A survey-based study on attitudes of the clinicians toward contrast-induced nephropathy: which drugs to discontinue?

Abstract

Objective: Contrast-induced nephropathy (CIN) is the third leading cause of iatrogenic acute kidney injury, affecting approximately 10% of patients. Multiple risk factors, including preexisting kidney disease, diabetes mellitus, and hypertension, have been described; however, there is no specific therapeutic approach. Also, there is no consensus on premedication or which drugs should be discontinued before the exposure, whether discontinued drugs should be restarted, and, if started, how long after the exposure. In this cross-sectional survey-based study, we aim to assess the attitudes of clinicians about the discontinuation of renin–angiotensin system (RAS) blockers, sodium–glucose cotransporter 2 (SGLT-2) inhibitors, loop diuretics, and metformin before contrast exposure to reduce the risk for CIN. Method: We performed a survey-based study on clinicians, for which announcements were made through online platforms and national associations. Fully licensed physicians from the fields of internal medicine, cardiology, endocrinology, and nephrology with adult patients were included. Results: We have included 517 clinicians—288 in internal medicine, 70 in endocrinology, 59 in cardiology, and 100 in nephrology. Most of the clinicians prefer the discontinuation of metformin before contrast exposure. About 51.5% of the nephrologists think that SGLT2 inhibitors should be stopped before exposure, as compared with only 25.9% of the cardiologists. The nephrologists were the main physicians who believed that RAS blockers should be stopped before the investigation (52.6%) and were more reluctant to restart rapidly after the exposure. The attitudes of the clinicians toward renin–angi otensin–aldosterone system blockers, loop diuretics, and SGLT-2 inhibitors are considerably variable. Conclusion: The attitudes of clinicians regarding the discontinuation and reinitiation of such medications are clinician dependent. We hereby emphasize the need for future large-scale randomized clinical trials investigating this issue to reach a consensus in such a common clinical scenario. © 2024 Turkish Society of Nephrology. All rights reserved.