Contrast-associated acute kidney injury is a myth: Yes

Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation

“…This definition is problematic because in most cases, "exclusion of other nephrotoxic factors" is not feasible or reliable (2). Consequently, many cases of AKI that are coincident with but causally unrelated to intravenous contrast media administration have been incorrectly attributed as contrast induced, thereby overstating the risks of intravenous contrast media administration (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)15). The vast majority of studies on this topic have not included a control group of similar patients who were not exposed to contrast media, making it impossible to separate causal from coincident AKI (20).…”

“…In such studies, the risk of CI-AKI has been estimated to be near 0% at eGFR greater than or equal to 45, 0%-2% at eGFR of 30-44, and 0%-17% at eGFR less than 30 mL/min/1.73 m 2 . These studies (1)(2)(3)(4)(5)(6)(7)(8)10,11,13) are underpowered to establish risk in patients with severe kidney disease, differ in their conclusions about risk in patients with eGFR less than 30 mL/min/1.73 m 2 (estimated CI-AKI risk range, 0%-17%), and are observational in design (ie, only known confounders can be addressed). There are no randomized trials differentiating CA-AKI from CI-AKI in patients with eGFR less than 30 mL/min/1.73 m 2 .…”

“…However, clinical decision making in patients potentially at risk for acute kidney injury (AKI) is often fraught with confusion, uncertainty, and heterogeneity. This is due in part to shifting perceptions regarding the true risks of modern contrast media (1)(2)(3)(4)(5)(6), improvements in scientific methodology used to study these adverse events (7)(8)(9)(10)(11)(12)(13), incomplete penetrance of new knowledge into scientific practice (14), latent bias related to historical precedent (1,2), uncertainty regarding the interpretation of recently conducted well-controlled observational studies (4)(5)(6), and differences in recommendations across radiology and medical subspecialties (15)(16)(17)(18).…”

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

“…Patients who re ceive contrast often have numerous other independent risk factors for AKI, either from their primary pathology or comorbidities, independent of contrast administration. As stated by Ehrmann et al 52) , this distinction between a causal and an associative relationship between CM and AKI is of great importance, because suboptimal care may result from excessive caution ("renalism"). For fear of ne phrotoxicity, patients may undergo unenhanced imaging which is less accurate than contrastenhanced imaging, resulting in negative impact on clinical decisions related to treatment.…”

Effectiveness of contrast-associated acute kidney injury prevention methods; a systematic review and network meta-analysis

“…There is ongoing discussion about the impact of new contrast media on the size of the problem and the outcomes of prevention methods or even the existence of the problem, on the other side these conclusions were challenged as coming only from retrospective studies that does not take in account patients factors or indications for using contrast media in deferent cases with deferent baseline renal profile [ 10 , 11 ].…”