Risk factors for Contrast induced nephropathy
What are the risk factors for the development of Contrast induced nephropathy?
• Chronic Kidney Disease: The main predisposing risk factor is preexisting kidney disease with serum creatinine ≥1.5 mg/dL or estimated glomerular filtration rate below 60 mL/min/1.73 m2. Furthermore, the more severe the degree of CKD, the greater the risk of Contrast induced nephropathy.
• Diabetes: The presence of diabetes further enhances this risk; however, diabetes itself without kidney disease has not been associated with Contrast induced nephropathy.
• Contrast volume: High doses of contrast are associated with increased risk. Several studies in percutaneous coronary intervention (PCI) patients have shown that low-volume contrast (<50 mL) during coronary angiography can be adequate for coronary artery visualization and stent placement, but they have not directly looked at the decreased rates of Contrast induced nephropathy. However, it would be expected—with minimal contrast volumes—that the incidence of Contrast induced nephropathy post-PCI would be either eliminated or mitigated.
• Intra-arterial administration carries a higher risk of injury than does IV administration.
• Advanced age
• Proteinuria
• Hypotension
• Volume depletion
• Congestive heart failure
• Multiple myeloma (historical risk factor; unlikely a risk factor with modern contrast agents)
• Concurrent use of nonsteroidal anti-inflammatory agents
• Renin-Angiotensin-Aldosterone System (RAAS) blockade*
• Kidney transplant without Chronic Kidney Disease*
• Cirrhosis*
* Synergistic risk factors; controversial data about true risk.
Although Contrast induced nephropathy has been described for years following IV contrast radiologic studies, large trials with propensity matching suggest that IV contrast media has had no statistically significant increase in Acute Kidney Injury, dialysis, or mortality, compared to patients with similar procedures without contrast.
Despite these findings, we still recommend that in high-risk patients (i.e., with impaired kidney function) scheduled for IV contrast radiologic studies, the usual prophylactic steps be followed (see later) to minimize risk and prophylactic techniques.
