Circulation Journal JCS GUIDELINES Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp Guidelines on the Use of Iodinated Contrast Media in Patients With Kidney Disease 2012 – Digest Version – JSN, JRS and JCS Joint Working Group Table of Contents Abbreviations ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1884 CQ IV-3: Does the risk for developing CIN differ I Outline of the Digest Version of Guidelines between iso- and low-osmolar contrast media? ∙∙∙∙∙∙∙∙∙∙ 1893 on the Use of Iodinated Contrast Media in CQ IV-4: Does the risk for developing CIN differ among Patients With Kidney Disease ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1884 different low-osmolar contrast media? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1893 1. Purpose of the Guidelines ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1884 CQ IV-5: Is the risk for developing CIN higher in patients 2. A Cautionary Note on the Use of the Present receiving contrast media via invasive (intra-arterial) Guidelines ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1885 administration than in those receiving contrast media 3. Selection of Literature, Levels of Evidence, and via non-invasive (intravenous) administration? ∙∙∙∙∙∙∙∙∙∙∙ 1896 Grades of Recommendations ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1885 V Invasive Diagnostic Imaging Including 4. Independent Assessment ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1885 Cardiac Angiography or Percutaneous 5. Future Plans ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1885 Catheter Intervention ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1896 6. Conflict of Interest ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1886 CQ V-1: Does CKD increase the risk for developing CIN 7. Digest Version ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1886 after CAG? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1896 II Definition of Contrast-Induced Nephropathy ∙∙∙∙ 1886 CQ V-2: Does the use of a smaller volume of contrast CQ II-1: What is the definition of CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1886 medium decrease the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙ 1897 CQ V-3: Does repeated CAG at short intervals increase ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1887 III Risk Factors and Patient Assessment the risk of developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1898 CQ III-1: Does CKD increase the risk for developing CQ V-4: Does CKD increase the incidence of CIN after CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1887 PCI? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1898 CQ III-2: Does aging increase the risk for developing CQ V-5: How can CIN be differentiated from kidney CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1887 injury due to cholesterol embolism? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1898 CQ III-3: Does diabetes increase the risk for developing VI Intravenous Contrast Media Imaging CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1887 Including Contrast-Enhanced CT∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1899 CQ III-4: Does the use of renin-angiotensin system inhibitors increase the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙ 1888 CQ VI-1: Does CKD increase the risk for developing CQ III-5: Does the use of diuretics increase the risk for CIN after contrast-enhanced CT? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1899 developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1888 CQ VI-2: Does the use of a smaller volume of contrast CQ III-6: Does the use of non-steroidal anti-inflammatory media reduce the risk for developing CIN after drugs increase the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1888 contrast-enhanced CT? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1899 CQ III-7: Does the use of iodinated contrast media CQ VI-3: Does repeated contrast-enhanced CT at short increase the risk of lactic acidosis in patients intervals increase the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙ 1900 receiving biguanide antihyperglycemic drugs? ∙∙∙∙∙∙∙∙∙∙∙ 1888 CQ VI-4: Is the risk for developing CIN after contrast- CQ III-8: Does the development of CIN worsen vital enhanced CT higher in outpatients than inpatients? ∙∙∙ 1901 prognpsis of patients with CKD? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1891 VII Prevention of Contrast-Induced CQ III-9: Does the use of contrast media increase the Nephropathy: Fluid Therapy ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1901 risk of a decline of residual kidney function in CQ VII-1: Does physiological saline hydration decrease patients undergoing peritoneal dialysis? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1891 the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1901 CQ III-10: Are risk scores useful as predictors of CQ VII-2: Does oral water intake decrease the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1892 developing CIN as much as administration of fluid IV Type and Volume of Contrast Media ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1892 therapy does? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1902 CQ IV-1: Does the use of a smaller volume of contrast CQ VII-3: Does sodium bicarbonate-based hydration media reduce the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1892 decrease the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1902 CQ IV-2: Is the risk for developing CIN lower in CQ VII-4: Is short-term intravenous hydration as patients receiving low- rather than high-osmolar effective as standard intravenous hydration in contrast media? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1893 preventing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1903 Released online June 15, 2013 Mailing address: Scientific Committee of the Japanese Circulation Society, 18F Imperial Hotel Tower, 1-1-1 Uchisaiwai-cho, Chiyoda-ku, Tokyo 100-0011, Japan. E-mail: [email protected] This guideline was developed in collaboration with the Japanese Society of Nephrology, Japan Radiological Society, and Japanese Circulation Society. This document was approved by the Japanese Society of Nephrology, Japan Radiological Society, and Japanese Circulation Society Science Advisory and Coordinating Committee in April 26. This article has been copublished in the Clinical and Experimental Nephrology and Japanese Journal of Radiology. Permission: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the ex- press permission of the Japanese Circulation Society. ISSN-1346-9843 doi: 10.1253/circj.CJ-66-0069 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: [email protected] Circulation Journal Vol.77, July 2013 1884 JSN, JRS and JCS Joint Working Group VIII Prevention of Contrast-Induced X Treatment of Contrast-Induced Nephropathy ∙∙∙ 1905 Nephropathy: Pharmacologic Therapy ∙∙∙∙∙∙∙∙∙∙∙ 1904 CQ X-1: Does the treatment of CIN with loop diuretics CQ VIII-1: Does NAC decrease the risk for developing improve the recovery from AKI? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1905 CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1904 CQ X-2: Does fluid therapy prevent the progression of CQ VIII-2: Does hANP decrease the risk for developing kidney dysfunction in patients with CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1906 CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1904 CQ X-3: Does the low-dose dopamine prevent the CQ VIII-3: Does ascorbic acid decrease the risk for progression of kidney dysfunction in patients with developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1905 CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1906 CQ VIII-4: Do statins decrease the risk for developing CQ X-4: Does the treatment of CIN with hANP improve CIN?∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1905 recovery from AKI? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1906 IX Prevention of Contrast-Induced CQ X-5: Does early renal replacement therapy improve Nephropathy: Dialysis ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1905 the outcome of kidney function in patients with CIN? ∙∙∙ 1906 CQ IX-1: Does hemodialysis conducted after contrast References ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1907 exposure as a measure to prevent CIN decrease the (Circ J 2013; 77: 1883 – 1914) risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1905 CQ IX-2: Is hemofiltration superior to hemodialysis in decreasing the risk for developing CIN? ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ 1905 Abbreviations ACC(F): American College of Cardiology (Foundation) MHLW: Ministry of Health, Labour and Welfare ACR: American College of Radiology Minds: Medical Information Network Distribution Service AHA: American Heart Association NAC: N-acetylcysteine AKI: acute kidney injury NHI: National Health Insurance AKIN: Acute Kidney Injury Network NRD: nephropathy requiring dialysis AP: angina pectoris NS: not significant BNP: B-type natriuretic peptide NSAIDs: non-steroidal anti-inflammatory drugs BUN: blood urea nitrogen OR: odds ratio CAG: coronary angiography PCI: percutaneous catheter intervention CCr: creatinine clearance PREPARED: Preparation for Angiography in Renal Dysfunc- CHF: congestive heart failure tion CI: confidence interval PREVENT: Preventive strategies of renal insufficiency in pa- CIN: contrast-induced nephropathy tients with diabetes undergoing intervention or CKD: