#EMConf: Contrast Induced Nephropathy - Fake News?
Clinical question: Does the use of contrast media in CT scans cause acute kidney injury (AKI)?
The bottom line:
The use of contrast enhanced CTs is imperative in making timely diagnosis in critical illness.
For years, it has been thought that contrast media leads to AKI.
Previous studies are limited with many based on the use of hyper-osmolar and large volumes of contrast.
Moreover, older studies drew conclusions without comparing to a control group.
Newer, controlled, observational studies have shown no associated between contrast media and the development of AKI.
Study 1: Hinson 2017
- Single-center retrospective cohort analysis of 17,934 patients who underwent contrast enhanced (CECT), non-contrast enhanced, or no CT.
- Objective: evaluate the incidence of AKI attributable to IV contrast
Propensity Score Matching:
Study 2: Hinson 2019
- Single-center retrospective propensity matched cohort analysis of 4171 patients who underwent CECT, non-contrast enhanced, or no CT in the ED.
- Objective: Determine the risk for AKI attributable to IV contrast in patients with sepsis.
Hinson JS et al. Risk of Acute Kidney Injury After Intravenous contrast Media Administration. Ann Emerg Med 2017; S0196 – 0644(16): 31388 -9. PMID: 28131489
Hinson JS et al. Acute Kidney Injury Following contrast Media Administration in the Septic Patient: A Retrospective Propensity-Matched Analysis. J Crit Care 2019. PMID: 30798098