Patient selection and preparation strategies for the use of contrast material in patients with chronic kidney disease

The prevalence of chronic kidney disease and peripheral arterial disease is increasing. Thus, it is increasingly problematic to image these patients as the number of patients needing a vascular examination is increasing accordingly. In high-risk patients with impaired kidney function, intravascular administration of iodinated contrast media can result in contrast-induced acute kidney injury and Gadolinium can induce nephrogenic systemic fibrosis (NSF). It is important to identify these high-risk patients by means of se-creatinine/e glomerular filtration rate. The indication for contrast examination should counterbalance the increased risk. One or more alternative examination methods without contrast media, such as CO2 angiography, Ultrasound/Doppler examination or magnetic resonance angiography without contrast should be considered, but at the same time, allow for a meaningful outcome of the examination. If contrast is deemed essential, the patient should be well hydrated, the amount of contrast should be restricted, the examination should be focused, metformin and diuretics stopped, and renal function monitored. Sodium bicarbonate and N-acetylcysteine are popular but their efficiency is not evidence-based. There is no evidence that dialysis protects patients with impaired renal function from contrast-induced nephropathy or NSF.