January 22, 2020
Consensus Statement Published on the Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease
January 22, 2020—A consensus statement from the American College of Radiology and the National Kidney Foundation addresses the use of intravenous iodinated contrast media in patients with kidney disease. The document by Matthew S. Davenport, MD, et al is available online ahead of print in the two organizations’ respective journals, Radiology and Kidney Medicine.
According to the statement, the risk of acute kidney injury (AKI) developing in patients with reduced kidney function after exposure to intravenous iodinated contrast media, which is commonly used with CT to evaluate disease and to determine treatment response, has been overstated. This is primarily due to the historic lack of control groups sufficient to separate contrast-induced (CI) AKI from contrast-associated AKI.
As summarized in the document, although the true risk of CI-AKI remains uncertain for patients with severe kidney disease, prophylaxis with intravenous normal saline is indicated for patients who have AKI or an estimated glomerular filtration rate < 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis.
In individual high-risk circumstances, prophylaxis may be considered in patients with an estimated glomerular filtration rate of 30 to 44 mL/min/1.73 m2 at the discretion of the ordering clinician.
Additionally, the document advised, “The presence of a solitary kidney should not independently influence decision making regarding the risk of CI-AKI. Ad hoc lowering of contrast media dose below a known diagnostic threshold should be avoided due to the risk of lowering diagnostic accuracy.”
Finally, when feasible, nephrotoxic medications should be withheld by the referring clinician in high-risk patients. However, renal replacement therapy should not be initiated or altered solely based on contrast media administration.
The authors noted that prospective controlled data are needed in adult and pediatric populations to clarify the risk of CI-AKI.
A summary of these recommendations in comparison to existing guidelines is provided in Table 1 in the document.