Upstate EM Residents
Journal Club: Contrast Induced Nephropathy. Myth or Merit?
Hinson, Jeremiah S., et al. “Risk of Acute Kidney Injury After Intravenous Contrast Media Administration.” Annals of Emergency Medicine, vol. 69, no. 5, 2017, doi:10.1016/j.annemergmed.2016.11.021.
This large single center retrospective cohort analysis was performed in a large urban academic Emergency Department to study a controversial topic regarding intravenous contrast media and the development of acute kidney injury. The study occurred over a 5-year period and included patients who underwent contrast enhanced CT, unenhanced CT, or no CT during their ED visit. They found that the rates of acute kidney injury were similar among all groups and that contrast administration is not associated with increased incidence of chronic kidney disease, dialysis, or renal transplant at 6 months. With this study in mind, it is generally reasonable to administer contrast to individuals with a baseline serum creatinine less than 4.0 mg/dL and GFR >30 but it is important to keep in mind other factors which may attribute to nephrotoxicity (medications, comorbidities, severity of illness). Hopefully, future studies performed in a well-controlled randomized prospective manner will further help determine the contribution of intravenous contrast media to the development of acute kidney injury.
Moore, R D, et al. “Nephrotoxicity of High-Osmolality versus Low-Osmolality Contrast Media: Randomized Clinical Trial.” Radiology, vol. 182, no. 3, 1992, pp. 649–655., doi:10.1148/radiology.182.3.1535876.
This randomized, double-blind clinical trial evaluated nephrotoxicity (defined as an increase in serum creatinine level that was greater than both 33% and 0.4 mg/dL above baseline level within 48 hours after radiologic procedure) among patient undergoing diagnostic angiocardiography or contrast-enhanced CT. The study showed that patients in these groups receiving either low osmolar contrast versus high osmolar contrast had similar frequency of nephrotoxicity with factors associated with increased risk being insulin-dependent diabetes, baseline serum creatinine greater than 1.5 mg/dL, concurrent use of furosemide, and angiocardiographic examination. This is an older study establishing a frequency of nephrotoxicity associated with contrast administration but had significant limitations including lack of control group. Analysis of this article along side the new ACEP study allowed for further thoughtful journal club discussion.
Journal Club Discussion Leader: Dan Hossain, DO (PGY-2)
2019-2020 Academic Year Journal Club Leaders: Sarah Balog, DO (PGY-3); Rose Solomon, MD (PGY-2); David Andonian, MD (Faculty Advisor)