How is contrast-induced azotemia treated?

Updated: Sep 19, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Contrast-induced azotemia, which typically becomes evident 3-5 days after exposure, is best prevented by adequate hydration with half-normal saline at 1 mL/kg/h 12 hours before contrast administration and the use of smaller amounts of contrast. Clearly explain the risks of such procedures to the patient.

The benefits of N-acetylcysteine and sodium bicarbonate for prevention of contrast-induced azotemia are still being debated. [16, 17, 18] A systematic review and meta-analysis of prevention strategies found that the greatest clinically and statistically significant reduction in contrast-induced nephropathy occurred with N-acetylcysteine in patients receiving low-osmolar contrast media (compared with IV saline) and with statins plus N-acetylcysteine (compared with N-acetlycysteine alone). [19]

The Prevention of Serious Adverse Events Following Angiography (PRESERVE) trial, which included 5177 patients at high risk for renal complications who were undergoing angiography, found no benefit of IV sodium bicarbonate over IV saline or of oral acetylcysteine over placebo. Outcomes measured included the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days, as well as the prevention of contrast-associated acute kidney injury. [20]


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