More Evidence Relieving the Defendant: IV Contrast Material itself Does Not Cause Acute Kidney Injury
It's remains a residual concern for clinicians: The fear that intravenous iodinated contrast material used for medical imaging might cause acute kidney injury (AKI), more dialysis and even death. In fact, practice guidelines still tell us to be cautious to use IV contrast material in patients at risk for acute renal failure.
In March 2014 a review article in BioMed Research International came to the conclusion, that by reviewing more recent evidence this risk is almost nonexistent in patients with normal renal function. Even in patients with pre-existing renal insufficiency the risk of secondary contrast-induced AKI is probably much smaller than traditionally assumed.
Mc Donald et al. have now provided further evidence, that the risk associated with the administration of IV iodinated contrast material has been overstated. In this single-center retrospective study they looked at almost all CT scans from 2000-2010 and, using propensity score matching, created two large groups (approx. 10'000 patients each) to compare patients with enhances CT-scans to the ones without enhanced CT-scans. They were able to show that the rate of emergent dialysis and short-term mortality among the two groups were not significantly different. In fact the development of AKI was independent of contrast material administration.
Take home message:
- AKI is associated with worse overall short-term outcomes (dialysis, 30-day mortality), but these outcomes are independent of contrast material exposure.
The nephrotoxic risk associated with administration of intravenous iodinated contrast material appears to have been overstated.
Or short: If you have a good indication for an enhanced CT-scan: Go for it!
McDonald RJ et al. Radiology 2014 December OPEN ACCESS
Also worth looking at:
Davenport MS et al. Radiology 2013 April OPEN ACCESS
BIJC post: Iodinated Radiocontrast Agents can cause Kidney Injury... But not as much as we thought they would!