Thursday, November 11, 2010

CONSULT ROUNDS: Risk Factors of Contrast Induced Nephropathy

1. What are the risk factors for contrast nephropathy?
Some we came up with and I confirmed with literature are: Pre existing renal disease, CKD with DM, reduced intravascular volume are the three classic ones.
Other risk factors that people can consider as risk factors are: Load of contrast, presence of CHF, Use of IABP, age, anemia and being on nephrotoxic agents.
2. There have been developed few point systems based on Literature in the cardiology world and can give a better risk assessment of chance of having CIN.
Risk Factors:
Systolic blood pressure <80 mm Hg - 5 points
Intraarterial balloon pump - 5 points
Congestive heart failure (Class III-IV or history of pulmonary edema) - 5 points
Age >75 y - 4 points
Hematocrit level <39% for men and <35% for women - 3 points
Diabetes - 3 points
Contrast media volume - 1 point for each 100 mL
Renal insufficiency: Serum creatinine level >1.5 g/dL - 4 points
or GFR 40–60 mL/min/1.73 m2 -2 points
 20–40 mL/min/1.73 m2- 4 points
 < 20 mL/min/1.73 m2 - 6 points
And how does the scoring work:
5 or less point :Risk of CIN - 7.5% and Risk of Dialysis - 0.04%
6–10 points Risk of CIN - 14.0% and Risk of Dialysis - 0.12%
11–16 points Risk of CIN - 26.1% and Risk of Dialysis - 1.09%
>16 points Risk of CIN - 57.3% and Risk of Dialysis - 12.8%
Here is the website where you can calculate the risk

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