European Society of Cardiology CIN prevention guidelines, 2014
| Recommendation | Detail | Class | Level |
|---|---|---|---|
| Intravenous hydration with isotonic saline is recommended | I | A | |
| Use of either LOCM or IOCM is recommended | <350 mL or <4 mL/kg or V/CrCl <3.7:1 | I | A |
| IOCM use should be considered over LOCM | IIa | A | |
| Short term, high-dose statin therapy should be considered | Rosuvastatin 20/40 mg or atorvastatin 80 mg or simvastatin 80 mg | IIa | A |
| Volume of CM should be minimised | IIa | B | |
| A CIN risk assessment should be performed | IIa | C | |
| In patients at very high CIN risk or when prophylactic hydration is impossible, furosemide with matched hydration may be considered over standard hydration | 250 mL 0.9% saline intravenously over 30 min (or ≤150 mL in LV dysfunction) with 0.25–0.5 mg/kg of furosemide intravenous bolus. Adjust intravenous fluid rate to match urine output until >300 mL/h then perform CM procedure. Continue matched fluid replacement for 4 h post procedure | IIb | A |
| In severe CKD, prophylactic haemofiltration prior to complex PCI may be considered | Fluid replacement rate 1 L/h without negative loss, 0.9% sodium chloride intravenous hydration for 24 h post procedure | IIb | B |
| N-acetyl-cysteine instead of intravenous hydration is not recommended | III | A | |
| Infusion of 8.4% sodium bicarbonate instead of 0.9% sodium chloride is not recommended | III | A | |
| In severe CKD prophylactic renal replacement therapy is not routinely recommended | III | B |
CIN, contrast-induced nephropathy; CKD, chronic kidney disease; CM, contrast medium; IOCM, iso-osmolar contrast medium; LOCM, low-osmolar contrast medium; LV, left ventricular; PCI, percutaneous coronary intervention; V/CrCl, volume of contrast media to creatinine clearance.
Adapted from Windecker et al.59