Clin Exp Nephrol (2013) 17:441–479 DOI 10.1007/s10157-013-0843-3 GUIDELINE Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version JSN, JRS, and JCS Joint Working Group Iwao Ohno • Hiromitsu Hayashi • Kazutaka Aonuma • Masaru Horio • Naoki Kashihara • Hirokazu Okada • Yasuhiro Komatsu • Shozo Tamura • Kazuo Awai • Yasuyuki Yamashita • Ryohei Kuwatsuru • Atsushi Hirayama • Yoshihiko Saito • Toyoaki Murohara • Nagara Tamaki • Akira Sato • Tadateru Takayama • Enyu Imai • Yoshinari Yasuda • Daisuke Koya • Yoshiharu Tsubakihara • Shigeo Horie • Yukunori Korogi • Yoshifumi Narumi • Katsumi Hayakawa • Hiroyuki Daida • Koichi Node • Isao Kubota Published online: 30 July 2013 Ó Japanese Society of Nephrology, Japan Radiological Society, and the Japanese Circulation Society 2013 Table of Contents 2 Definition of contrast-induced nephropathy......................... 447 2.1 CQ 2-1 What is the definition of CIN? ...................... 447 3 Risk factors and patient assessment ..................................... 447 1 Outline of the digest version of guidelines on the use of iodinated 3.1 CQ3-1 DoesCKDincrease theriskfordevelopingCIN? 447 contrast media in patients with kidney disease.................... 445 3.2 Doesaging increase therisk fordeveloping CIN? 447 1.1 Purpose of the guidelines ............................................. 445 CQ 3-2 3.3 Does diabetes increase the risk for developing 1.2 A cautionary note on the use of the present guidelines 445 CQ 3-3 CIN? .............................................................................. 447 1.3 Selection of literature, levels of evidence, and grades of recommendations...................................................... 445 3.4 CQ3-4 Does the use of renin–angiotensin system (RAS) 1.4 Independent assessment................................................ 446 inhibitors increase the risk for developing CIN? ........ 447 1.5 Future plans................................................................... 447 3.5 CQ3-5 Does the use of diuretics increase the risk for devel- 1.6 Conflict of interest........................................................ 447 oping CIN?.................................................................... 447 1.7 Digest version ............................................................... 447 3.6 CQ3-6 Does the use of non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk for developing CIN? 447 3.7 CQ3-7 Does the use of iodinated contrast media increase This guideline was developed in collaboration with the Japanese the risk of lactic acidosis in patients receiving biguanide Society of Nephrology, the Japan Radiological Society, and the antihyperglycemic drugs?............................................. 447 Japanese Circulation Society. 3.8 CQ3-8 Does the development of CIN worsen vital prognosis This document was approved by the Japanese Society of Nephrology, of patients with CKD?.................................................. 447 the Japan Radiological Society, and the Japanese Circulation Society 3.9 CQ3-9 Does the use of contrast media increase the risk Science Advisory and Coordinating Committee in April 26, 2013. of a decline of residual kidney function in patients under- This article has been copublished in the Japanese Journal of going peritoneal dialysis?............................................. 447 Radiology and Circulation Journal. 3.10 Are risk scores useful as predictors of developing Permission: Multiple copies, modification, alteration, enhancement, CQ3-10 CIN? .............................................................................. 447 and/or distribution of this document are not permitted without the express permission of the Japanese Society of Nephrology. 4 Type and volume of contrast media..................................... 447 The affiliations of the members are as of December 2012. 4.1 CQ4-1 Does the use of a smaller volume of contrast media reduce the risk for developing CIN? (see CQ5-2)..... 447 I. Ohno (&) M. Horio Chair, Japanese Society of Nephrology, Division of Kidney and Member, Japanese Society of Nephrology, Department of Hypertension, Department of Internal Medicine, Jikei University Functional Diagnostic Science, Osaka University Graduate School of Medicine, Tokyo, Japan School of Medicine, Suita, Japan e-mail: [email protected] N. Kashihara H. Hayashi Member, Japanese Society of Nephrology, Department of Chair, Japan Radiological Society, Department of Clinical Nephrology and Hypertension, Kawasaki Medical School, Radiology, Graduate School of Medicine, Nippon Medical Kurashiki, Japan School, Tokyo, Japan H. Okada K. Aonuma Member, Japanese Society of Nephrology, Department of Chair, Japanese Circulation Society, Cardiovascular Division, Nephrology, Faculty of Medicine, Saitama Medical University, Institute of Clinical Medicine, Graduate School of Saitama, Japan Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan 123 guide.medlive.cn 442 Clin Exp Nephrol (2013) 17:441–479 4.2 CQ4-2 Is the risk for developing CIN lower in patients 7.2 CQ7-2 Does oral water intake decrease the risk for devel- receiving low- rather than high-osmolar contrast media? 447 oping CIN as much as administration of fluid therapy 4.3 CQ4-3 Does the risk for developing CIN differ between iso- does?.............................................................................. 447 and low-osmolar contrast media? ................................ 447 7.3 CQ7-3 Does sodium bicarbonate-based hydration decrease 4.4 CQ4-4 Does the risk for developing CIN differ among dif- the risk for developing CIN? ....................................... 447 ferent low-osmolar contrast media?............................. 447 7.4 CQ7-4 Is short-term intravenous hydration as effective 4.5 CQ4-5 Is the risk for developing CIN higher in patients as standard intravenous hydration in preventing CIN? 447 receiving contrast media via invasive (intra-arterial) admin- 8 Prevention of contrast-induced nephropathy: pharmacologic ther- istration than in those receiving contrast media via non- apy.......................................................................................... 447 invasive (intravenous) administration? ........................ 447 8.1 CQ8-1 DoesNAC decreasethe risk for developing CIN? 447 5 Invasive diagnostic imaging including cardiac angiography 8.2 CQ8-2 Does hANP decrease the risk for developing CIN? 447 or percutaneous catheter intervention................................... 447 8.3 CQ8-3 Does ascorbic acid decrease the risk for developing 5.1 Does CKD increase the risk for developing CIN CQ5-1 CIN? .............................................................................. 447 after CAG?.................................................................... 447 8.4 CQ8-4 Do statins decrease the risk for developing CIN? 447 5.2 CQ5-2 Does the use of a smaller volume of contrast medium decrease the risk for developing CIN? ........................ 447 9 Prevention of contrast-induced nephropathy: dialysis ......... 447 9.1 CQ9-1 Does hemodialysis conducted after contrast exposure 5.3 Does repeated CAG at short intervals increase CQ5-3 as a measure to prevent CIN decrease the risk for developing the risk for developing CIN? ....................................... 447 CIN? .............................................................................. 447 5.4 CQ5-4 Does CKD increase the incidence of CIN 9.2 CQ9-2 Is hemofiltration superior to hemodialysis in decreas- after PCI? ...................................................................... 447 ing the risk for developing CIN?................................. 447 5.5 How can CIN be differentiated from kidney injury CQ5-5 10 Treatment of contrast-induced nephropathy......................... 447 due to cholesterol embolism?....................................... 447 10.1 CQ10-1 Does the treatment of CIN with loop diuretics 6 Intravenous contrast media imaging including contrast-enhanced improve the recovery from AKI? ................................ 447 CT .......................................................................................... 447 10.2 Does fluid therapy prevent the progression of kid- 6.1 CQ6-1 Does CKD increase the risk for developing CIN CQ10-2 after contrast-enhanced CT?......................................... 447 ney dysfunction in patients with CIN?........................ 447 10.3 Does the low-dose dopamine prevent the progres- 6.2 CQ6-2 Does the use of a smaller volume of contrast media CQ10-3 reduce the risk for developing CIN after contrast-enhanced sion of kidney dysfunction in patients with CIN? ...... 447 CT?................................................................................ 447 10.4 CQ10-4 Does the treatment of CIN with hANP improve recovery from AKI? ..................................................... 447 6.3 CQ6-3 Does repeated contrast-enhanced CT atshort intervals increase the risk for developing CIN? ............................... 447 10.5 CQ10-5 Does early renal replacement therapy (RRT) improve the outcome of kidney function in patients 6.4 CQ6-4 Is the risk for developing CIN after contrast- enhanced CT higher in outpatients than inpatients? ... 447 with CIN?...................................................................... 447 7 Prevention of contrast-induced nephropathy: fluid therapy. 447 11 Appendix................................................................................ 470 7.1 CQ7-1 Does physiological saline hydration decrease the