SCAI Publishes Recommendations for Prevention of Contrast-Induced Nephropathy

December 13, 2006

December 13, 2006 (Springfield, MA) – The Society of Cardiovascular Angiography and Interventions (SCAI) has published recommendations to assist in the prevention of contrast-induced nephropathy (CIN). In addition to the routine use of the estimated glomerular filtration rate (eGFR) to identify patient risk for CIN, recommendations include vigorous volume repletion, limiting contrast volume, and the use of low- or iso-osmolar contrast media.

"The risk of CIN varies from 2% to 3% in unselected patients undergoing cardiovascular angiographic procedures," writes lead author Dr Marc Schweiger (Baystate Medical Center, Springfield, MA) and colleagues in the consensus statement, published in the January 2007 issue of Catheterization and Cardiovascular Interventions. "It is associated with a significant increase in patient morbidity and mortality. Recognition of the high-risk patient coupled with appropriate periprocedural management can reduce the incidence of CIN."

Recommendations for the prevention of CIN

• Identify patient risk and kidney function--Kidney function is best assessed by estimating the eGFR, a superior measure to serum creatinine tests. For patients at high risk, those with an eGFR <60 mL/min/1.73 m 2, outpatient should be scheduled for early arrival or procedure should be delayed to allow time to accomplish hydration.

• Manage medications--Potentially nephrotoxic drugs, including aminoglycoside antibiotics, antirejection medications, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be withheld 24 hours to 48 hours before the procedure.

• Avoid dehydration--A minimum 1 L of isotonic saline should be administered three hours before and continuing at least six to eight hours after the procedure. There are limited data that suggest a modified regimen with sodium bicarbonate may be effective in high-risk patients.

• Use low- or iso-osmolar contrast agents and minimize the amount of contrast media volume used.

• Monitor patients at increased risk of CIN for 48 hours--Follow-up serum creatinine should be obtained 48 hours after the procedure and the physician should consider withholding appropriate medications--metformin, NSAIDs--until renal function returns to normal.

  1. Schweiger MJ, Chambers CE, Davidson CJ, et al. Prevention of contrast induced nephropathy: recommendations for the high-risk patient undergoing cardiovascular procedures. Catheter Cardiovasc Interv 2006; DOI:10.1002/ccd.20964. Available at: https://www3.interscience.wiley.com/cgi-bin/abstract/113493001/ABSTRACT

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