E K Fishman1, D Reddan. 1. Johns Hopkins Hospital, Baltimore, Maryland 21287-0801, USA. efishman@jhmi.edu
Abstract
BACKGROUND: Contrast-induced nephropathy (CIN) is a serious complication of the use of iodinated contrast media (CM), and is associated with increased morbidity and mortality. PURPOSE: To investigate whether radiologists take sufficient measures to prevent CIN in computed tomography (CT). MATERIAL AND METHODS: 2005 survey of 509 European radiologists who had > or =3 years' experience and performed > or =50 CT scans/week. RESULTS: The most common methods used to identify patients at risk of CIN were renal function measurements (64%), clinical judgment (55%), and patient questionnaires (31%); 9% made no routine attempt to identify at-risk patients. The most common preventive protocols used in at-risk patients included: intravenous (i.v.) saline volume repletion (59%) or oral hydration (52%) before/after CT; use of low-osmolar CM (LOCM; 40%) or isosmolar CM (IOCM; 36%); and N-acetylcysteine (20%); 8% used no hydration regimen. While 78% of respondents used < or =100 ml of CM in high-risk patients, 14% used < or =150 ml, and 9% set no volume limit. For 57% of respondents, osmolality was the most important attribute in choosing an iodinated CM in at-risk patients; 41% agreed that CIN risk is lower with IOCM versus LOCM (31% disagreed). CONCLUSION: A European radiologist survey identified a need for increased implementation of evidence-based protocols to improve CIN prevention: routine identification of at-risk patients; withdrawal of nephrotoxic drugs; use of volume repletion regimens; lowest possible volume of CM; and appropriate CM.
BACKGROUND: Contrast-induced nephropathy (CIN) is a serious complication of the use of iodinated contrast media (CM), and is associated with increased morbidity and mortality. PURPOSE: To investigate whether radiologists take sufficient measures to prevent CIN in computed tomography (CT). MATERIAL AND METHODS: 2005 survey of 509 European radiologists who had > or =3 years' experience and performed > or =50 CT scans/week. RESULTS: The most common methods used to identify patients at risk of CIN were renal function measurements (64%), clinical judgment (55%), and patient questionnaires (31%); 9% made no routine attempt to identify at-risk patients. The most common preventive protocols used in at-risk patients included: intravenous (i.v.) saline volume repletion (59%) or oral hydration (52%) before/after CT; use of low-osmolar CM (LOCM; 40%) or isosmolar CM (IOCM; 36%); and N-acetylcysteine (20%); 8% used no hydration regimen. While 78% of respondents used < or =100 ml of CM in high-risk patients, 14% used < or =150 ml, and 9% set no volume limit. For 57% of respondents, osmolality was the most important attribute in choosing an iodinated CM in at-risk patients; 41% agreed that CIN risk is lower with IOCM versus LOCM (31% disagreed). CONCLUSION: A European radiologist survey identified a need for increased implementation of evidence-based protocols to improve CIN prevention: routine identification of at-risk patients; withdrawal of nephrotoxic drugs; use of volume repletion regimens; lowest possible volume of CM; and appropriate CM.
Authors: Fulvio Stacul; Aart J van der Molen; Peter Reimer; Judith A W Webb; Henrik S Thomsen; Sameh K Morcos; Torsten Almén; Peter Aspelin; Marie-France Bellin; Olivier Clement; Gertraud Heinz-Peer Journal: Eur Radiol Date: 2011-08-25 Impact factor: 5.315
Authors: Shira I Moos; Jaap Stoker; Gajenthiran Nagan; Roderick S de Weijert; David N H van Vemde; Shandra Bipat Journal: Eur Radiol Date: 2014-03-25 Impact factor: 5.315