Preventie van contrastnefropathie bij ouderen: zin of onzin?

Abstract

Prevention of contrast nephropathy in elderly: useful or not? Contrast nephropathy (CN) is considered to be a form of acute kidney injury (AKI) due to the administration of intravascular contrast agents. However, more recent studies suggest that the risk of this condition could be overestimated. This article offers a narrative overview of the pathophysiology, definitions and risk of CN. Furthermore, preventive strategies to avoid CN are provided, as well as the evidence for this condition, specifically highlighting the geriatric population. Studies compared different hydration schemes. These showed that peroral hydration is not inferior to intravenous hydration. For the use of sodium bicarbonate and N-acetylcysteine, there is as yet no hard evidence in the geriatric population. The risk for CN is probably highly overestimated and cannot be an argument to a priori withhold the patient from a possible life-saving intervention. If prevention seems necessary, peroral hydration is in most cases sufficient. There is a lack of evidence to support the common use of other preventive strategies (such as N-acetylcysteine and sodium bicarbonate). It seems appropriate to perform a risk assessment, whereby individual tailoring should be given priority.