Recommended Interventions for Prevention of Contrast Nephrotoxicity

Intervention Recommendation

Recommendation

Gradea

Contrast

   Minimize contrast volume/dose

   Use noniodinated contrast studies

   Use low- or isoosmolar contrast agents

A-1

A-2

A-2

Medications

    Avoid concurrent use of potentially nephrotoxic drugs (e.g., nonsteroidal antiinflammatory drugs, aminoglycosides)

A-2

Normal (0.9%)

saline

     Initiate infusion at least 3 hours prior to contrast exposure and continue 8–24 hours postexposure Infuse at 1 mL/kg/hr up to 150 mL/h, adjusting postexposure as clinically indicated

A-1

Sodium bicarbonate

154 mEq/L

 Initiate infusion at 3 L/kg/h,beginning 1 hour prior to contrast exposure, then continue at 1 mL/kg/h for 6 hours postexposure

B-2

N-acetylcysteine

    Administer 600 mg orally, every 12 hours × 4 doses beginning prior to contrast exposure (i.e., one dose prior to exposure and 3 doses postexposure)

B-1

aStrength of recommendations: A, B, C, good, moderate, and poor evidence to support recommendation,respectively. Quality of evidence: 1, Evidence from more than one properly randomized,controlled trial. 2, Evidence from more than one well-designed clinical trial with randomization, fromcohort or case-controlled analytic studies or multiple time series; or dramatic results fromuncontrolled experiments. 3, Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert communities.

Derived from data in references 27, 28, 31, 32.

refPharmacotherapy:A Pathophysiologic Approach Seventh Edition

關鍵字: Acetin acetylcysteine 預防 顯影劑 腎毒性 

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