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Patients with eGFR 30 to 60 who are undergoing imaging with IV contrast: temporarily discontinue metformin. KDA + KSN 12. (2020) IV administration of iodinated CM: Discontinue metformin starting the day of procedure and up to 48 hours after the procedure if eGFR is <60.
For most patients, metformin should be stopped at the time of contrast administration. There is some controversy about when to stop and restart metformin for patients scheduled to undergo intravenous contrast-enhanced examinations. 4 The guidelines from the Canadian Association of Radiologists 2 state that patients taking metformin who have an ...
AKI developing after contrast material administration is reversible in most cases, but its development may be associated with adverse outcomes . (See "Contrast-associated and contrast-induced acute kidney injury: Clinical features, diagnosis, and management", section on 'Diagnosis' .)
Metformin should be stopped at the time of your test and for at least 48 hours after your test, because of the risk of lactic acidosis in the rare event that a serious change in your kidney function were to occur.
In patients with cardiovascular disease, kidney disease, and/or diabetes, renin-angiotensin system blockers, non-steroidal anti-inflammatory drugs, diuretics, and metformin can increase the risk of CI-AKI when undergoing contrast imaging.
Key points: There is no need to discontinue metformin either before or after intravenous contrast medium exposure in patients with eGFR > 30 mL/min/1.73 m 2. In patients receiving intra-arterial contrast medium with first-pass renal exposure, there is no need to withhold metformin if eGFR is above 60 mL/min/1.73 m 2.
The most common practice is for the patient to be told to hold their metformin for 2 days after contrast administration and then restart the medication. If the Cr level is not routinely being checked and changes in Cr are rare and clinically insignificant, why discontinue metformin at all?
The American College of Radiology (ACR) guidelines recommend discontinuing metformin before or after exposure to iodinated contrast or checking kidney function after the procedure for patients with eGFR ≥ 30 mL/min/1.73 m 2.
Most guidelines recommend withdrawing metformin before using contrast agents in diabetic patients with severely impaired kidney function but disagree on the renal function thresholds.
If patients with normal renal function who are taking metformin receive less than 100 mL of intravenous contrast (e.g., enhanced CT of the brain), stopping metformin and/or rechecking creatinine levels 48 hours after the procedure may be unnecessary, because the risk of contrast-induced nephropathy in patients with normal renal function is very ...