Who must have a creatinine level prior to IV contrast?

Reference: ACR Manual on Contrast Media, 2021

All inpatients require a current (within one week) creatinine level or estimated glomerular filtration rate (eGFR) prior to an IV contrast-enhanced CT.

Outpatients and ED patients being scheduled for a CT with IV contrast will not require a serum creatinine unless they meet one of the following criteria:

  • Personal history of renal disease, including:
    • Known chronic kidney disease (CKD)
    • Remote history of AKI
    • Dialysis
    • Kidney surgery or kidney transplant
    • Kidney ablation
    • Albuminuria
  • History of diabetes mellitus (optional)
  • Metformin or metformin-containing drug combinations

These parameters are intended to serve as guidelines. Obviously, medical necessity may mandate administering contrast without a current measure of renal function.