Harbor:Creatinine screening prior to IV contrast

Background

• It may be possible to reduce the use of creatinine screening in ED patients requiring IV contrast for CT or other radiographic evaluation
• Data is sparse, however, and any guidelines should be utilized with that in mind, and in the context of local policies.

Guideline

• DHS IV Contrast Expected Practices 10-2022
  • No need for screening
    • GFR>30

ED patients do NOT require creatinine measurement prior to IV contrast:

• If the study is immediately necessary to prevent life-threatening decompensation or delay in emergent treatment (e.g. trauma patients)
• If they do not meet any of the following criteria:
  • Age >60
  • History of kidney disease
    • Kidney transplant
    • Dialysis
    • Single kidney
    • Renal cancer
    • Kidney surgery
  • Family history of kidney failure
  • Diabetes
  • Hypertension
  • Collagen vascular disease (e.g. SLE, scleroderma, rheumatoid arthritis)
  • Paraproteinemia (e.g. multiple myeloma)
  • Recent use of nephrotoxic medication (eg, metformin, aminoglycosides)

See Also

• Contrast-induced nephropathy