RANZCR 2016 IODINATED CONTRAST MEDIA GUIDELINE

Some of you may have seen this document from the College of Radiology (free download). Of particular interest is the turn-around regarding contrast induced nephropathy.

The summary of the new recommendations are below (see page 14). In particular, note the bolded ones:

• R4.  Intravascular iodinated contrast media should be given to any patient regardless of renal function status if the perceived diagnostic benefit to the patient, in the opinion of the radiologist and the referrer, justifies this administration.

• R5.  Emergency imaging procedures requiring contrast media administration e.g. acute stroke, acute bleeding, trauma etc. should not be delayed in order to obtain renal function testing results prior to the procedure.

• R6.  The risk of intravenous contrast media related acute kidney injury (CI-AKI) is likely to be non-existent for patients with eGFR greater than 45 mL/min/1.73m2.No special precautions are recommended in this group prior to or following intravenous administration of iodinated contrast media.

• R7.  The risk is of intravenous CI-AKI is also very likely to be low or non-existent for patients with eGFR 30 - 45 mL/min/1.73m2. Universal use of periprocedural hydration in this group to prevent the theoretical risk of CI-AKI cannot be recommended but patients with impaired function in this range that is acutely deteriorating rather than stable may benefit from this intervention.

• R8.  In patients with severe renal function impairment (eGFR less than 30 ml/min/1.73m2) or actively deteriorating renal function (acute kidney injury) careful weighing of the risk versus the benefit of iodinated contrast media administration needs to be undertaken. Consideration should be given to periprocedural renal protection using intravenous hydration with 0.9% saline (see relevant section). However, severe renal function impairment should not be regarded as an absolute contraindication to medically indicated iodinated contrast media administration.

Next time your friendly radiology registrar gives you a hard time, you can give give them some of their own medicine.

Danny Ben-Eli