Background: Contrast-induced Nephropathy (CIN) is a major cause of mortality and morbidity among elderly patients. Its occurrence increases with the patient’s age. Elderly patients who suffer from impaired renal function constitute a large percentage of individuals at an increased risk of developing CIN. Several studies have shown the independent risk factors and prevalence of CIN in the elderly patients. However, the current guidelines may need revision; anecdotally, significant disease progression is noted in the elderly despite precautions taken with contrast use in hospitals. A systematic review of the current literature was conducted to determine the risk factors, pathogenesis, and the prevalence of CIN in the elderly patient group.

Methods: Our study methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement for systematic reviews guidelines.  The PubMed, EMBASE, and CINHAL databases were utilized. All prospective, cross-sectional or retrospective studies investigating CIN in elderly were evaluated for eligibility. Studies were included if they were: at the level of evidence between I and IV, written in English language, published within the last 15 years and included human subjects at the age of 80 and over. Studies that only reported issues other than different contrast media, risk factors, epidemiology, or pathophysiology were excluded. 930 studies were initially considered prior to exclusion criteria. 68 studies were used in our final analysis.

Results: The onset of nephrotoxicity in elderly patients after administering contrast media during invasive and diagnostic procedures is a relatively common occurrence in hospitals. Several studies reported the frequent occurrence of contrast induced nephropathy in the elderly over the age of 85. Multiples studies seem to bolster the concern that age by itself is a risk factor for developing contrast-associated nephropathy. Studies have shown a dose-dependent risk of renal dysfunction; lower doses of contrast are safer, but they are not devoid of risk. Prospective, randomized trials established major distinctions between contrast agents based upon their chemical attributes. The use of first generation hyperosmolal ionic contrast agents is associated with an increased risk of nephropathy compared to nonionic low osmolal or iso-osmolal agents.

Conclusions: Based upon the current studies and review, CIN appears to be common among elderly patients, particularly those over 80 years of age, leading to acute renal function impairment. Hospitalists should recognise key risk factors and take steps to reduce CIN in high risk patients. Contrast agents have major differences based upon chemical characteristics. Low-osmolar and iso-osmolar media should be utilized to prevent CIN in the at-risk patient population. Still, further revisions of current guidelines are warranted. Overall, hospitalists should exercise caution when administering contrast in elderly patients.