Are there steps physicians can take to reduce the risk of CIN?

Yes. SCAI's Catheterization Laboratory Standards Committee has analyzed the available data about CIN and issued recommendations for the prevention of CIN at each stage in the treatment of patients who are undergoing interventional procedures that involve the use of contrast media. 

The first step is to assess a patient's kidney function. SCAI recommends that physicians assess kidney function using estimated glomerular filtration rate, or eGFR, which takes into account the patient's age, race, and other factors. The eGFR is most accurate assessment of kidney function currently available. 

Another important precaution for preventing CIN is to ensure that the patient is adequately hydrated before, during, and after interventional procedures that involve the use of contrast dyes. Patients who are at increased risk for CIN should come into the hospital far enough in advance of the procedure so that they can be given appropriate intravenous hydration. 

Patients should consult with their physicians to determine whether to discontinue taking non-steroidal anti-inflammatory agents (NSAIDS) 24-48 hours before a procedure. These medications include ibuprofen and Naprosyn, and are commonly taken for headaches, backaches, and arthritis pain. NSAIDS may cause a decrease in blood flow to the kidneys and, when combined with contrast media, are more likely to interfere with kidney function in some patients. 

SCAI recommends that physicians use low osmolar and iso-osmolar contrast agents instead of high-osmolar agents in patients at increased risk for CIN. Osmolarity refers to the number of ion particles in the blood. A low-osmolar agent is thinner than a higher osmolar agent and is considered to be safer because it is less likely to interfere with blood flow to the kidneys. Iso-osmolar contrast agents are even thinner. 

Patients at increased risk for CIN should be monitored closely after their procedure for any signs of kidney failure. In patients at increased risk for CIN, a serum creatinine test should be done during follow-up to provide assess kidney function. This test measures the amount of creatinine, an amino acid excreted by the kidneys, in a person's blood work.