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 m2, outpatient should be scheduled for
early arrival or procedure should be delayed to allow time to accomplish
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
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.