Table 5 Descriptions on the selection of contrast media in CIN guidelines ACC(F) American College of Cardiology (Foundation), AHA American Heart Association, CIN contrast-induced nephropathy, selleck chemical ESUR European Society of Urogenital Radiology, SCAI Society for Cardiovascular Angiography and Interventions High-osmolar contrast media have been used for a long period of time, and have caused adverse reactions due to their high osmolality. As low-osmolar contrast media became available in the 1980s and iso-osmolar contrast media were introduced thereafter, the incidence of adverse reactions to contrast media has decreased. In Japan, the

intravascular use of ionic high-osmolar contrast media has not been covered by the NHI since February 2001. Although the incidence of CIN has decreased as the use of low-osmolar contrast media has become common, CIN is still a major adverse reaction to contrast media. Considerable interest has been focused on the difference in incidence of CIN among currently available low- and iso-osmolar contrast media. The osmolarity of contrast media, when compared in iodine equivalent concentrations, is highest in high-osmolar contrast media followed by low-osmolar contrast

media and iso-osmolar contrast media. It also should be noted that the osmotic pressure ratio of low-osmolar contrast media to physiological saline ranges from 2–4, which is a higher ratio than that of iso-osmolar contrast media (1.0). Is the risk for developing CIN higher in patients receiving contrast media via invasive (intra-arterial) administration than in those receiving contrast media via non-invasive this website (intravenous) administration? Answer: Although there is no evidence

demonstrating that intra-arterial administration of contrast media is an independent risk factor for developing CIN, the incidence of CIN tends to be higher in patients receiving contrast media intra-arterially than in those receiving them intravenously. The STAT inhibitor majority of studies on CIN have been conducted in patients receiving contract media intra-arterially, and only a few studies have investigated a possible difference in the incidence of CIN by route of administration. The incidence of CIN tends to be lower in patients receiving contrast Acyl CoA dehydrogenase media intravenously than in those receiving them intra-arterially (Table 6) [62–64], although this difference might be explained by other factors such as catheter techniques. In a review of 7 prospective observational studies, the overall incidence of CIN was 5.4 % in patients with CKD who intravenously received low- or iso-osmolar contrast media, which suggested that intravenous administration of contrast media may pose a smaller risk of CIN as compared with that seen with intra-arterial administration [42]. Table 7 lists the incidence of CIN in patients with CKD after receiving different contrast media [5, 65–70]. Table 8 summarizes currently available iodinated contrast media and their osmolar pressure [71, 72].