OAK BROOK, Ill. — The risk of administering modern intravenous iodinated contrast media in patients with reduced kidney function has been overstated, according to new consensus statements from the American College of Radiology (ACR) and the National Kidney Foundation (NKF), jointly published in the journals Radiology and Kidney Medicine.
Intravenous iodinated contrast media are commonly used with computed tomography (CT) to evaluate disease and to determine treatment response. Although patients have benefited from their use, iodinated contrast media have been denied or delayed in patients with reduced kidney function due to the perceived risks of contrast-induced acute kidney injury. This practice can hinder a timely and accurate diagnosis in these patients.
"The historical fears of kidney injury from contrast-enhanced CT have led to unmeasured harms related to diagnostic error and diagnostic delay," said lead author Matthew S. Davenport, M.D., associate professor of radiology and urology at the University of Michigan in Ann Arbor, Michigan. "Modern data clarify that this perceived risk has been overstated. Our intent is to provide multi-disciplinary guidance regarding the true risk to patients and how to apply a consideration of that risk to modern clinical practice."
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These consensus statements were developed to improve and standardize the care of patients with
impaired kidney function who may need to undergo exams that require intravenous iodinated contrast media to provide the clearest images and allow for the most informed diagnosis.
In clinical practice, many factors are used to determine whether intravenous contrast media should be administered. These include probability of an accurate diagnosis, alternative methods of diagnosis, risks of misdiagnosis, expectations about kidney function recovery, and risk of allergic reaction. Decisions are rarely based on a single consideration, such as risk of an adverse event specifically related to kidney impairment. Consequently, the authors advise that these statements be considered in the context of the entire clinical scenario.
Importantly, the report outlines the key differences between contrast-induced acute kidney injury (CI-AKI) and contrast-associated acute kidney injury (CA-AKI). In CI-AKI, a causal relationship exists between contrast media and kidney injury, whereas in CA-AKI, a direct causal relationship has not been demonstrated. The authors suggest that studies that have not properly distinguished the two have contributed to the overstatement of risk.