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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.
Eur Radiol 2018; 28(7):2856-2869ER

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.

Authors+Show Affiliations

Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands.Institute for Diagnostic and Interventional Radiology Klinikum Karlsruhe, Moltkestraβe 90, D-76133, Karlsruhe, Germany.Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands.Department of Diagnostic Radiology, University Hospitals of Basel, Petersgaben 4, CH-4033, Basel, Switzerland.Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807, Villejuif, France.Department of Radiology, University of Trieste, Strada di Fiume 447, I-34149, Trieste, Italy.Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris Cedex 15, F-71015, Paris, France.Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straβe 4, AT-3100, St. Pölten, Austria.S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, I-34129, Trieste, Italy.Department of Radiology, St. Bartholomew's Hospital, University of London, West Smithfield, EC1A 7BE, London, UK.Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730, Herlev, Denmark. Henrik.Thomsen@regionh.dk.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29417249

Citation

van der Molen, Aart J., et al. "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." European Radiology, vol. 28, no. 7, 2018, pp. 2856-2869.
van der Molen AJ, Reimer P, Dekkers IA, et al. 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. Eur Radiol. 2018;28(7):2856-2869.
van der Molen, A. J., Reimer, P., Dekkers, I. A., Bongartz, G., Bellin, M. F., Bertolotto, M., ... Thomsen, H. S. (2018). 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. European Radiology, 28(7), pp. 2856-2869. doi:10.1007/s00330-017-5247-4.
van der Molen AJ, et al. 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. Eur Radiol. 2018;28(7):2856-2869. PubMed PMID: 29417249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - van der Molen,Aart J, AU - Reimer,Peter, AU - Dekkers,Ilona A, AU - Bongartz,Georg, AU - Bellin,Marie-France, AU - Bertolotto,Michele, AU - Clement,Olivier, AU - Heinz-Peer,Gertraud, AU - Stacul,Fulvio, AU - Webb,Judith A W, AU - Thomsen,Henrik S, Y1 - 2018/02/07/ PY - 2017/10/03/received PY - 2017/12/05/accepted PY - 2017/11/22/revised PY - 2018/2/9/pubmed PY - 2018/10/3/medline PY - 2018/2/9/entrez KW - Acute kidney injury KW - Contrast media KW - Haemodialysis KW - Metformin KW - Practice guidelines SP - 2856 EP - 2869 JF - European radiology JO - Eur Radiol VL - 28 IS - 7 N2 - 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. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/29417249/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_ L2 - https://dx.doi.org/10.1007/s00330-017-5247-4 DB - PRIME DP - Unbound Medicine ER -