Background/Aims: Radiocontrast nephropathy (RCN) is a common and costly form of acute renal failure. Current preventative strategies include the use of intravenous (IV) fluids and the discontinuation of nephrotoxic medications at the time of radiocontrast administration. We sought to determine whether providers employ these strategies in high-risk patients to limit the development of RCN. Methods: High-risk patients undergoing procedures using radiocontrast media over a 12-month period were identified. Medical records were reviewed for all subjects who developed RCN and a randomly selected 25% of patients without RCN. Patients with a contraindication to IV volume expansion were excluded. Medical records of the remaining patients were reviewed to determine whether IV fluids were administered and whether NSAIDs or COX-2 inhibitors were prescribed at the time of contrast administration. Results: RCN developed in 8% of patients overall. Of 144 patients eligible for IV volume expansion, 16% failed to receive any IV fluids. When IV fluids were employed, their dose and timing of administration varied significantly by treating specialty and procedure. NSAIDs and COX-2 inhibitors were prescribed to 8% of patients. Conclusions: Commonly accepted strategies for the prevention of RCN are underutilized. Quality improvement efforts are needed to increase the use of these two simple prophylactic measures.

Keywords:
Intravenous fluids, Nonsteroidal anti-inflammatories, Cyclo-oxygenase inhibitors, Radiocontrast nephropathy
1.
Davidson CJ, Hlatky M, Morris KG et al: Cardiovascular and renal toxicity of a nonionic radiographic contrast agent after cardiac catheterization. A prospective trial. Ann Intern Med 1989;110:119–124.
2.
Parfrey PS, Griffiths SM, Barrett BJ et al: Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 1989;320:143–149.
3.
Deray G, Brillet G, Baumelou A, Jacobs C: Acute renal failure following coronary arteriography and ventriculography with ioxaglate, a low-osmolality radiocontrast agent. Am J Kidney Dis 1990;16:506–507.
4.
Porter GA: Contrast-associated nephropathy. Am J Cardiol 1989;64:22E–26E.
5.
Vari RC, Natarajan LA, Whitescarver SA, Jackson BA, Ott CE: Induction, prevention and mechanisms of contrast media-induced acute renal failure. Kidney Int 1988;33:699–707.
6.
Lautin EM, Freeman NJ, Schoenfeld AH et al: Radiocontrast-associated renal dysfunction: Incidence and risk factors. AJR Am J Roentgenol 1991;157:49–58.
7.
McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW: Acute renal failure after coronary intervention: Incidence, risk factors and relationship to mortality. Am J Med 1997;103:368–375.
8.
Rich MW, Crecelius CA: Incidence, risk factors and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study. Arch Intern Med 1990;150:1237–1242.
9.
Taliercio CP, Vlietstra RE, Fisher LD, Burnett JC: Risks for renal dysfunction with cardiac angiography. Ann Intern Med 1986;104:501–504.
10.
Levy EM, Viscoli CM, Horwitz RI: The effect of acute renal failure on mortality. A cohort analysis. JAMA 1996;275:1489–1494.
11.
Aronow HD, Peyser PA, Eagle KA et al: Predictors of length of stay after coronary stenting. Am Heart J 2001;142:799–805.
12.
Cacoub P, Deray G, Baumelou A, Jacobs C: No evidence for protective effects of nifedipine against radiocontrast-induced acute renal failure. Clin Nephrol 1988;29:215–216.
13.
Kellum JA: The use of diuretics and dopamine in acute renal failure: a systematic review of the evidence. Crit Care (Lond) 1997;1:53–59.
14.
Cosentino F: Drugs for the prevention and treatment of acute renal failure. Cleve Clin J Med 1995;62:248–253.
15.
Solomon R, Werner C, Mann D, D’Elia J, Silva P: Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994;331:1416–1420.
16.
Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W: Prevention of radiographic contrast agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180–184.
17.
Abizaid AS, Clark CE, Mintz GS et al: Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency. Am J Cardiol 1999;83:260–263.
18.
Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M: Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 2000;11:97–104.
19.
Kurnik BR, Allgren RL, Genter FC, Solomon RJ, Bates ER, Weisberg LS: Prospective study of atrial natriuretic peptide for the prevention of radiocontrast-induced nephropathy. Am J Kidney Dis 1998;31:674–680.
20.
Shammas NW, Kapalis MJ, Harris M, McKinney D, Coyne EP: Aminophylline does not protect against radiocontrast nephropathy in patients undergoing percutaneous angiographic procedures. J Invasive Cardiol 2001;13:738–740.
21.
Erley CM: Does hydration prevent radiocontrast-induced acute renal failure? Nephrol Dial Transplant 1999;14:1064–1066.
22.
Eisenberg RL, Bank WO, Hedgock MW: Renal failure after major angiography can be avoided with hydration. AJR Am J Roentgenol 1981;136:859–861.
23.
Kerstein MD, Puyau FA: Value of periangiography hydration. Surgery 1984;96:919–922.
24.
Conger J: Hemodynamic factors in acute renal failure. Adv Ren Replace Ther 1997;4:25–37.
25.
Ahmad SR, Kortepeter C, Brinker A, Chen M, Beitz J: Renal failure associated with the use of celecoxib and rofecoxib. Drug Saf 2002;25:537–544.
26.
Workman RJ, Shaff MI, Jackson RV, Diggs J, Frazer MG, Briscoe C: Relationship of renal hemodynamic and functional changes following intravascular contrast to the renin-angiotensin system and renal prostacyclin in the dog. Invest Radiol 1983;18:160–166.
27.
Baker CS, Baker LR: Prevention of contrast nephropathy after cardiac catheterisation. Heart 2001:361–362.
28.
Barrett BJ: Contrast nephrotoxicity. J Am Soc Nephrol 1994;5:125–137.
29.
Bennett WM, Porter GA: Nephrotoxicity of common drugs used by urologists. Urol Clin North Am 1990;17:145–156.
30.
Yount R, Vries J, Council C: The Medical Archival Retrieval System: An information retrieval system based on distributed parallel processing. Inf Process Manage 1991;27:1–11.
31.
Iezzoni LI, Moskowitz MA: A clinical assessment of MedisGroups. JAMA 1988;260:3159–3163.
32.
Levey AS GT, Kusek JW, Beck GJ: A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol 2000;11:A0828.
33.
Heyman SN, Brezis M, Reubinoff CA et al: Acute renal failure with selective medullary injury in the rat. J Clin Invest 1988;82:401–412.
34.
Yoshioka T, Fogo A, Beckman JK: Reduced activity of antioxidant enzymes underlies contrast media-induced renal injury in volume depletion. Kidney Int 1992;41:1008–1015.
35.
Erley CM, Heyne N, Rossmeier S, Vogel T, Risler T, Osswald H: Adenosine and extracellular volume in radiocontrast media-induced nephropathy. Kidney Int Suppl 1998;67:S192–S194.
36.
Anto HR, Chou SY, Porush JG, Shapiro WB: Infusion intravenous pyelography and renal function. Effect of hypertonic mannitol in patients with chronic renal insufficiency. Arch Intern Med 1981;141:1652–1656.
37.
Mueller C, Buerkle G, Buettner HJ et al: Prevention of contrast media-associated nephropathy: Randomized comparison of two hydration regimens in 1,620 patients undergoing coronary angioplasty. Arch Intern Med 2002;162:329–336.
38.
Trivedi HS, Moore H, Nasr S et al: A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron 2003;93:C29–C34.
39.
National Quality Forum website: http://www.qualityforum.org/
40.
Sheldon WC: Trends in cardiac catheterization laboratories in the United States. Catheter Cardiovasc Interv 2001;53:40–45.
41.
Schneider EL, Guralnik JM: The aging of America. Impact on health care costs. JAMA 1990;263:2335–2340.
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2004
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