April 28, 2021

Background: It has long been thought that intravenous contrast can lead to acute kidney injury. Recent data, however, has called this dogmatic teaching into question.  Unfortunately, the data arguing against the association of contrast with AKI comes from observational trials and, thus, carry with it numerous biases.  One potential bias is baseline differences in the risk between exposure groups with patients not receiving contrast perceived to be at higher risk and those receiving contrast at lower risk of PC-AKI. Another example is selection bias due to requiring subsequent renal function testing in patients deemed to be higher risk and not those at lower risk.  Both of these can form a control group at high risk of kidney injury which creates a bias in favor of contrast and potentially masking harm.

April 4, 2019

Background: Computed tomography (CT) scans using IV contrast agents are one of the most common imaging modalities used in the emergency department (ED). The reason for this is no secret. CT scans with IV contrast offer a large amount of information on patients when limited information is available, they are diagnostic of many conditions with good performance characteristics, and they are often requested by consultants.   Many patients get suboptimal studies without IV contrast due to fear of contrast induced nephropathy (CIN). However, more recent studies suggest that with the use of iso- and low-osmolar contrast agents (almost universally used today) this concern is unwarranted.  Most studies on this topic have focused on unselected populations, and not focused on patient groups at higher risk for AKI, including those with sepsis.

September 25, 2017

Background: One of the most common imaging modalities used in the emergency department (ED) today is computed tomography (CT) scans using intravenous radiocontrast agents. Use of IV contrast can help increase visualization of pathology as compared to non-contrast CTs. However, many patients do not get IV contrast due to fear of contrast induced nephropathy.  Furthermore, waiting for renal function values delays the care of patients and prolongs time spent in the ED with a potential to increase adverse effects on patient centered outcomes due to delays.

March 24, 2017

Background: In patients with compromised renal function, the use of intravascular iodinated contrast material is generally not given to avoid contrast induced nephropathy (CIN). Currently, there is no treatment for contrast-induced nephropathy, therefore the focus has been on prevention. Guidelines recommend prophylactic prehydration in the prevention of CIN in high risk patients.  These recommendations are based on expert consensus and until now, there has not been a prospective randomized trial of IV hydration versus no hydration in high-risk patients.

March 20, 2017

Background: Use of contrast media in CT scans has been cited as one of the most common causes of iatrogenic acute kidney injury.  Its use however improves the diagnostic accuracy of CT scans.  Some studies have even reported an incidence of contrast induced nephropathy (CIN) as high as 14%.  Many of the studies coming to these conclusions were performed before the use of low- and iso-osmolar contrast agents. Also to date, all controlled studies on this topic have been observational and not randomized controlled trials.  More recent propensity-scored analyses have had conflicting results. One study found no increased risk of acute kidney injury, dialysis or mortality regardless of baseline renal function, while others have found increased acute kidney injury in patients with renal dysfunction. This current study tried to clarify the incidence of acute kidney injury attributable to IV contrast media administration.