Which of the following is the most impoant strategy to prevent contrast nephropathy:
Correct Answer: Hydration with normal saline
Description: Answer is C (Hydration with Normal Saline): Despite extensive study of a variety of agents for renal protection, use of low or iso-osmolar contrast agents and IV hydration with normal saline or sodium bicarbonate are the only strategies that have been shown to be effective in the reduction of Contrast Induced Nephropathy (CIN) in those at risk. N-Aceytl-Cystine (NAC) continues to he the most widely used pharmacologic agent however its effectiveness remains unproven. Interventions to prevent Contrast Induced Nephropathy (Consensus Statement from CIN Working Panel) Adequate Hydration Use of Pharmacological Agents Prophylactic Hemodialysis or Hemofiltration * Adequate intravenous * There are no Pharmacological Agents with * Prophylactic hemodialysis or hemofiltration has volume expansion robust and consistent trial evidence to not been validated as an effective strategy. * Although hemodialysis is not useful for reducing with isotonic suppo clinical use in patients at risk for crystalloid for 3-12 CIN. the risk for CIN, the CIN Consensus Working hours before the * However, the CIN Consensus Working Panel Panel recommends that for patients with severe procedure and agreed that in patients at increased risk for renal impairment who require contrast medium continued for 6 --24 CIN (ie, with an eGFR< 60 mL/min per 1.73 administration, preparation for the procedure hours afterward can m2) consideration could be given to should include planning for hemodialysis in the lessen the probability prophylactic treatment with any of the agents event that CIN occurs despite appropriate - of CIN in patients at that have given promising results, precautions. risk specifically theophylline, statins, ascorbic acid, or PGE1. These agents deserve fuher evaluation. * Hemofiltration requires fuher validation. N-Acetvl-Cvsteine(NAC) is one of the most commonly used agents given before contrast media in patients with renal impairment in an effo to minimize the risk of Contrast Induced Nephropathy (CIN). Use of this agent is attractive due to its wide availability, ease of administration, and low cost. However, despite extensive research, any benefit offered by NAC remains unclear. In fact, a CIN Consensus Working Panel repoed in 2006 that NAC is not consistently effective in reducing the risk for CIN. NAC is most commonly administered as a dose of 600 to 12001112 by mouth twice daily on the day before the procedure and the day of the procedure. However, there are currently no data to guide choice of an optimum oral or IV acetylcysteine regimen. Several Studies on NAC for Contrast Induced Nephropathy have produced conflicting results . Based on current evidence the use of NAC for Contrast Induced Nephropathy cannot be recommended. NAC Despite extensive research, any benefit offered by NAC remains unclear. Routine use of NAC for Contrast Induced Nephropathy cannot be recommended. Given the lack of compelling evidence of efficacy, contrast studies should not be delayed to administer NAC.
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