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Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury

PURPOSE: Iodinated contrast media is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after iodinated contrast administration was...

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Autores principales: Macdonald, D. Blair, Hurrell, Casey D., Costa, Andreu F., McInnes, Matthew D. F., O’Malley, Martin, Barrett, Brendan J., Brown, Pierre Antoine, Clark, Edward G., Hadjivassiliou, Anastasia, Kirkpatrick, Iain Donald Craik, Rempel, Jeremy, Jeon, Paul, Hiremath, Swapnil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134018/
https://www.ncbi.nlm.nih.gov/pubmed/35646375
http://dx.doi.org/10.1177/20543581221097455
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author Macdonald, D. Blair
Hurrell, Casey D.
Costa, Andreu F.
McInnes, Matthew D. F.
O’Malley, Martin
Barrett, Brendan J.
Brown, Pierre Antoine
Clark, Edward G.
Hadjivassiliou, Anastasia
Kirkpatrick, Iain Donald Craik
Rempel, Jeremy
Jeon, Paul
Hiremath, Swapnil
author_facet Macdonald, D. Blair
Hurrell, Casey D.
Costa, Andreu F.
McInnes, Matthew D. F.
O’Malley, Martin
Barrett, Brendan J.
Brown, Pierre Antoine
Clark, Edward G.
Hadjivassiliou, Anastasia
Kirkpatrick, Iain Donald Craik
Rempel, Jeremy
Jeon, Paul
Hiremath, Swapnil
author_sort Macdonald, D. Blair
collection PubMed
description PURPOSE: Iodinated contrast media is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after iodinated contrast administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow-up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations. INFORMATION SOURCES: Published literature, including clinical trials, retrospective cohort series, review articles, and case reports, along with expert opinions from radiologists and nephrologists across Canada. METHODS: The leadership of the CAR formed a working group of radiologists and nephrologists with expertise in contrast administration and patient management related to contrast-associated AKI. We conducted a comprehensive review of the published literature to evaluate the evidence about contrast as a cause of AKI, and to inform evidence-based recommendations. Based on the available literature, the working group developed consensus recommendations. KEY FINDINGS: The working group developed 21 recommendations, on screening, choice of iodinated contrast media, prophylaxis, medication considerations, and post contrast administration management. The key changes from the 2012 guidelines were (1) Simplification of screening to a simple questionnaire, and not delaying emergent examinations due to a need for creatinine measurements (2) Prophylaxis considerations only for patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 (3) Not recommending the routine discontinuation of any drugs to decrease risk of AKI, except metformin when eGFR is less than 30 mL/min/1.73 m2 and (4) Not requiring routine follow up serum creatinine measurements post iodinated contrast administration. LIMITATIONS: We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. IMPLICATIONS: Given the importance of iodinated contrast media use in diagnosis and management, and the low risk of AKI after contrast use, these guidelines aim to streamline the processes around iodinated contrast use in most clinical settings. As newer evidence arises that may change or add to the recommendations provided, the working group will revise these guidelines.
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spelling pubmed-91340182022-05-27 Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury Macdonald, D. Blair Hurrell, Casey D. Costa, Andreu F. McInnes, Matthew D. F. O’Malley, Martin Barrett, Brendan J. Brown, Pierre Antoine Clark, Edward G. Hadjivassiliou, Anastasia Kirkpatrick, Iain Donald Craik Rempel, Jeremy Jeon, Paul Hiremath, Swapnil Can J Kidney Health Dis Guidelines PURPOSE: Iodinated contrast media is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after iodinated contrast administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow-up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations. INFORMATION SOURCES: Published literature, including clinical trials, retrospective cohort series, review articles, and case reports, along with expert opinions from radiologists and nephrologists across Canada. METHODS: The leadership of the CAR formed a working group of radiologists and nephrologists with expertise in contrast administration and patient management related to contrast-associated AKI. We conducted a comprehensive review of the published literature to evaluate the evidence about contrast as a cause of AKI, and to inform evidence-based recommendations. Based on the available literature, the working group developed consensus recommendations. KEY FINDINGS: The working group developed 21 recommendations, on screening, choice of iodinated contrast media, prophylaxis, medication considerations, and post contrast administration management. The key changes from the 2012 guidelines were (1) Simplification of screening to a simple questionnaire, and not delaying emergent examinations due to a need for creatinine measurements (2) Prophylaxis considerations only for patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 (3) Not recommending the routine discontinuation of any drugs to decrease risk of AKI, except metformin when eGFR is less than 30 mL/min/1.73 m2 and (4) Not requiring routine follow up serum creatinine measurements post iodinated contrast administration. LIMITATIONS: We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. IMPLICATIONS: Given the importance of iodinated contrast media use in diagnosis and management, and the low risk of AKI after contrast use, these guidelines aim to streamline the processes around iodinated contrast use in most clinical settings. As newer evidence arises that may change or add to the recommendations provided, the working group will revise these guidelines. SAGE Publications 2022-05-24 /pmc/articles/PMC9134018/ /pubmed/35646375 http://dx.doi.org/10.1177/20543581221097455 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Guidelines
Macdonald, D. Blair
Hurrell, Casey D.
Costa, Andreu F.
McInnes, Matthew D. F.
O’Malley, Martin
Barrett, Brendan J.
Brown, Pierre Antoine
Clark, Edward G.
Hadjivassiliou, Anastasia
Kirkpatrick, Iain Donald Craik
Rempel, Jeremy
Jeon, Paul
Hiremath, Swapnil
Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury
title Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury
title_full Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury
title_fullStr Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury
title_full_unstemmed Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury
title_short Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury
title_sort canadian association of radiologists guidance on contrast-associated acute kidney injury
topic Guidelines
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134018/
https://www.ncbi.nlm.nih.gov/pubmed/35646375
http://dx.doi.org/10.1177/20543581221097455
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