Renal impairment is one of the major side effects of intravenous iodinated contrast administration. A wide variety of risk factors have been described, of which pre-existing renal impairment and diabetes mellitus are the most important. The true frequency of contrast nephropathy is difficult to establish because there are no standard diagnostic criteria for these side effects of iodine contrast. In two large series (n = 1114 and 443) of patients undergoing coronary angiography, 6 to 10% of patients had a post-procedural rise in serum creatinine of greater than 0.5 mg/dl [1, 2]. None of these patients became anuric or required hemodialysis. The major factors predictive of contrast nephropathy were elevated baseline serum creatinine and diabetes mellitus. Another study that only included patients with impaired renal function (creatinine greater than 1.35 mg/dl) found the frequency of contrast nephropathy (defined as a rise of at least 25% in serum creatinine) depended on the baseline creatinine level and presence of diabetes mellitus. The risk of contrast nephropathy requiring dialysis significantly increases in patients with an estimated glomerular filtration rate below 30 ml/min/1.732 as shown in figure .
Renal impairment is one of the major side effects of iodinated contrast.
The true frequency of contrast nephropathy is difficult to establish because there are no standard diagnostic criteria for these side effects of iodine contrast, but it is clear that the primary risk factor is baseline renal impairment, especially with co-existent diabetes.
- 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.
- Schwab SJ, Hlatky MA, Pieper KS, et al. Contrast nephrotoxicity: a radomized controlled trial of a nonionic and an ionic radiographic contrast agent. NEJM 1989; 320:149-153.
- 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 (5): 368-75.
- Patient Screening Prior to Administration of Iodinated Contrast
- Administrative Process for Iodinated Contrast
- Vascular Access and Use of Central Lines and Ports in Adults
- Vascular Access and use of Central Lines and Ports in Pediatrics
- Background Information on Adverse Effects of Iodinated Contrast
- Creatinine Testing Prior to Contrast Administration
- Contrast Administration in Patients with an Elevated Creatinine
- Contrast Administration in Patients with Renal Failure
- Contrast Administration in Patients Receiving Metformin
- Contrast Administration in Patients with Multiple Myeloma
- Management of Acute Contrast Reactions
- Permissible Doses
- Iso-Osmolar Dimeric Contrast Media
- Contrast Extravasation
- Useful Links