Iodinated contrast for patients with chronic kidney disease—writing on the wall or free for all?

摘要

Acute kidney injury (AKI) is associated with adverse outcomes, including worse short- and long-term mortality, increased length of hospital stay and development of chronic kidney disease (CKD) (1). Iodinated contrast has been associated with AKI since its use began in the middle of the 20th century, termed contrast induced nephropathy and later contrast induced acute kidney injury (CI-AKI). Studies on the underlying pathogenesis have mainly been limited to animal models (2). With the development of newer contrast types, low osmolar contrast media and iso-osmolar contrast media that have replaced high osmolar contrast media, the importance of contrast in development of AKI has been questioned (3). The term contrast associated AKI (CA-AKI) or post-contrast exposure AKI have now been proposed since other factors such as age, CKD and other comorbidities have been shown to increase the risk of AKI (4,5).