Patients with a baseline estimated glomerular filtration rate (eGFR) below 60 ml/min per 1.73 m² carry an elevated risk for contrast-induced AKI (CI-AKI) when intravascular iodinated contrast media is administered — whether intravenously or intra-arterially.
All patients considered for such a procedure should be screened for pre-existing kidney function impairment before contrast exposure. When baseline eGFR falls below this threshold, targeted precautions are indicated.
Prophylactic intravenous volume expansion is a central element of the preventive strategy; the full protocol specifies the agents involved, any adjunctive measures, and guidance on contrast medium selection and dosing.
Prevention of contrast-induced AKI, defined as no rise in serum creatinine of 0.5 mg/dl or more — or a 25% increase from baseline — at 48 hours after the procedure.
DOI: 10.1159/000339789
The CI-AKI Consensus Working Panel recommended that precautions to reduce the risk should be implemented in patients with a baseline eGFR<60 ml/min per 1.73 m2.
Assess the risk for CI-AKI and, in particular, screen for pre-existing impairment of kidney function in all patients who are considered for a procedure that requires intravascular (i.v. or i.a.) administration of iodinated contrast medium.
We recommend i.v. volume expansion with either isotonic sodium chloride or sodium bicarbonate solutions, rather than no i.v. volume expansion, in patients at increased risk for CI-AKI.
The term contrast-induced nephropathy is widely used in the literature and usually defined as a rise in SCr of ≥0.5 mg/dl (≥44 mmol/l) or a 25% increase from baseline value, assessed at 48 hours after a radiological procedure.
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