Table 1.

Tips for non-specialists [3]

1	Identify patients with recognised risk factors for developing CI-AKI.
2	Assess pre-procedure renal function (eGFR and SCr) before the CM examination in patients with risk factors, >70 years of age, those due to undergo intra-arterial CM administration, and known eGFR <60 ml/min/1.73 m2.
3	Consider stopping nephrotoxic drugs such as NSAIDs and aminoglycosides.
4	Stop metformin based on eGFR:
	eGFR ≥60 ml/min/1.73m2 – continue metformin.
	eGFR 30 – 59 ml/min/1.73m2
	Intra-arterial CM administration – stop metformin 48 h before CM administration and start 48 h later if renal function not deteriorated.
	Intravenous CM administration – continue with metformin if eGFR ≥45 ml/min/1.73m2. If eGFR
	30 – 44 ml/min/1.73 m2 – as above for intra-arterial route.
	eGFR <30 ml/min/1.73m2 – metformin is contraindicated.
	In emergency patients: stop metformin, monitor for signs of lactic acidosis and restart metformin after 48 h of CM if renal function unchanged from the pre-imaging level.
5	Nephrotoxic role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is controversial, and at present there is no strong evidence to stop these before CM administration.
6	Intravenous volume expansion with saline, with or without additional sodium bicarbonate supplementation is the only recommended prophylaxis against CI-AKI.
7	Determine eGFR and SCr 48 – 72 h after CM examination in high-risk patients.
8	Discuss with nephrologist if CI-AKI is identified.