CHEST Guidelines-In-the-Name-of-Contrast-Induced-Acute-Kidney-Injur

In-the-Name-of-Contrast-Induced-Acute-Kidney-Injur

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The article examines the concept of contrast-induced acute kidney injury (AKI), questioning the substantial human and financial resources invested in studying its prevention and treatment. The authors contend that despite experimental models suggesting the existence of contrast-induced AKI, clinical practice does not conclusively support this. Initial studies with no control groups reported high AKI incidences following iodinated contrast medium use, but these findings were insufficient to attribute causality solely to contrast, as other factors might also contribute to AKI in patients requiring such procedures.<br /><br />Subsequent research endeavored to address this ambiguity by including control groups and employing randomization or propensity score matching. A notable study by Williams et al., which used this methodological approach in over 2,306 ICU patient pairs, found no substantial association between iodinated contrast and increased AKI incidence, aligning with previous observational studies in various settings.<br /><br />Critically, the findings suggest that the belief in the nephrotoxicity of modern IV iodinated contrast media may be overstated. Nonetheless, the authors highlight the necessity of careful kidney management, especially in vulnerable patients, recommending measures like ensuring proper fluid balance and avoiding other nephrotoxic agents when contrast procedures are necessary.<br /><br />The article also advises caution in extending these findings to intra-arterial contrast procedures, where higher renal exposure occurs, and warns against using older, high-osmolar contrast media. Overall, the growing body of evidence challenges the long-standing belief in significant renal risks associated with IV iodinated contrast, urging a proportionate clinical response based on evidence.

Keywords

contrast-induced AKI

iodinated contrast

nephrotoxicity

kidney injury

clinical practice

Williams study

ICU patients

fluid balance

nephrotoxic agents

renal exposure