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

http://www.zunis.org/Contrast-Induced%20Nephropathy%20Calculator2.htm

http://www.ncbi.nlm.nih.gov/pubmed/15464318
http://journals.lww.com/jcardiovascularmedicine/Abstract/2010/06000/Preprocedural_score_for_risk_of_contrast_induced.11.aspx