In addition to discontinuing diuretic therapy, the most appropriate periprocedural management for this patient is to begin intravenous isotonic saline. She is at risk for contrast-induced nephropathy (CIN), and administration of intravenous isotonic saline (1-1.5 mL/kg/h) 3 to 12 hours before the procedure and continued for 6 to 24 hours afterward has been shown to decrease the incidence of CIN in high-risk patients. Risk factors include age older than 75 years, diabetes mellitus, chronic kidney disease, conditions of decreased renal perfusion, and concurrent use of nephrotoxic drugs. Therefore, this patient is at high risk for CIN. In addition to intravenous isotonic saline, other strategies to minimize the risk for CIN include discontinuation of potentially nephrotoxic medications, minimization of contrast volume, and use of low- or iso-osmolal contrast media. The benefit of hydration regimens utilizing isotonic sodium bicarbonate is comparable to isotonic sodium chloride and is not considered to be of significant benefit relative to normal saline.

The benefit of N-acetylcysteine in patients at risk for CIN remains controversial, and results from trials are inconsistent. It is therefore not recommended as routine treatment to prevent CIN.

Prophylactic hemodialysis has not been shown to provide benefit compared with medical therapy alone for patients at risk for CIN.

Discontinuation of ACE inhibitors or angiotensin receptor blockers has not been clearly shown to decrease the risk of CIN. Although ACE inhibitors should be discontinued in most cases of acute kidney injury, they can be continued in patients with stable kidney function.