renal disease, including
o Kidney transplant
o Single kidney
o Kidney cancer
o Kidney surgery
o History of renal insufficiency
 History of hypertension requiring medical therapy
 History of diabetes
 Metformin (or metformin-containing drug combinations)
Page 2 of 3
Policy # Rad2065 Guidelines: Recommendations for Safe Administration of Iodinated Contrast Administration
in Patients with Diminished Renal Function
For inpatients and ER patients, the same guidelines will apply unless documented in the
medical record that medical emergency precludes screening. If labs have already been
drawn but are pending, the results should be waited for unless medical emergency is
documented.
Labs specific to renal function (eGFR) will be reviewed by the technologist
administering the intravenous contrast on the same date, immediately prior to the
administration of intravenous contrast to ensure that the most current clinical information
is utilized to classify patients with renal insufficiency (see section IV.)
IV.
Clinical/Departmental Procedure:
PATIENTS WITH RENAL INSUFFICIENCY
eGFR > 60
No restrictions
(very
low
risk)
eGFR 45-60
If acute renal failure, consider IV hydration. Otherwise,
(low risk)
encourage oral hydration and salt loading as clinically
appropriate.
eGFR 30 – 44 Consider alternative exams (MRI/Ultrasound). Otherwise
(moderate
IV hydration required (see below) unless documented that
risk)
medical emergency precludes hydration. Iodixanol
(Visipaque) contrast is suggested.
eGFR < 30
No IV contrast unless approved by nephrology or deemed
(high risk)
a medical emergency, which must be documented.
Iodixanol (Visipaque) contrast is suggested in the event of
a documented medical emergency/override authorizing
the administration of IV contrast.
*Patients with end-stage renal disease on maintenance hemodialysis (and no expected
return of renal function) may receive IV contrast regardless of GFR. Unless an unusually
large amount of contrast is administered or there is substantial cardiac dysfunction, there
is no need for emergent hemodialysis.
HYDRATION PROTOCOL
For outpatients, isotonic NaCl at 3ml/kg/hr for a minimum of 1 hour prior to contrast
administration and 6 hours following contrast.
For inpatients, isotonic NaCl at 1ml/kg/hr for 12 hours prior to contrast administration
and 12 hours after contrast administration.
MULTIPLE CONTRAST BOLUSES
Patients should not receive greater than 200mL of iodinated contrast material within a 24
hour period unless medical emergency is documented or nephrology consult has
approved administration. Care should be taken to assure that patients did not receive
Page 3 of 3
Policy # Rad2065 Guidelines: Recommendations for Safe Administration of Iodinated Contrast Administration
in Patients with Diminished Renal Function
contrast from other departments, for example cardiac catheterization or neuro/vascular IR
procedure.
FOLLOW UP TESTING
Renal function testing should be measured greater than 48 hours after administration of
IV contrast for those with GFR < 45. To be ordered by referring physician.
V.
Supplemental Materials:
N/A
VI.
References:
ACR Manual on Contrast Media v9, 2013.
safety/resources/contrast-manual
Accessed online: www.acr.org/quality-
Trivedi HS et al. A randomized prospective trial to assess the role of saline hydration on
the development of contrast nephrotoxicity. Nephron Clin Pract 2003; 93: C29–C34
Mueller C et al. Prevention of contrast media-associated nephropathy: randomized
comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty.
Arch Intern Med 2002; 162: 329–336
Stacul F,Adam A,Becker CR, et al. Strategies to reduce the risk of contrast- induced
nephropathy. Am J Cardiol 2006; 98: 59K–77K.
Younathan CM et al. Dialysis is not indicated immediately after administration of
nonionic contrast agents in patients with end-stage renal disease treated by maintenance
dialysis. AJR Am J Roentgenol 1994; 163:969-971.