Contrast medium-induced nephropathy, a more practical approach to prevention?

Abstract

To The Editor: we read with interest the good review article by Drs Sterner and Nyman [1] concerning the safe use of intravascular contrast medium for both coronary interventions and multi- channel detector computed tomography. As a radiology department in the United Kingdom, our current policy is to follow specific guidelines issued by the Royal College of Radiologists [2] When compared, the two publications hold many similarities with respect to their recommendations for clinical practice. This is especially true with the recommendations for optimising the patient's renal state prior to any procedure requiring the administration of intravascular contrast media. However, on a practical note, we would suggest that the different calculations proposed to determine the Glomerular Filtration Rate [3–5] are too complex for use in every patient requiring intravascular contrast medium. As a department, we continue to use baseline creatinine levels as a screening tool in high risk patients (i.e. the elderly and patients with a history of diabetes and/or renal disease). We have found this to be sufficient. A review paper by P. Aspelin [6] conveys a very similar message but perhaps in a more general physician-orientated approach. His concluding recommendations are simple: confirm the need for contrast media, identify the at risk patient, hydrate adequately, discontinue nephrotoxic drugs before the procedure, and choose a contrast medium with the lowest nephrotoxic effects. These simple guidelines are perhaps more appropriate for day- to-day practice and for general distribution to referring clinicians who may be deterred by the more complicated equations in the other publications.