Canadian Association of Radiologists Guidance on Contrast Associated Acute Kidney Injury

Abstract

Iodinated contrast media (ICM) is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after ICM administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations. This revised guidance document was developed by a multidisciplinary CAR Working Group of radiologists and nephrologists, and summarizes changes in practice related to contrast administration, screening, and risk stratification since the last guideline. It reviews the scientific evidence for contrast associated AKI and provides consensus-based recommendations for its prevention and management in the Canadian healthcare context. This article is a joint publication in the Canadian Association of Radiologists Journal and Canadian Journal of Kidney Health and Disease, intended to inform both communities of practice.

Did the COVID-19 Pandemic Affect Contrast Media-Induced Adverse Drug Reaction’s Reporting? A Pharmacovigilance Study in Southern Italy

“…In fact, from our results, iodinated CM was more frequently involved in a major number of ICSRs, and serious ADRs, resulting in a more probable relationship with drug-adverse events according to the applied Naranjo algorithm. In the last years, attention has been given to CM nephrotoxicity among organ-specific adverse reactions, probably caused by induced endothelial dysfunction and renal cell apoptosis [ 21 , 45 ]. However, in our period study, renal disorders did not emerge as frequently, and only a few cases reported nephropathies or renal disorders.…”

A multidisciplinary team reduces in‐hospital clinical complications and mortality in patients with diabetic foot ulcers

“…IHC was defined by any new infection different from wound infection, new cardiovascular events including cerebral and myocardial ischaemia, acute renal injury due to contrast induced nephropathy (CIN), onset of severe anaemia (hb < 8 gr/dL) requiring blood transfusion, and any new other clinical or surgical problem not present at the assessment. CIN was considered as the increase creatinine values of 0.5 mg/dL or 25% from baseline in 48–72 h after the contrast media administration 15 . Major amputation was considered any amputation above‐the‐ankle.…”

“…CIN was considered as the increase creatinine values of 0.5 mg/dL or 25% from baseline in 48-72 h after the contrast media administration. 15 Major amputation was considered any amputation above-the-ankle.…”

Diagnosis, pathophysiology and preventive strategies for cardiac surgery-associated acute kidney injury: a narrative review

“…Iodinated contrast agent is the main media of contrast-induced nephropathy, and its osmotic pressure is one of the influencing factors. Studies have confirmed that the risk of CI-AKI is lower in high-osmolar contrast than in low-osmolar contrast, but there is no significant difference between iso-osmolar contrast and low-osmolar contrast [ 91 , 92 ].…”