Contrast Administration in Patients with Elevated Creatinine

Estimated glomerular filtration rate is a better predicator of renal dysfunction than creatinine alone. The decision to proceed with contrast administration in patients with an estimated GFR < 45 ml/min/1.732 is a matter of clinical judgment, based on the individual circumstances of the patient and following consultation between the radiologist and requesting physician. Strategies to prevent nephropathy in patients with renal impairment include hydration, reduction of contrast dose, and discontinuation of nephrotoxic drugs. A critical diagnostic study should not be delayed because of excessive concern regarding possible contrast nephropathy.        

Contrast Administration in Patients with Renal Failure

Patients on dialysis can receive IV contrast, and early post-procedural dialysis is not routinely required; however, the fact that a patient is on dialysis should not be regarded as automatically allowing the administration IV contrast. The administration of contrast may jeopardize the return of renal function in patients who are receiving dialysis for acute renal failure and may further worsen renal function in patients who still make some urine but receive dialysis intermittently. The volume of iv contrast should also be considered in patients on dialysis who are at risk for volume overload.