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Practical Techniques to Minimize the Risk of CIN in the High-risk Patient

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Author(s): Mark Downes

Journal: Iranian Journal of Radiology
ISSN 1735-1065

Volume: 5;
Issue: S1;
Start page: 11;
Date: 2008;
Original page

ABSTRACT
The use of iodinated contrast media (CM) is integral to the practice of interventional radiology, facilitating visualization of anatomic structures during MDCT guided diagnostic and therapeutic procedures and leading to advances in patient care.The benefits of contrast-enhanced MDCT imaging,"nhowever, must be viewed in the context of the potential risks of CM use, of which contrast-induced nephropathy (CIN) may be the most serious. CIN is the third commonest cause of hospital-acquired renal insufficiency, with approximately 33% of these cases attributed to CM use in CT procedures in patients who are at risk of CIN due to the presence of established risk factors. Reported patient risk factors for CIN include age, congestive heart failure, and dehydration but pre-existing renal impairment, particularly in association with diabetes, is generally recognized as the most important variable. Based on this, it is recommended that patients who are to undergo intravenous administration of an iodinated contrast agent be questioned about potential renal dysfunction at the time of referral and those who answer positively to at least 1 question should be screened for elevated serum Cr. When a high-risk patient is identified, several strategies can be implemented to minimize the occurrence of CIN. Cessation of all nephrotoxic medications should be implemented if possible ≥24 hours before the contrast-enhanced CT procedure. Adequate pre-and post-procedural hydration is considered one of the most effective CIN prevention measures. Studies of pharmacological prophylaxis are less encouraging and the role of N-acetylcysteine for CIN prevention, for example, remains unclear to date. Finally, volume and type of CM used during the CT procedure may influence the development of CIN. Findings from randomized controlled trials that have considered the role of CM osmolality on nephrotoxicity in at-risk populations suggest that the iso-osmolar CM iodixanol is reno-protective, particularly in the case of high-risk, renally impaired populations. In"nthese randomized controlled trials conducted in the intra-arterial setting or the CT setting, the CIN incidence for iodixanol was at least as low, if not lower, than for the various low-osmolar comparators. This presentation will review the importance of identifying patients who are at-risk of CIN and will discuss strategies that can be implemented to minimize this risk and, thereby, optimize the clinical value of contemporary contrast-enhanced CT procedures.

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