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A multidisciplinary group consisting of specialists of different disciplines\u2014radiologists, nephrologists and oncologists, members of the respective Italian Scientific Societies\u2014agreed to draw up this position paper, to assist clinicians increasingly facing the challenges posed by CM-related renal dysfunction in their daily clinical practice.<\/jats:p><jats:p>The major risk factor for acute renal failure following CM administration (post-CM AKI) is the preexistence of renal failure, particularly when associated with diabetes, heart failure or cancer.<\/jats:p><jats:p>In accordance with the recent guidelines ESUR, the present document reaffirms the importance of renal risk assessment through the evaluation of the renal function (eGFR) measured on serum creatinine and defines the renal risk cutoff when the eGFR is\u2009&lt;\u200930\u00a0ml\/min\/1.73\u00a0m2 for procedures with intravenous (i.v.) or intra-arterial (i.a.) administration of CM with renal contact at the second passage (i.e., after CM dilution with the passage into the pulmonary circulation).<\/jats:p><jats:p>The cutoff of renal risk is considered an eGFR\u2009&lt;\u200945\u00a0ml\/min\/1.73\u00a0m2 in patients undergoing i.a. administration with first-pass renal contact (CM injected directly into the renal arteries or in the arterial district upstream of the renal circulation) or in particularly unstable patients such as those admitted to the ICU.<\/jats:p><jats:p>Intravenous hydration using either saline or Na bicarbonate solution before and after CM administration represents the most effective preventive measure in patients at risk of post-CM AKI. In the case of urgency, the infusion of 1.4% sodium bicarbonate pre- and post-CM may be more appropriate than the administration of saline.<\/jats:p><jats:p>In cancer patients undergoing computed tomography, pre- and post-CM hydration should be performed when the eGFR is\u2009&lt;\u200930\u00a0ml\/min\/1.73\u00a0m2 and it is also advisable to maintain a 5 to 7\u00a0days interval with respect to the administration of cisplatin and to wait 14\u00a0days before administering zoledronic acid.<\/jats:p><jats:p>In patients with more severe renal risk (i.e., with eGFR\u2009&lt;\u200920\u00a0ml\/min\/1.73\u00a0m2), particularly if undergoing cardiological interventional procedures, the prevention of post-CM AKI should be implemented through an internal protocol shared between the specialists who treat the patient.<\/jats:p><jats:p>In magnetic resonance imaging (MRI) using gadolinium CM, there is a lower risk of AKI than with iodinated CM, particularly if doses\u2009&lt;\u20090.1\u00a0mmol\/kg body weight are used and in patients with eGFR\u2009&gt;\u200930\u00a0ml\/min\/1.73\u00a0m2. Dialysis after MRI is indicated only in patients already undergoing chronic dialysis treatment to reduce the potential risk of systemic nephrogenic fibrosis.<\/jats:p>","DOI":"10.1007\/s11547-022-01483-8","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T07:02:47Z","timestamp":1647586967000},"page":"534-542","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["SIRM-SIN-AIOM: appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations\u2014consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM)"],"prefix":"10.1007","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7053-8813","authenticated-orcid":false,"given":"Antonio","family":"Orlacchio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Guastoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giordano Domenico","family":"Beretta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Cosmai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Galluzzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Gori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Grassedonio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena","family":"Incorvaia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmelita","family":"Marcantoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe Stefano","family":"Netti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Passamonti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camillo","family":"Porta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Procopio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mimma","family":"Rizzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Roma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Romanini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fulvio","family":"Stacul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Casinelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"1483_CR1","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1148\/radiol.2019182834","volume":"292","author":"JS McDonald","year":"2019","unstructured":"McDonald JS, Hunt CH, Kolbe AB et al (2019) Acute adverse events following gadolinium-based contrast agent administration: a single-center retrospective study of 281945 injections. 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