Intravenous Contrast Medium-Induced Acute Kidney Injury from a Feared Complication to Non-Existence.

Contrast-induced acute kidney injury (CI-AKI) has been a great concern since the 1970s and considered a leading cause of hospital-acquired AKI as late as 2002. This has now been questioned, especially following contrast medium-enhanced CT. Though the nephrotoxicity of previous high osmolar contrast media (CM) has been proven in randomized studies, several recent propensity score-matched controlled observational studies have failed to show any association between AKI and modern CM, which may be true for iso-osmolar but not for low osmolar CM. The studies have been criticized due to their retrospective nature, which makes selection bias a serious concern, and their evidence value has been graded as low. We are concerned regarding the recently revised European and American guidelines lowering the CI-AKI risk threshold to 30 mL/min/1.73 m2 and omitting nonrenal risk factors based on such studies. The lack of association between AKI and modern CM given intravenously at CT may also be a result of a better adherence to existing guidelines with proper patient selection and preventive measures We advocate prospective studies with careful analysis of the etiology of AKI in individual cases, propensity matching of patients with different CM dose/GFR ratio or controlled studies in patients who as a routine are planned for CT with and without CM.
 

Author(s): Ulf Nyman

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