Prevention

Use low-osmolality contrast media ^a particularly for high-risk patients

• with pre-existing renal impairment ^a
• with diabetes ^b
• undergoing angiography ^b

Why?

• Around 3% of patients develop nephrotoxicity following contrast media studies ^b
• Low-osmolality contrast media causes less nephrotoxicity than high-osmolality contrast media in high-risk patients.^a

Low-osmolality contrast media cause less acute renal dysfunction than high-osmolality media

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
undergoing contrast study a	low-osmolality contrast media	high-osmolality contrast media	increase in Cr levels of > 44 µmol/L at 2 days	3%	0.61 (0.48 to 0.77)	90 (68 to 150)
			increase in Cr levels of > 90 µmol/L at 2 days	3%	0.44 (0.26 to 0.73)	120 (95 to 260)
pre-existing renal impairment undergoing contrast study			increase in Cr levels of > 44 µmol/L at 2 days	1.5%	0.50 (0.36 to 0.70)	70 (55 to 120)

Angiography, pre-existing renal failure or insulin-dependent diabetes increase the risk of nephrotoxicity

Patient	Prognostic Factor	Outcome	CER	RR (95% CI)	NNF+ (95% CI)
elderly b	angiocardiography independent	nephrotoxicity at 48 hours	3%	3.44 (1.25 to 6.79)	14 (6 to 140)
	pre-existing renal insufficiency independent			3.06 (1.29 to 5.41)	17 (8 to 120)
	insulin-dependent diabetes mellitus independent			3.06 (1.19 to 7.80)	17 (5 to 180)