The fear for contrast-induced nephropathy in kidney transplant recipients: time for a paradigm shift?

Benjamens, Stan; Yakar, Derya; Slart, Riemer H. J. A.; Sanders, Jan-Stephan; Pol, Robert A.

doi:10.1111/tri.13277

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…In the light of the new data, this fear seems to be ungrounded. The situation is similar in other risk groups in the field of oncology or transplantation, where caution needs to be exercised when administering iodinated contrast media, but it is not advisable to postpone the diagnosis because of fear of renal complications [31][32][33]. From our clinical perspective, if in CT with contrast will change the diagnosis, prognosis, and therefore outcome, it should be performed.…”

Section: Study Limitationsmentioning

confidence: 92%

Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Chomicka

Kwiatkowska

Lesniak

et al. 2021

Toxins

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Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14–28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.

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Section: Study Limitationsmentioning

confidence: 92%

Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Chomicka

Kwiatkowska

Lesniak

et al. 2021

Toxins

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Whole Body CT Imaging in Deceased Donor Screening for Malignancies

Mensink

Pol

Nijboer

et al. 2019

Transplantation Direct

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Background. In most western countries, the median donor age is increasing. The incidence of malignancies in older populations is increasing as well. To prevent donor-derived malignancies we evaluated radiologic donor screening in a retrospective donor cohort. Methods. This study analyzes the efficacy of a preoperative computed tomography (CT) scan on detecting malignancies. All deceased organ donors in the Netherlands between January 2013 and December 2017 were included. Donor reports were analyzed to identify malignancies detected before or during organ procurement. Findings between donor screening with or without CT-scan were compared. Results. Chest or abdominal CT-scans were performed in 17% and 18% of the 1644 reported donors respectively. Screening by chest CT-scan versus radiograph resulted in 1.5% and 0.0% detected thoracic malignancies respectively. During procurement no thoracic malignancies were found in patients screened by chest CT compared with 0.2% malignancies in the radiograph group. Screening by abdominal CT-scan resulted in 0.0% malignancies, compared with 0.2% in the abdominal ultrasound group. During procurement 1.0% and 1.3% malignancies were found in the abdominal CT-scan and ultrasound groups, respectively. Conclusions. Screening by CT-scan decreased the perioperative detection of tumors by 30%. A preoperative CT-scan may be helpful by providing additional information on (aberrant) anatomy to the procuring or transplanting surgeon. In conclusion, donor screening by CT-scan could decrease the risk of donor-derived malignancies and prevents unnecessary procurements per year in the Netherlands.

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Contrast-associated acute kidney injury - up to date 2019

Richtrova¹

2019

Klin Farmakol Farm

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I. interní klinika LF UK a FN Plzeň Kontrastem indukovaná nefropatie (CIN) a později používané kontrastem indukované akutní poškození ledvin (CI-AKI) je diagnóza známá již od 60. let minulého století. Běžně se považuje za 3. nejčastější příčinu poškození ledvin u hospitalizovaných nemocných. Je definována jako vzestup sérového kreatininu o 25 % či o 44 µmol/l, a to po 48-72 hod. po podání kontrastní látky. V poslední době se však náš pohled na toto postižení mění, zejména v souvislosti s její relativně snižující se incidencí a pochopením různých úskalí, kterými jsou výsledky dosavadních studií a analýz zatíženy. Tento článek má za cíl shrnout dosavadní poznatky, popsat chybějící informace a pokusit se nabídnout nefroprotektivní opatření, která se ve světle dnešních znalostí zdají být nejúčelnější. Klíčová slova: kontrast, kontrastem indukovaná nefropatie, kontrastem indukované akutní poškození ledvin, nefroprotekce. Contrast-associated acute kidney injury-up to date 2019 Contrast-induced nephropathy (CIN) and later used contrast-induced acute kidney injury (CI-AKI) have been mentioned since the 1960s. It is often considered the 3rd most common cause of kidney injury in hospitalized patients. We define CI-AKI as an increase in serum creatinine of 25% or 44 µmol/l after 48-72 hours after administration of the contrast agent. Recently, however, our view of this diagnosis has changed. We have understood various pitfalls and bias of the results of the former studies. In this article we try to summarize the existing knowledge, describe the missing information and try to offer nephroprotective regime, which seems to be most effective.

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The fear for contrast-induced nephropathy in kidney transplant recipients: time for a paradigm shift?

Cited by 3 publications

References 11 publications

Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Whole Body CT Imaging in Deceased Donor Screening for Malignancies

Contrast-associated acute kidney injury - up to date 2019

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