Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media

Perioperative acute kidney injury: impact and recent update

“…Guidelines also recommend consideration of i.v. volume expansion with either isotonic sodium bicarbonate or isotonic saline in particularly highrisk patients [113].…”

Risk of acute kidney injury in cancer patients after iodinated contrast medium administration and prophylactic strategies: Summary from the most recent guidelines

“…• • CI-AKI: an increase in serum creatinine ⩾0.3 mg/dl (or ⩾26.5 µmol/l), or ⩾1.5 times baseline, within 48-72 h of intravascular administration of a contrast medium in the absence of an alternative etiology. [3][4][5][6] During CT examination CM is administered intravenously, meaning that it circulates through peripheral or pulmonary capillary bed, and reaches renal arteries only after being diluted.…”

“…), and the latter suggest estimated glomerular filtration rate (eGFR) as the only confirmed CI-AKI independent risk factor. 6,8 Intra-arterial CM administration is associated with a higher incidence of PC-AKI, as compared to intravenous injection (13% vs 5%-6%). Several studies compared different outcomes of intravenous/intra-arterial with second pass renal exposure/intra-arterial with first pass renal exposure CM administration, concluding that differences in incidence of AKI are not due to the injection site, but to CM volume, which is greater in intra-arterial procedures, to patients' comorbidities, as well as to the risks connected to the procedure itself.…”

“…8 There is agreement across all the guidelines on how to behave in case of patients with GFR >45 ml/ min/1.73 mq or <30 ml/min/1.73 mq: in the first case patients do not require prophylaxis before CM administration, whereas, in the second one, prevention strategies should be implemented. [4][5][6] On the contrary, the debate about what to do with patient with an eGFR between 30 and 44 ml/min/1.73 mq is still on-going: ESUR guidelines and Consensus Statements from the ACR and the NKF suggest to consider the prophylaxis when multiple risk factors are present, or in patients who will receive intra-arterial CM injection with first pass renal exposure, while no prophylaxis is suggested for patients with heart failure or with stable eGFR >30 ml/min/1.73 mq. 4,8…”

“…4 The 2021 NICE guidelines propose, for the first time, to use oral hydration in non-acute settings. 6 The 2018 ESUR committee suggests the following hydration schedule:…”