Prophylaxis to prevent AKI prior to IV contrast administration is indicated for patients with AKI or an eGFR<30mL/min/1.73m2 who are not undergoing maintenance dialysis. The risks of prophylaxis (eg, heart failure, other hypervolemic conditions) should be considered prior to initiation. In individual high risk circumstances, (eg, numerous risk factors, recent AKI, borderline eGFR), prophylaxis may be donsidered in patients with eGFR 30-44 ml/min/1.73m2 at the discretion of the ordering clinician.
When prophylaxis is indicated, isotonic volume expansion with normal saline is the preferred method. The ideal timing, volume and rate is uncertain but typical volume expansion regimens begin 1 hour before and continue 3-12 hours after contrast media administration, with typical doses ranging from fixed (eg, 500 mL before and after) to weight based volumes (eg, 1-3 ml/kg per hour). For inpatients, longer regimens (approximately 12 hours) may lower the risk of contrast-associated AKI if feasible. One possible protocol would be 0.9% saline at 100 ml/hr, beginning 6-12 hrs before contrast and continuing for 4-12 hours after contrast in the inpatient setting. Oral hydration has not been well studied.
- 1. Davenport MS, Perazella MA, Yee J, et al. Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020:192094