NEW GUIDELINES regarding gadolinium and at risk patients https://pubmed.ncbi.nlm.nih.gov/31255393/
Ionic cyclic agents are safest
Known chronic renal problems, either on or not on dialysis, eGFR< 30? Proceed, no consent, if MRI is necessary.
If on dialysis, schedule 2-3 hours after MRI. No need to change peritoneal to hemodialysis.
Do NOT double or triple dose in patients with eGFR between 30-60.
Acute kidney injury, eGFR 50? Do not give contrast. AKI has a clinical definition and if it is met, it is dangerous with contrast. eGFR is not always reliable in these patients.
Screening for renal function in the outpatient setting is no longer recommended.
It is the job of the radiologist and not the patient (i.e. through consent) to know what is safe.
everything regarding contrast media https://www.acr.org/Clinical-Resources/Contrast-Manual
european contrast media guidelines http://www.esur.org/esur-guidelines/
Copy-Paste for Email purposes (German):
Laut empfehlungen für Prämedikation wäre folgendes Schema passend:
Prednisone-based: 50 mg prednisone by mouth at 13 hours, 7 hours, and 1 hour before contrast medium administration, plus 50 mg diphenhydramine intravenously, intramuscularly, or by mouth 1 hour before contrast medium administration.
Quelle: Seite 10 von https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
Dazu ist notiert:
There is no evidence to support a premedication duration of 2 hours or less (oral or IV; corticosteroid- orantihistamine-based).