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→Alternatives: Adjusted
===Alternatives===
In people with risk factors, the main alternatives are:*'''Adjustment''' of the contrast dose. Evidence suggests that contrast doses should be limited to a ratio of grams of iodine to glomerular filtration rate (I<sub>gram</sub> / GFR<sub>ml/min</sub>) of a maximum of 1.<ref name="KeaneyHannon2013">{{cite journal|last1=Keaney|first1=J. J.|last2=Hannon|first2=C. M.|last3=Murray|first3=P. T.|title=Contrast-induced acute kidney injury: how much contrast is safe?|journal=Nephrology Dialysis Transplantation|volume=28|issue=6|year=2013|pages=1376–1383|issn=0931-0509|doi=10.1093/ndt/gfs602}}</ref> The local practice at NU Hospital Group has a I<sub>gram</sub>/GFR ratio of maximum 0.7 in patients with GFR ≥45 ml/min. It recommends a ratio of maximum 0.5 if GFR is lower, or in the presence of risk factors.{|class="wikitable"align="center"|+ Volume for various I<sub>gram</sub> / GFR<sub>ml/min</sub> ratios! Iodine<br>concentration !! Maximum volume<ref name="KeaneyHannon2013"/>1 !! 0.7 !! 0.5
|-
| 240 mg/ml || 4.2 ml *GFR<sub>ml/min</sub> || 2.9 ml *GFR<sub>ml/min</sub> || 2.1 ml *GFR<sub>ml/min</sub>
|-
| 350 mg/ml || 2.9 ml *GFR<sub>ml/min</sub> In people with risk factors, the main alternatives are:|| 2 ml *'''Adjustment''' of the contrast dose. Evidence suggests that contrast doses should be limited to a ratio of grams of iodine to glomerular filtration rate (I<sub>gram</sub> / GFR<sub>ml/min</sub>) of a maximum of 1.<ref name="KeaneyHannon2013">{{cite journal|last1=Keaney|first1=J1. J.|last2=Hannon|first2=C. M.|last3=Murray|first3=P. T.|title=Contrast-induced acute kidney injury: how much contrast is safe?|journal=Nephrology Dialysis Transplantation|volume=28|issue=6|year=2013|pages=1376–1383|issn=0931-0509|doi=10.1093/ndt/gfs602}}</ref> The local practice at NU Hospital Group has a I4 ml *GFR<sub>gramml/min</sub>/GFR ratio of maximum 0.7 in patients with GFR ≥45 ml/min. It recommends a ratio of maximum 0.5 if GFR is lower, or in the presence of risk factors.|}
*Using ''no intravenous contrast''' for the investigation.
*Switching to '''another modality''' such as [[ultrasonography]] or [[MRI]]
*'''Treating or mitigating risk factors'''.
:*'''Hydration''' by drinking or intravenous volume expander, either before or after contract administration, decreases the risk of contrast-induced nephropathy.<ref name="YangHiremath2013">{{cite journal|last1=Yang|first1=Xiaoming|last2=Hiremath|first2=Swapnil|last3=Akbari|first3=Ayub|last4=Shabana|first4=Wael|last5=Fergusson|first5=Dean A.|last6=Knoll|first6=Greg A.|title=Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence|journal=PLoS ONE|volume=8|issue=3|year=2013|pages=e60009|issn=1932-6203|doi=10.1371/journal.pone.0060009}}</ref>
==Phases==
