Andersen made a number of recommendations for reducing the risk of radiocontrast material renal injury in a patient with chronic kidney disease. The goal is to avoid further deterioration in renal function if possible. The author is from Odense University in Denmark.
Patient selection: chronic kidney disease
Situation: procedure performed with iodinated radiocontrast material or gadolinium
Avoid gadolinium contrast material if the GFR is < 60 mL per minute.
Avoid iodinated contrast material if possible when the GFR is < 30 mL per minute.
If possible consider an alternative contrast-free imaging procedure (ultrasound, MRI, CO2 angiography).
If an alternative method is not feasible then:
(1) Hydrate the patient starting at least 6 hours prior to the start of the procedure.
(2) Use the minimum amount of contrast, focusing the exam as much as possible.
(3) Discontinue metformin, nephrotoxic drugs and diuretics at least 24 hours prior to the procedure.
(4) Monitor renal function for 2 days after the procedure.
