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      Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines

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          Abstract

          Objectives

          The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.

          Areas covered in part 2

          Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium.

          Key points

          • In CKD, hydration reduces the PC-AKI risk

          • Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis

          • No drugs have been consistently shown to reduce the risk of PC-AKI

          • Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m 2

          • Dialysis schedules need not change when intravascular contrast medium is given

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          Most cited references128

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          AGREE II: advancing guideline development, reporting and evaluation in health care.

          M. Brouwers, M E Kho, G P Browman … (2010)
          Article 0 comments Cited 1034 times – based on 0 reviews     Review now
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            A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

            Roxana Mehran, Eve Aymong, Eugenia Nikolsky … (2004)
            We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown. A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase >or=25% and/or >or=0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value 75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient. The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [ or=16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively). The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.
            Article 0 comments Cited 487 times – based on 0 reviews     Review now
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              Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines.

              Fulvio Stacul, Aart J van der Molen, Peter Reimer … (2011)
              The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN). Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points • Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed. • CIN risk is lower with intravenous than intra-arterial iodinated contrast medium. • eGFR of 45 ml/min/1.73 m (2) is CIN risk threshold for intravenous contrast medium. • Hydration with either saline or sodium bicarbonate reduces CIN incidence. • Patients with eGFR ≥ 60 ml/min/1.73 m (2) receiving contrast medium can continue metformin normally.
              Article 0 comments Cited 245 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Henrik S. Thomsen: Henrik.Thomsen@regionh.dk
                Journal
                Journal ID (nlm-ta): Eur Radiol
                Journal ID (iso-abbrev): Eur Radiol
                Title: European Radiology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0938-7994
                ISSN (Electronic): 1432-1084
                Publication date (Electronic): 7 February 2018
                Publication date PMC-release: 7 February 2018
                Publication date (Print): 2018
                Volume: 28
                Issue: 7
                Pages: 2856-2869
                Affiliations
                [1 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Radiology, C2-S, , Leiden University Medical Center, ; Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
                [2 ]ISNI 0000 0004 0391 0800, GRID grid.419594.4, Institute for Diagnostic and Interventional Radiology Klinikum Karlsruhe, ; Moltkestraße 90, D-76133 Karlsruhe, Germany
                [3 ]GRID grid.410567.1, Department of Diagnostic Radiology, , University Hospitals of Basel, ; Petersgaben 4, CH-4033 Basel, Switzerland
                [4 ]Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807 Villejuif, France
                [5 ]ISNI 0000 0001 1941 4308, GRID grid.5133.4, Department of Radiology, , University of Trieste, ; Strada di Fiume 447, I-34149 Trieste, Italy
                [6 ]GRID grid.414093.b, Department of Radiology, Assistance Publique-Hôpitaux de Paris, , Hôpital Européen Georges Pompidou, ; 20 rue Leblanc, Paris Cedex 15, F-71015 Paris, France
                [7 ]Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straße 4, AT-3100 St. Pölten, Austria
                [8 ]ISNI 0000 0004 4671 8595, GRID grid.417543.0, S.C. Radiologia Ospedale Maggiore, ; Piazza Ospitale 1, I-34129 Trieste, Italy
                [9 ]ISNI 0000 0001 2161 2573, GRID grid.4464.2, Department of Radiology, St. Bartholomew’s Hospital, , University of London, ; West Smithfield, EC1A 7BE, London, UK
                [10 ]ISNI 0000 0004 0646 8325, GRID grid.411900.d, Department of Diagnostic Radiology 54E2, , Copenhagen University Hospital Herlev, ; Herlev Ringvej 75, DK-2730 Herlev, Denmark
                Article
                Publisher ID: 5247
                DOI: 10.1007/s00330-017-5247-4
                PMC ID: 5986837
                PubMed ID: 29417249
                SO-VID: 4c743e58-a2c2-497d-9767-e9a6aa53f8f0
                Copyright © © The Author(s) 2018
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 3 October 2017
                Date revision received : 22 November 2017
                Date accepted : 5 December 2017
                Categories
                Subject: Contrast Media
                Custom metadata
                issue-copyright-statement © European Society of Radiology 2018

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: contrast media,acute kidney injury,metformin,haemodialysis,practice guidelines
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: contrast media, acute kidney injury, metformin, haemodialysis, practice guidelines

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