Our standard agent is Omnipaque-350 but for high risk patients we use an iso-osmolar agent which is Visipaque-320. A list of increased risk patient follows but we also use Visipaque-320 for all PE studies, cardiac CTA studies, and all pediatric patients.
Patient-related Risk Factors for CIN Established – Pre-existing renal impairment with diabetes – Pre-existing renal impairment without diabetes – Dehydration – Congestive heart failure – Multiple myeloma – Advanced age – Administration of nephrotoxic drugs Newly identified – Hypertension – Metabolic syndrome CIN, contrast-induced nephropathy Asif A et al. Am J Ther. 2003;10:137-147; Morcos SK et al. Eur Radiol. 1999;9:1602-1613.
"Intravenous contrast material application in high risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups." Iso-osmolality versus Low Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function Nguyen SA et al. Radiology 2008; 248:97-105
"In patients with impaired renal function, SCr levels are less likely to increase when iso-osmolality iodixanol is used, as compared with low osmolality iopromide." Iso-osmolality versus Low Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function Nguyen SA et al. Radiology 2008; 248:97-105
"Fewer patients in the iodixanol group (8.5%) than in the iopromide group (27.8%) had SCr increase 0.5 mg/dL or higher (≥25%, P=.012)." Iso-osmolality versus Low Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function Nguyen SA et al. Radiology 2008; 248:97-105
Contrast induced nephropathy: CT of the kidney looks as if the contrast was just injected. Look at aorta and see that no injection of contrast occurred. |