Guidelines for the Prevention of Contrast Induced Nephropathy: Intravenous Contrast Sparrow Andrew B. MacKersie, M.D. F

1. Guidelines for the Prevention of Contrast Induced Nephropathy: Intravenous ContrastSparrowAndrew B. MacKersie, M.D.February 19, 20131 of 2 • General Guidelines for all patients with GFR <= 40 mL/min: • Consider alternative imaging studies not requiring iodinated contrast medium (CM). • Contrast volume is minimized per standard protocols. • Avoid repeat contrast studies within 24 hours. Follow-up GFR prior to repeat contrast injection. • ***Following guidelines assume stable GFR. Patients with acute renal insufficiency are at high risk for CIN.*** • GFR < 30 mL/min • High risk for CIN • Consider alternative study • IV 0.9% Saline Hydration • Follow-up GFR in 48 hours • Physician Approval Only • GFR 30-40mL/min • Low to Moderate risk for CIN • Inpatient - IV 0.9% Saline • Outpatient- • IV 0.9% Saline or • Oral hydration • GFR > 40 mL/min • Very Low risk for CIN • Proceed with examination. Peri-Procedural Fluid Administration Protocols Intravenous: Inpatients: IV 0.9% saline at 100 ml/hr 6 to 12 hours before and continuing 4 to 12 hours after CM. Outpatients: IV 0.9% saline at 100 ml/hr 6 hours prior to CM. Liberal oral fluids immediately following CM. Oral hydration: Liberal fluids the day before and up to 2 hours before CM and immediately following CM. ***Salty foods the day before the examination to encourage volume expansion.***

2. Guidelines for the Prevention of Contrast Induced Nephropathy: Intravenous ContrastSparrowAndrew B. MacKersie, M.D.February 19, 20132 of 2 • Indications for GFR determination prior to IV Iodinated Contrast Media: • Kidney problems • Kidney disease • Renal insufficiency/failure • Kidney surgery or kidney transplant • Kidney injury • Diabetes (treated with insulin or other medication) • Certain diseases: (e.g. multiple myeloma or systemic lupus erythematosa) • Potentially Nephrotoxic Medications, e.g.: • chronic or high-dose NSAID therapy • aminoglycoside antibiotics • Cardiovascular disease: • History of congestive heart failure and hypertension requiring medication • Peripheral vascular disease – all CTA runoff examinations • 70 years of age or older • Inpatients and emergency department patients • Note: GFR results are required within 30 days for outpatients