Algorithm for the Prevention and Management of Contrast-Induced Acute Kidney Injury (AKI) - Flowchart
Algorithm for the Prevention and Management of Contrast-Induced Acute Kidney Injury (AKI) - Flowchart Contrast-Associated Acute Kidney Injury (CA-AKI) Contrast-Associated Acute Kidney Injury (CA-AKI)
«Flowchart»

Calculate eGFR
Assess CI-AKI risk

Calculate eGFR
Assess CI-AKI risk

Calculate eGFR
Assess CI-AKI risk


End

End

End


Ensure statin use before and after
Preprocedure IV volume expansion**
LVEDP guided procedure +4 hr post isotonic crystalloid management
Low-osmolar contrast
Iodixanol (if ACS, CKD+DM, HF, TAVI)
ALARA contrast volume


Ensure statin use before and after
Preprocedure IV volume expansion**
LVEDP guided procedure +4 hr post isotonic crystalloid management
Low-osmolar contrast
Iodixanol (if ACS, CKD+DM, HF, TAVI)
ALARA contrast volume


Ensure statin use before and after
Preprocedure IV volume expansion**
LVEDP guided procedure +4 hr post isotonic crystalloid management
Low-osmolar contrast
Iodixanol (if ACS, CKD+DM, HF, TAVI)
ALARA contrast volume


Ensure statin use before and after
Preprocedure IV volume expansion** ** **
LVEDP guided procedure +4 hr post isotonic crystalloid management
Low-osmolar contrast
Iodixanol (if ACS, CKD+DM, HF, TAVI)
ALARA contrast volume


Hospital admission
Nephrology consultation
Dialysis planning*
Iodixanol
Other strategies as for eGFR 30-59 ml


Hospital admission
Nephrology consultation
Dialysis planning*
Iodixanol
Other strategies as for eGFR 30-59 ml


Hospital admission
Nephrology consultation
Dialysis planning*
Iodixanol
Other strategies as for eGFR 30-59 ml


Hospital admission
Nephrology consultation
Dialysis planning* * *
Iodixanol
Other strategies as for eGFR 30-59 ml

Good clinical practice

Good clinical practice

Good clinical practice

Serial serum Cr and electrolytes

Serial serum Cr and electrolytes

Serial serum Cr and electrolytes

If critical care unit or cardiac surgery

If critical care unit or cardiac surgery

If critical care unit or cardiac surgery

Serial SCr, 1-2, 7, 90 d, renal damage markers, and electrolytes

Serial SCr, 1-2, 7, 90 d, renal damage markers, and electrolytes

Serial SCr, 1-2, 7, 90 d, renal damage markers, and electrolytes

SCr before discharge or within 24-72 hr

SCr before discharge or within 24-72 hr

SCr before discharge or within 24-72 hr

Initial LVEDP-guided crystalloid


<13 mm Hg 5 ml/kg/hr × 4 hr
13-18 mm Hg 3 ml/kg/hr × 4 hr
>18 mm Hg 1.5 ml/kg/hr × 4 hr

ALARA = As Low as Reasonably Achievable

Renal damage markers


TIMP2*IGFBP-7 (NephroCheck), NGAL, L-FABP

Initial LVEDP-guided crystalloid


<13 mm Hg 5 ml/kg/hr × 4 hr
13-18 mm Hg 3 ml/kg/hr × 4 hr
>18 mm Hg 1.5 ml/kg/hr × 4 hr

ALARA = As Low as Reasonably Achievable

Renal damage markers


TIMP2*IGFBP-7 (NephroCheck), NGAL, L-FABP

Initial LVEDP-guided crystalloid

Initial LVEDP-guided crystalloid


<13 mm Hg 5 ml/kg/hr × 4 hr
13-18 mm Hg 3 ml/kg/hr × 4 hr
>18 mm Hg 1.5 ml/kg/hr × 4 hr


<13 mm Hg 5 ml/kg/hr × 4 hr
13-18 mm Hg 3 ml/kg/hr × 4 hr
>18 mm Hg 1.5 ml/kg/hr × 4 hr

Renal damage markers

Renal damage markers


TIMP2*IGFBP-7 (NephroCheck), NGAL, L-FABP


TIMP2*IGFBP-7 (NephroCheck), NGAL, L-FABP

* Plans should be made in case CI-AKI occurs and dialysis is required

* Plans should be made in case CI-AKI occurs and dialysis is required

* Plans should be made in case CI-AKI occurs and dialysis is required

*

** IV isotonic crystalloid 3 ml/kg/hr for 1 hr prior

** IV isotonic crystalloid 3 ml/kg/hr for 1 hr prior

** IV isotonic crystalloid 3 ml/kg/hr for 1 hr prior

**

eGFR <30 ml/min/1.72 m2

Same apply plus

eGFR <30 ml/min/1.72 m2

2

Same apply plus

eGFR <30 ml/min/1.72 m[2]

eGFR 30–59 ml/min/1.73 m2

Discontinue NSAIDs, other nephrotoxic drugs, metformin, RASi

eGFR 30–59 ml/min/1.73 m2

2

Discontinue NSAIDs, other nephrotoxic drugs, metformin, RASi

eGFR 30–59 ml/min/1.73 m[2]

eGFR ≥60 ml/min/1.73 m2

Discontinue metformin

eGFR ≥60 ml/min/1.73 m2

≥ 2

Discontinue metformin

eGFR >=60 ml/min/1.73 m[2]