Major Consensus Statement on IV Contrast Nephropathy
June 26, 2020
Written by Alex Chen
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This is a summary of the major American College of Radiology/National Kidney Foundation (ACR/NKF) consensus statements.
Why does this matter?
If you work in Emergency Medicine, there is an inevitable phone call (or multiple calls in my case) from the radiology tech to tell you that the CT scan that you ordered three hours ago cannot be done because of the patient’s GFR. After you are finished swearing under your breath, you can now rest easier knowing that the ACR sort of affirms what you have been telling people all along.
Now can you please scan my patient?!
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Do not withhold contrasted CT exams based on contrast-induced acute kidney injury (CI-AKI) risk if there is no suitable alternative.
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High-risk patients are those with recent AKI, eGFR < 30 mL/min/1.73 m2, which includes non-anuric patients undergoing dialysis.
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Perform kidney function screening on patients with a history of kidney disease.
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There are no clinically relevant differences in CI-AKI risk between iso-osmolality and low-osmolality iodinated contrast.
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Give IV normal saline prophylaxis to patients not undergoing dialysis who have eGFR < 30 or AKI. You can consider giving this prophylaxis at eGFR of 30-44 if they have high-risk circumstances.
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Prophylaxis is not indicated for patients with eGFR > 45.
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Kidney replacement therapy should not be initiated or adjusted solely based on contrast administration.
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A solitary kidney is not an independent risk factor for CI-AKI.
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In high-risk patients, use the minimum amount of contrast necessary.
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Withhold nephrotoxic medications in patients with AKI or eGFR < 30.
Source
Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease: Consensus Statements From the American College of Radiology and the National Kidney Foundation. Radiology. 2020 Mar;294(3):660-668. doi: 10.1148/radiol.2019192094. Epub 2020 Jan 21.
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