Risk ThresholdsThere is no agreed-u

Risk ThresholdsThere is no agreed-upon threshold of serum creatinine elevation or eGFR declination beyond which the risk ofCIN is considered so great that intravascular iodinated contrast medium should never be administered. In fact,since each contrast medium administration always implies a risk-benefit analysis for the patient, contrastmedium administration for all patients should always be taken in the clinical context, considering all risks,benefits and alternatives [2,6].In a 2006 survey of radiologists by Elicker et al [64], the cutoff value for serum creatinine beyond whichintravascular iodinated contrast medium would not be administered varied widely among radiology practices.For patients with no risk factors other than elevated serum creatinine, 35% of respondents used1.5 mg/dL, 27% used 1.7 mg/dL, and 31% used 2.0 mg/dL (mean, 1.78 mg/dL). Threshold values wereslightly lower in patients with diabetes mellitus (mean: 1.68 mg/dL).Some practices have advocated stratification of potential risk by eGFR instead of serum creatinine because it isa better indicator of baseline renal function [49,50]. This has been limited in the past by insufficient data [65-67], but there are now two large propensity score-adjusted studies that stratify CIN risk by eGFR [3,7]. Oneshowed no risk of CIN from IV iodinated contrast material, regardless of baseline eGFR [7], while anotheridentified patients with an eGFR