Contrast-Induced Nephropathy risk

Recognize

• eGFR < 30 mL/min/1.73 m² → highest risk
• eGFR 30–44 → consider risk/benefit
• AKI (acute kidney injury) → highest risk

Act — tap each step

1. 1Check most recent eGFR (within 30–90 days for outpatients)
2. 2eGFR ≥ 30: routine IV iodinated contrast generally acceptable
3. 3eGFR < 30 not on dialysis: weigh risk/benefit; use lowest dose; consider alternatives
4. 4On dialysis (anuric): IV iodinated contrast is acceptable; no urgent dialysis required
5. 5Hydration: NS 1 mL/kg/h IV for 6–12 h pre + post (if at risk and feasible)
6. 6Hold metformin if eGFR < 30 OR AKI: 48 h post-contrast, restart after renal function confirmed stable

Notes

• Gadolinium-based contrast: avoid Group I agents in eGFR < 30. Group II agents are considered low-risk for NSF.
• Causality of CIN with modern low-/iso-osmolar agents at eGFR ≥ 30 is debated.