Which factors require assessment of patient renal function prior to administration of intravascular contrast material

Which factors require assessment of patient renal function prior to administration of intravascular contrast material?

1. Known or Suspected Kidney Disease

• History of chronic kidney disease (CKD)
• Elevated serum creatinine or known eGFR < 60 mL/min/1.73 m²

2. Diabetes Mellitus

• Especially when coexisting with renal disease, even if creatinine is normal
• Diabetic nephropathy increases risk

3. Use of Nephrotoxic Medications

• NSAIDs, aminoglycosides, cisplatin, vancomycin, methotrexate, etc.
• Concurrent use can amplify renal toxicity risk

4. Dehydration or Volume Depletion

• Increases risk of renal hypoperfusion and contrast-related injury

5. Recent or Ongoing Acute Kidney Injury (AKI)

• If there is suspicion of recent AKI (e.g., due to infection, hypotension, drugs)

6. Congestive Heart Failure or Hemodynamic Instability

• Poor renal perfusion can increase the likelihood of renal injury after contrast exposure

7. Planned Use of Intra-Arterial Contrast Administration

• Especially with first-pass renal exposure (e.g., during angiography or cardiac catheterization)
• Higher risk than intravenous contrast

8. Multiple Contrast Exposures in a Short Time

• Repeated contrast studies within 48–72 hours may increase cumulative risk

9. Age > 60 Years

• Age-related decline in kidney function may not always be clinically obvious

10. Transplant Recipients (Renal or Non-Renal)

• May have reduced renal reserve or be on nephrotoxic immunosuppressants

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What to Assess:

• Serum Creatinine
• Estimated Glomerular Filtration Rate (eGFR)

eGFR < 30 mL/min/1.73 m² = high risk
eGFR 30–59 mL/min/1.73 m² = moderate risk, clinical judgment needed
eGFR ≥ 60 = generally safe

• • Patient age >60
• • History of renal disease, including:
  • • Dialysis
  • • Renal transplant
  • • Single kidney
  • • Renal cancer
  • • Renal surgery
• • History of hypertension requiring medical therapy
• • History of diabetes mellitus
• • Metformin or metformin-containing drug combinations (for iodinated contrast material administration only)

At our institution, when the serum creatinine level is ≤ 1.4 mg/dL, iodinated contrast material can be administered, assuming that there are no other contraindications.

When the serum creatinine level is between 1.5 and 1.9 mg/dL or rising, iodinated contrast material can still be administered, but only after a conversation with the referring physician has taken place to discuss the risks and benefits of administering contrast material and possible diagnostic test alternatives.

When the serum creatinine level is ≥ 2.0 mg/dL, iodinated contrast material is generally not administered unless there is an urgent medical necessity.