Clinical inquiries. What interventions reduce the risk of contrast nephropathy for high-risk patients?

Full Abstract

Several interventions may reduce the risk of contrast nephropathy for high-risk patients; however, most evidence uses surrogate markers for clinically relevant outcomes. Because dehydration is a risk factor for developing contrast nephropathy, periprocedural hydration is routinely recommended (strength of recommendation [SOR]: C, expert opinion). Single studies have suggested that isotonic saline is associated with less risk than half-normal saline, and hydration with fluids containing sodium bicarbonate is more efficacious than those containing isotonic saline (SOR: B, single randomized controlled trial [RCT]). Oral acetylcysteine lowers the risk of postcontrast elevations in creatinine if taken more than 24 hours before contrast administration (SOR: A, RCTs). Acetylcysteine's low cost and favorable side effect profile make it an appealing option. Hypo-osmolar contrast media are less likely to induce contrast nephropathy than hyper-osmolar media (SOR: A, RCTs). Finally, hemofiltration might be considered for patients with extremely high risk of developing contrast nephropathy (SOR: B, single RCT).

Author information

Author/s: Grossman, Paul D (PD); Burroughs, Martha (M); Guthmann, Richard A (RA);

Affiliation: Del Norte Community Health Center, Crescent City, CA, USA. pdgrossman(-atsign-)yahoo.com

Journal and publication information

Publication Type: Journal Article; Review

Journal: The Journal of family practice (J Fam Pract), published in United States. (Language: eng)

Reference: 2005-Apr; vol 54 (issue 4) : pp 365-7

Dates: Created 2005/04/18; Completed 2005/05/19; Revised 2005/11/16;

PMID: 15833230, status: MEDLINE (last retrieved date: 2/18/2009)

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