IV Contrast in Pt w/ Kidney Disease

Summary

The risk of contrast induced acute kidney injury (AKI) vs benefit of information obtained from contrast enhanced imaging is a topic of much debate. Recent guildines from American College of Radiology (ACR) and National Kidney Foundation (NKF) show what the risk of PC-AKI is much higher than previously estimated d/t poorly studied and assumed causation from correlation.

Key Terms

Contrast-induced Nephropathy

not an endorsed term. Historical definition to mean AKI w/in 48 hrs of IV contrast media.

PC-AKI

Postcontrast Acute Kidney Injury. Synonymous w/ CA-AKI.

CA-AKI

Contrast-induced Acute Kidney Injury. Synonymous w/ PC-AKI.

LOCM

Low-osmolality Contrast Media. Despite name, actually hyperosmolar around 600 mOsm/kg (physiological serum at 290).

IOCM

Iso-osmolar Contrast Media. More viscours than LOCM d/t dimeric structure.

HOCM

High-osmolality Contrast Media. Higher osmolality than LOCM or IOCM. LOCM and IOCM have replaced HOCM in modern practice.

eGFR

Estimated Glomerular Filtration Rate. Estimated based on blood serum creatinine. Innacurate, especially in GFR stages 1 and 2. ^3-NKF

mGFR

Measured Glomercular Filtration Rate. Expensive and timeconsuming. The test uses Iohexol contrast and inulin fiber. Very accurate. Can detect early stage 1 and stage 2 GFR changes.^3-NKF

Iodinated Contrast Media

Risk Factors for PC-AKI

• eGFR stages 4 or 5
• Nephrotoxic Agents
• Hypotension
• Albuminuria

Prophylaxis

• Indication:Prophylaxis is indicated for patients who have AKI or an eGFR less than 30 mL/min/1.73 m2 and are not undergoing maintenance dialysis.^1-ACR/NKF
• Contraindications:poor fluid response (e.g. heart failure, hypervolemic conditions)
• Technique: Preprocedural IV hydration w/ normal saline in pts w/ AKI or GFR < 30 not undergoing maintenance dialysis. Begin 1 hr before and continue 3-12 hours after contrast media administration. Dose range from fixed (500mL) to weight based (1-3mL/kg/hr). ^1-ACR/NKF

Referrals

• Nephrology

References

1. Davenport MS, Perazella MA, Yee J, et al. Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med. 2020;2(1):85-93. Published 2020 Jan 22. doi:10.1016/j.xkme.2020.01.001
2. Observational Series
   • Davenport M.S., Khalatbari S., Dillman J.R., Cohan R.H., Caoili E.M., Ellis J.H. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material. Radiology. 2013;267(1):94–105. doi: 10.1148/radiol.12121394
   • Davenport M.S., Khalatbari S., Cohan R.H., Dillman J.R., Myles J.D., Ellis J.H. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013;268(3):719–728. doi: 10.1148/radiol.13122276
   • McDonald R.J., McDonald J.S., Bida J.P. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon? Radiology. 2013;267(1):106–118. doi: 10.1148/radiol.12121823
   • McDonald J.S., McDonald R.J., Carter R.E., Katzberg R.W., Kallmes D.F., Williamson E.E. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology. 2014;271(1):65–73. doi: 10.1148/radiol.13130775
   • Dekkers I.A., van der Molen A.J. Propensity score matching as a substitute for randomized controlled trials on acute kidney injury after contrast media administration: a systematic review. AJR Am J Roentgenol. 2018;211(4):822–826. doi: 10.2214/AJR.17.19499
3. National Kidney Foundation. Estimated Glomerular Filtration Rate (eGFR). Last updated July 13, 2022. Accessed March 2025.