hydration for low GFR's

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    I would like to hear how other institutions are handling low GFR's. At my institution, we recently started calculating GFR's for both CT. If GFR is below 60 for CT, we hydrate patients prior to the CT with contrast. The hydration process is 200cc/hr x 2 hours prior to contrast administration and 200cc/hr x 2 hours after contrast. The bad thing is that patients are coming to the hospital for what they think is a 30-60 minute visit winds up being 4 1/2 to 5 hours. We previously were just taking creatinines into consideration, but now that GRF calculations are used, many people with normal creatinines are havubg ti receuve hydration.
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    Hydration is the single best intervention to decrease the potential for renal impairment secondary to contrast, and contrast is the third leading cause of kidney failure in hospitalized patients. At my facility, we look up the GFR the day before CT.
    GFR 50-60 we change the contrast to iso-osmolar i.e. Visipaque 320.
    GFR 40-50, I call the pt. physician and ask them if they want to (a) cancel IV contrast and/or do another study (b) Use renal protection measures such as mucomust 600 mg bid x 3 days the day before, day of, & day aftere CT; or IV hydration in their preferred amount. Lately, they are ording D5W 500 ml with Bicarb 50 mEq to infuse over 5 hours. This is very impracticle for me, so I set them up to get their IV through the infusion or same day services department.


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