Contrast-induced nephropathy: Current practices among cardiologists

Objective: Contrast-induced nephropathy (CIN) is a serious complication of diagnostic and therapeutic coronary angiography. There are an increasing number of guidelines in the literature to help lessen this complication. Practice patterns in the cardiology community remain relatively unknown. This survey is an effort to better understand such practices. Methods: Questions were written based on the American College of Cardiology (ACC), the American Heart Association (AHA), and the Society of Cardiovascular Angiography and Intervention (SCAI) guidelines to identify cardiologist background and experience. The survey was emailed to 5000 randomly chosen cardiologists in December 2009. Results: A total of 291 responses were received. Among these, 97% reported checking renal function in all patients prior to angiography, 45% checked both estimated glomerular filtration rate (eGFR) and serum creatinine (SCr), 31% checked SCr alone, 19% checked eGFR alone, and 2% checked albumin-to-creatinine (A-C) ratio. Among responding cardiologists, 70% considered eGFR level less than 60 mL/min/1.73 m² a high risk for CIN whereas 25% considered a level less than 30 mL/min/1.73 m2 a high risk. Thirty percent used only isosmolar media in high-risk patients, 33% used only low osmolar media, and 37% used either one. Conclusions: There is significant diversity in the measures taken by cardiologists to prevent CIN. More studies and clearer guidelines are needed to unify the practices.