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

Aart J van der Molen, Peter Reimer, Ilona A Dekkers, Georg Bongartz, Marie-France Bellin, Michele Bertolotto, Olivier Clement, Gertraud Heinz-Peer, Fulvio Stacul, Judith A W Webb, Henrik S Thomsen, Aart J van der Molen, Peter Reimer, Ilona A Dekkers, Georg Bongartz, Marie-France Bellin, Michele Bertolotto, Olivier Clement, Gertraud Heinz-Peer, Fulvio Stacul, Judith A W Webb, Henrik S Thomsen

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.

Keywords: Acute kidney injury; Contrast media; Haemodialysis; Metformin; Practice guidelines.

Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Prof. Henrik S. Thomsen.

Conflict of interest

Aart van der Molen has received incidental payments for lectures and chairmanships at scientific meetings for contrast agent safety related issues (contrast agent reactions, Gd-retention) from GE, Bayer, Bracco and Guerbet.

Fulvio Stacul has received lecture fees from Bracco and Guerbet.

Olivier Clément has received lecture fees from Bracco and Guerbet.

The other authors of this manuscript declare no relationships with any companies whose products and services may be related to the subject matter of this article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this is a special paper based on other publications. Thus informed consent is not necessary.

Ethical approval

Institutional review board approval was not required because it is a retrospective study based on other studies.

Methodology

• retrospective

• multicentre study

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