Consensus Report from Oncology Advisory Board Meeting

Strategies for Prevention and Management of CI-AKI and the Role of Contrast in Oncology CT Settings • 25 eGFR Levels <30 ml/min/1.73 m 2 Discontinue metformin, other nephrotoxic drugs, RAAS inhibitors Throughout Discontinue metformin, other nephrotoxic drugs, RAAS inhibitors Throughout Ensure statin use pre- procedure IV volume expansion* Before Ensure statin use Post Good clinical practice: Discontinue metformin, other nephrotoxic drugs, RAAS inhibitors Throughout LVEDP-guided intraprocedure + 4 hours post-procedure isotonic crystalloid management Low-osmolar contrast Iso-osmolar contrast (iodixanol) if ACS, CKD=DM, HF, TAVI As low as reasonably achievable contrast volume During Consider hospital admission Nephrology consultation Dialysis planning Before Iso-osmolar contrast (iodixanol) During Monitor damage markers and daily SCr Post eGFR 30–59 ml/min/1.73 m 2 >60 ml/ min/1.73 m 2 Fig. 1. Algorithm for the Prevention and Management of Contrast-Induced Acute Kidney Injury. *Adapted from Algorithm for the Prevention and Management of CI-AKI. McCullough, P.A., et al . J Am Coll Cardiol . 2016;68(13):1465–1473.