Q. Which of the following is incorrect regarding prevention of contrast induced nephropathy?
A. Preprocedure hydration with 0.9% NaCl is better than 0.45% NaCl
B. Low osmolar contrast media is better than iso-osmolar contrast media
C. Preprocedure use of N-acetyl cysteine is not recommended
D. Biplane angiography is useful in reducing the dose of contrast
Answer: B. Low osmolar contrast media is better than iso-osmolar contrast media
Explanation:
Contrast induced nephropathy (CIN)
Transient increase in creatinine by 0.5 mg/dl or 25% increase from baseline.
Occurs in 5% of patients following cardiac angiography.
It is non-oliguric, peak within 1 to 2 days and then return to baseline by 7 days but may rarely require chronic dialysis.
Risk factors:
DM
Pre-existing renal dysfunction
Multiple myeloma
Volume depletion
Other nephrotoxic drug therapy
The recommended maximum dose of contrast to limit CIN is 3 ml/kg (or 5 ml/kg divided by S. creatinine in patients with elevated baseline creatinine).
Strategies to minimize risk of CIN-
Smaller catheter is associated with lower amount of contrast per case.
Use of biplane angiography helps in minimizing the amount of contrast used for angiography.
Hydration protocol:
Isotonic saline 0.9%) is better than 0.45% saline.
0.9% NS 1 ml/kg/h starting 12 h before the procedure and continued for 12 h after the procedure.
2 ml/kg bolus infusion of NS 1 h before contrast administration, followed by an infusion of 1.5 ml/kg/h during the procedure and for 4 h thereafter.
Safety of contrast media used:
Iso-osmolar (Visipaque) > Low osmolar (Omnipaque) > High osmolar
The use Soda bicarbonate and NAC is not recommended.
Preprocedure statin use has been found to be associated with lower incidence of CIN and other complications of PCI.
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