KDIGO Clinical Practice Guideline for Acute Kidney Injury

Section 4: Contrast-induced AKI

• 4.1: Define and stage AKI after administration of intravascular contrast media as per Recommendations 2.1.1–2.1.2. (Not Graded)
• 4.1.1: In individuals who develop changes in kidney function after administration of intravascular contrast media, evaluate for CI-AKI as well as for other possible causes of AKI. (Not Graded)
• 4.2.1: Assess the risk for CI-AKI and, in particular, screen for pre-existing impairment of kidney function in all patients who are considered for a procedure that requires intravascular (i.v. or i.a.) administration of iodinated contrast medium. (Not Graded)
• 4.2.2: Consider alternative imaging methods in patients at increased risk for CI-AKI. (Not Graded)
• 4.3.1: Use the lowest possible dose of contrast medium in patients at risk for CI-AKI. (Not Graded)
• 4.3.2: We recommend using either iso-osmolar or low-osmolar iodinated contrast media, rather than high-osmolar iodinated contrast media in patients at increased risk of CI-AKI. (1B)
• 4.4.1: We recommend i.v. volume expansion with either isotonic sodium chloride or sodium bicarbonate solutions, rather than no i.v. volume expansion, in patients at increased risk for CI-AKI. (1A)
• 4.4.2: We recommend not using oral fluids alone in patients at increased risk of CI-AKI. (1C)
• 4.4.3: We suggest using oral NAC, together with i.v. isotonic crystalloids, in patients at increased risk of CI-AKI.(2D)
• 4.4.4: We suggest not using theophylline to prevent CI-AKI. (2C)
• 4.4.5: We recommend not using fenoldopam to prevent CI-AKI. (1B)
• 4.5.1: We suggest not using prophylactic intermittent hemodialysis (IHD) or hemofiltration (HF) for contrast-media removal in patients at increased risk for CI-AKI. (2C)