Protocol Development for Preventing Contrast-Induced Nephropathy

Abstract

Contrast-induced nephropathy (CIN) is related to substantial economic and clinical consequences, including extended hospitalization, the necessity for dialysis, and an amplified risk of death. As radiographic diagnostic testing becomes commonplace, a significant concern among practitioners is the prevention of radiographic contrast-induced nephropathy. Radiographic contrast agents are used most often in tests such as coronary angiography, percutaneous coronary angioplasty, atherectomy, and stent placement, computer-aided tomography (CAT) scanning, and magnetic resonance imaging (MRI). 1 Administration of these contrast agents often cause acute changes in renal function ranging from an acute reduction of renal function to the transient need for hemodialysis. Early studies assessing the renal effects of radiocontrast administration in dogs proved a reduction in renal perfusion lasting up to 20 hours after radiocontrast administration. 8 Although no randomized controlled trial (RCT) has studied the benefits of hydration alone, it appears reasonable that sufficient hydration may offset some of the presumed hemodynamic effects that could lead to contrast-induced nephropathy. Various preventative strategies have been studied with mixed results. This paper constitutes reviewing current and old practices and developing a tentative simple protocol for prevention of Contrast induced nephropathy in nearby hospitals.