A 62-year-old man on ICU requires a CT pulmonary angiogram to investigate suspected PE. He has stage 4 CKD (eGFR 18 mL/min). The radiologist expresses...

Question

A 62-year-old man on ICU requires a CT pulmonary angiogram to investigate suspected PE. He has stage 4 CKD (eGFR 18 mL/min). The radiologist expresses concern about contrast nephropathy. According to current evidence, what is the most effective strategy to prevent contrast-associated AKI?

Accepted Answer

IV isotonic saline (0.9% NaCl or sodium bicarbonate) hydration before and after the procedure - the PRESERVE trial showed no benefit of NAC or sodium bicarbonate over saline alone

Answer

IV N-acetylcysteine before and after contrast

Answer

Oral sodium bicarbonate tablets

Answer

IV mannitol before contrast

Answer

Haemodialysis immediately after contrast to remove it

uk-fficm MCQ (SBA): Contrast-Associated AKI Prevention

A 62-year-old man on ICU requires a CT pulmonary angiogram to investigate suspected PE. He has stage 4 CKD (eGFR 18 mL/min). The radiologist expresses concern about contrast nephropathy. According to current evidence, what is the most effective strategy to prevent contrast-associated AKI?