Contrast Preparation
Risk stratification and prophylaxis protocols for Contrast-Associated Acute Kidney Injury (CA-AKI).
Risk Assessment
Identify high-risk patients before procedure
Major Risk Factors:
- eGFR < 30 mL/min/1.73m²
- eGFR 30-44 mL/min/1.73m² (especially if diabetic)
- Acute Kidney Injury (AKI)
- Hypotension / Hypovolemia
Mehran Score (PCI): Predicts risk of CIN.
Factors: Hypotension, IABP, CHF, Age > 75, Anemia, Diabetes, Contrast Volume, eGFR.
Factors: Hypotension, IABP, CHF, Age > 75, Anemia, Diabetes, Contrast Volume, eGFR.
Prophylaxis Protocol
Standard of care for high-risk patients
1
Volume Expansion (IV Fluids)
Isotonic Saline (0.9% NaCl):
1 mL/kg/hr for 12h pre- and 12h post-procedure.
OR 3 mL/kg/hr for 1h pre- (AMACING protocol).
2
Medication Management
Metformin: Hold on day of procedure and 48h after. Restart only if renal function remains stable.
NSAIDs/Diuretics: Hold 24-48h prior if possible.
3
Contrast Volume
Use lowest possible volume of Iso-osmolar or Low-osmolar contrast.
Goal: Volume (mL) / eGFR < 3.7
N-Acetylcysteine (Mucomyst)
Routine use is no longer recommended by KDIGO or ACC/AHA due to lack of proven benefit in large randomized trials (PRESERVE trial).
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