Contrast-Induced Acute Kidney Injury and Cardiovascular Imaging: Danger or Distraction?

Abstract

2020, the American College of Radiology and the National Kidney Foundation released consensus statements declaring the prevalence of contrast-induced acute kidney injury (CI-AKI) to be much lower than historically reported. 1This guideline concluded that most CI-AKI from intravenous contrast medium administration is not caused by contrast medium, but instead by coincident nephrotoxic exposures. 1,2It was a dramatic shift in thinking.Just 2 decades earlier, in 2002, CI-AKI was believed to be the third most common cause of hospital-acquired AKI. 3 However, modern evidence indicated that such prevalence estimates were biased and overstated, as nearly all the literature on CI-AKI lacked adequate control groups. 1,2,4onsidering this, the term contrast-associated AKI (CA-AKI) was noted to be preferred over CI-AKI for labeling AKI that occurs after contrast exposure when the cause is unknown. 1 Regardless of cause, AKI continued to be defined using accepted Kidney Disease Improving Global Outcomes criteria: increase in serum creatinine ≥0.3 mg/dL within 48 hours, increase in serum creatinine ≥1.5-fold within 7 days, or urine volume <0.5 mL•kg -1 •h -1 for 6 hours. 1 Clinicians who image patients with kidney disease outside cardiology have reacted appropriately, and radiology guidelines have been revised worldwide.Screening with serum creatinine is no longer routinely performed in patients undergoing noncardiac imaging without known kidney disease.Contrast-enhanced computed tomography (CT) is now performed without prophylaxis in most patients with a stable estimated glomerular filtration rate (eGFR) ≥30 mL•min -1 •1.73 m -2 , and necessary contrast-enhanced CT is now performed irrespective of risk of CI-AKI if there is no reasonable alternative.

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