Keywords
Contrast media
glomerular filtration rate
Consensus
How to Cite
Abstract
Background: Contrast-Associated Acute Kidney Injury (CA-AKI) is an iatrogenic disorder with potential implications for morbidity and mortality, a matter of concern in medical imaging services. In recent years, significant changes have been made in our understanding of this condition, from a more precise definition, real incidence, risk factors, and predictive scales, to the actual impact of certain prevention strategies.
Purpose: To generate evidence-based recommendations about the use of iodinated contrast media in patients undergoing diagnostic and/or therapeutic radiological procedures, through expert consensus.
Methodology: Based on the formulation of research questions related to Contrast-Associated Acute Kidney Injury, evidence was searched in Pubmed, Embase, and Scopus from January 2013 to August 2022. Articles were selected through a systematic review and a modified Delphi consensus methodology. The documents were assessed using instruments that evaluate quality of their evidence.
Results: A total of 22 recommendations were formulated for the management of patients requiring administration of iodinated contrast media. An expert panel consisting of 11 members, including 4 nephrologists, 4 radiologists, 1 pediatric nephrologist, and 2 epidemiologists, actively participated in the consensus development. The process involved 5 virtual sessions and 15 hours of work. Conclusions: The term "Contrast-Associated Acute Kidney Injury" (CA-AKI) should ideally be used and other definitions implying a clear causality should be abandoned. Regarding its incidence, recent data show that it has been overestimated in the literature and perceived exaggeratedly by healthcare personnel. Similarly, only a low estimated glomerular filtration rate (eGFR) is considered an independent risk factor for the development of CA-AKI. Finally, in terms of prevention, hydration alone has shown potential benefits as a nephroprotective measure.
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