신기능 저하 환자의 조영제 신독성 예방에 관한 근거기반간호 사례

Evidence-based Nursing Case on Prevention of Contrast-induced Nephrotoxicity in Patients with Renal Insufficiency

Purpose: This study aimed to determine the impact of oral or intravenous fluid therapy to prevent contrast-induced nephrotoxicity in patients with renal insufficiency undergoing contrast-enhanced computed tomography (CT). Methods: We searched five electronic databases and reviewed prior studies according to the criteria. Finally, three randomized controlled trials (RCTs) and one non-random-ized study of intervention (NRSI) were selected. Results: According to the Scottish Intercollegiate Guidelines Network, the quality eval-uation was checked, and the results were 1++ for one RCT, 1+ for two RCTs, and 2+ for one NRSI. There was an insufficient benefi-cial evidence of pretreatment with intravenous fluid therapy to prevent contrast-induced nephrotoxicity in patients with reduced renal function undergoing contrast-enhanced CT. Conclusion: We recommend that patients with renal insufficiency with an estimated glo-merular filtration rate (eGFR) of 45~59 mL/min/1.73 m² can undergo contrast-enhanced CT without oral or intravenous fluid therapy as a pretreatment agent, and those with eGFR of 30~44 mL/min/1.73 m² can be treated with oral hydration treatment to prevent con-trast-induced nephrotoxicity. However, for patients with high risks, the decision to administer pretreatment should be considered ac-cording to the individual patient’s clinical condition and the clinical expertise of healthcare providers.