Recommendations for Chronic Kidney Disease
| 2007 Recommendations | 2011 Focused Update Recommendations | Comments |
|---|---|---|
| Class I | ||
| CrCl should be estimated in UA/NSTEMI patients, and the doses of renally cleared drugs should be adjusted appropriately. (Level of Evidence: B) | 1. CrCl should be estimated in UA/NSTEMI patients and the doses of renally cleared medications should be adjusted according to the pharmacokinetic data for specific medications.155,156 (Level of Evidence: B) | Modified recommendation (changed wording for clarity). |
| In CKD patients undergoing angiography, isosmolar contrast agents are indicated and are preferred. (Level of Evidence: A) | Deleted recommendation. | |
| 2. Patients undergoing cardiac catheterization with receipt of contrast media should receive adequate preparatory hydration.157,158 (Level of Evidence: B) | New recommendation | |
| 3. Calculation of the contrast volume to CrCl ratio is useful to predict the maximum volume of contrast media that can be given without significantly increasing the risk of contrast-associated nephropathy.159,160 (Level of Evidence: B) | New recommendation | |
| Class IIa | ||
| 1. An invasive strategy is reasonable in patients with mild (stage II) and moderate (stage III) CKD.155,156,161,162 (Level of Evidence: B) (There are insufficient data on benefit/risk of invasive strategy in UA/NSTEMI patients with advanced CKD [stages IV, V].) | Modified recommendation (class changed from IIb to IIa, level of evidence changed from C to B, and moved from Section 3.3). |