Patient handout

Contrast-Induced / Contrast-Associated AKI (CI-AKI / CA-AKI)

PRODUCTION

1. Your condition

This handout is for contrast-induced / contrast-associated aki (ci-aki / ca-aki). Your care team identified this based on: cr rise ≥0.3 mg/dl or ≥1.5× baseline within 48-72h post iodinated contrast (kdigo 2012 aki; esur).

Other reasons your team may use this plan: recent iodinated contrast (ct angiography, coronary angiography, pci, urography) (kdigo 2012 aki); pre-existing ckd (egfr <60) ± dm — highest-risk substrate (kdigo 2012 aki; preserve nejm 2018); hf + volume depletion + nephrotoxic co-exposure pre-contrast (kdigo 2012 aki).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
mehran_score_documentation	—	—	—	Mehran score components: eGFR, DM, HF, age >75, anemia, hypotension, contrast volume, IABP — risk-stratifies CI-AKI; schema-blocked calc

Plan: CI-AKI — risk-stratified prevention + supportive management (PRESERVE NEJM 2018 negative for NaHCO3+NAC; KDIGO 2012 AKI; ACR)

3. When to call your provider

Contact your care team if any of the following happen:

Sustained eGFR <60 at 3 mo → neph.ckd.core.v1 (KDIGO 2024 CKD)
Recurrent CI-AKI on repeat exposure → nephrology evaluation (KDIGO 2012 AKI)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

High-risk CI-AKI substrate — eGFR <30-45 + DM + Mehran score ≥16; reservation of contrast for emergent indication only (KDIGO 2012 AKI; Mehran 2004; PRESERVE NEJM 2018)
HF (NYHA III-IV / EF <40%) + CI-AKI risk — balance pre-hydration vs decompensation; coordinate cardiology + nephrology (KDIGO 2012 AKI)
Volume depletion at time of contrast — diuretic overshoot, GI losses, NPO status, dehydration → amplified CI-AKI risk (KDIGO 2012 AKI)
High-volume contrast administration (>140 mL or volume:eGFR ratio >3:1) — increased CI-AKI risk; multi-step PCI or staged angiography mitigates (KDIGO 2012 AKI; Mehran 2004)
Very-high Mehran score (≥16) — predicts CI-AKI risk 57% + dialysis risk 12% (Mehran 2004)
Gadolinium NSF risk — eGFR <30 + Group I gadolinium (gadodiamide, gadopentetate, gadoversetamide) contraindicated; macrocyclic Group II preferred if essential (ACR Group I/II/III)
COVID-19 + contrast-enhanced CT for PE or pulmonary evaluation → CI-AKI overlapping with COVID-AKI multiorgan; differentiate from COVID-direct kidney injury (KDIGO 2012 AKI)

5. Follow-up

Re-introduce held meds (metformin, ACEi/ARB) once Cr stable ≥1 wk; flag contrast-allergy / CI-AKI in chart for future imaging; future imaging optimization (US/MRI without gad first) (KDIGO 2012 AKI; KDIGO 2024 CKD; ACR)

6. Sources

Guideline: KDIGO 2012 AKI Guideline + PRESERVE (NEJM 2017, negative for IV NaHCO3 + acetylcysteine) + AMACING (Lancet 2017) + SMART balanced crystalloid (NEJM 2018) + KDIGO 2024 CKD