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

Davenport, Matthew S.; Perazella, Mark A.; Yee, Jerry; Dillman, Jonathan R.; Fine, Derek M.; McDonald, Robert J.; Rodby, Roger A.; Wang, Carolyn L.; Weinreb, Jeffrey C.

doi:10.1148/radiol.2019192094

Cited by 391 publications

(377 citation statements)

References 52 publications

(147 reference statements)

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“…We agree with the recent shift within radiology to distinguish between AKI that is contrast‐associated (CA‐AKI) and contrast‐induced (CI‐AKI). Reduced renal perfusion (whether in the context of haemodynamic instability or hypovolaemia) is a well‐established risk factor for postoperative AKI, but has not been demonstrated conclusively to be a specific risk factor for CI‐AKI within well controlled studies.…”

supporting

confidence: 80%

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Author response to: Does preoperative contrast administration really not affect the occurrence of acute kidney injury after major gastrointestinal surgery?

McLean¹,

Ahmed²,

Akhbari³

et al. 2020

British Journal of Surgery

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supporting

confidence: 80%

“…As postoperative AKI frequently involves pre‐renal factors, the common practice of periprocedural hydration in this patient population is likely appropriate. We acknowledge within our paper this may have ameliorated the true risk of postoperative AKI in our study, even if the evidence for prevention of CI‐AKI itself is mixed.…”

mentioning

confidence: 87%

Author response to: Does preoperative contrast administration really not affect the occurrence of acute kidney injury after major gastrointestinal surgery?

McLean¹,

Ahmed²,

Akhbari³

et al. 2020

British Journal of Surgery

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“…Furthermore, a recent consensus statement from the American College of Radiology and the ▶ National Kidney Foundation concludes that the risk of administering modern intravenous iodinated CM in patients with reduced kidney function has been overstated. Therefore, lowering the CM volume below a diagnostic threshold and a loss of diagnostic accuracy should be avoided [28]. Regarding objective and subjective image quality, our study found no statistically significant difference between the two protocols.…”

Section: Discussionmentioning

confidence: 53%

Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution’s Experience

Shnayien

Bressem

Beetz

et al. 2020

Rofo

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Purpose To retrospectively investigate the effectiveness of a novel 3-phase protocol for computed tomography (CT) before transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) in terms of radiation dose and image quality. Materials and Methods A total of 107 nonrandomized patients (81 ± 7.4 years) scheduled for TAVI/TAVR underwent preprocedural CT on an 80-row CT scanner. 55 patients underwent a combined ECG-synchronized spiral scan of the chest and non-ECG-synchronized spiral scan of the abdomen/pelvis as recommended by the Society of Cardiovascular Computed Tomography (SCCT). 52 patients underwent an updated 3-phase variable helical pitch (vHP3) protocol combining a non-ECG-synchronized spiral scan of the upper thoracic aperture, followed by a prospective ECG-synchronized spiral scan of the heart, and a non-ECG-synchronized abdominal/pelvic spiral scan. The radiation dose was determined from an automatically generated protocol based on the CT dose index (CTDI). Objective image quality in terms of vessel attenuation and image noise was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated using a 4-point scale and compared for interrater agreement using Cohen’s weighted kappa coefficient (κw). All data were compared and statistically analyzed. Results Use of the novel 3-phase vHP3 protocol reduced the dose-length product (DLP) from 1256.58 ± 619.05 mGy*cm to 790.90 ± 238.15 mGy*cm, reducing the effective dose (E) from 21.36 ± 10.52 mSv to 13.44 ± 4.05 mSv and size-specific dose estimates (SSDE) from 20.85 ± 7.29 mGy to 13.84 ± 2.94 mGy (p < 0.001). There were no significant differences in objective and subjective image quality between the two protocols and between the two readers. Conclusion The novel 3-phase vHP3 protocol significantly reduces the radiation dose of preprocedural TAVI/TAVR CT without a loss of image quality. Key Points: Citation Format

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“…Previous studies had already indicated these findings, with research groups suggesting that other factors including the underlying disease as the cause for AKI and nephropathy among patients receiving CM [20,21]. The latest consensus statement by the American College of Radiology also noted that risk of developing AKI after administering intravenous CM in renally impaired patients was overstated [22]. Given the different weighting that the risk of CM appears to have on AKI development depending on the procedure and route of administration, it is important to evaluate whether current practices regarding CM administration in TAVR are reasonable.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models

Mach

Hasan

Andreas

et al. 2020

JCM

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Recent studies have suggested that contrast medium (CM) volume is associated with acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). However, in a high-risk elderly TAVR population, the prognostic value and ideal threshold of CM dosage for AKI is unclear. Data of 532 successive TAVR patients (age 81.1 ± 6.8 years, EuroSCORE II 4.8% ± 6.0%) were therefore retrospectively analyzed. Based on a recently published formula, the renal function (preprocedural serum creatinine: SCr) corrected ratio of CM and body weight (CM*SCr/BW) was calculated to determine the risk of postprocedural contrast-associated AKI. AKI occurred in 94 patients (18.3%) and significantly increased 1-year all-cause mortality (23.4% vs. 13.1%; p = 0.001). A significant correlation between AKI and 30-day as well as 1-year all-cause mortality was observed (p = 0.001; p = 0.007). However, no association between CM dosage or the CM*SCr/BW ratio with the occurrence of AKI was seen (p = 0.968; p = 0.442). In our all-comers, all-access cohort, we found no relationship between CM dosage, or the established risk ratio model and the occurrence of postprocedural AKI. Further research needs to be directed towards different pathophysiological causes and preventive measures as AKI impairs short- and long-term survival.

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

Cited by 391 publications

References 52 publications

Author response to: Does preoperative contrast administration really not affect the occurrence of acute kidney injury after major gastrointestinal surgery?

Author response to: Does preoperative contrast administration really not affect the occurrence of acute kidney injury after major gastrointestinal surgery?

Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution’s Experience

Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models

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