Didactic: Intravenous Contrast Myth Busters: Up-to-date Evidence and Guidelines for Patients With Decreased Kidney Function
Administration of iodinated contrast media has long been held as a leading cause of acute kidney injury (AKI). Recently, numerous large and well-designed controlled observational studies have demonstrated that the risk for AKI attributable to intravenous contrast media was severely overestimated for decades. These include our own ED–based retrospective propensity-matched cohort analysis of 17,934 ED visits and a meta-analysis of 28 studies involving 107,335 participants published in Annals of Emergency Medicine in 2017 and 2018, respectively. In this session, presenters will describe the older literature that created the myth of contrast-induced AKI, before providing a concise deep-dive into the recent literature that has called its existence into question. They will then review the major recommendations of this spring’s American College of Radiology (ACR) and National Kidney Foundation (NKF) consensus statement on the use of IV contrast in patients with preexisting kidney disease. This evidence-driven statement downgrades the level of caution afforded to contrast administration and reflects a profound transformation of opinion among these specialist communities. Their consensus statement should have immediate and direct effects on the practice of Emergency Medicine and represents an important step forward for both evidence-based medicine and patient safety in the ED.
Learning Objectives
• Summarize the limitations of the historical literature that established contrast-induced AKI as a clinical entity
• Describe the important differences between older contrast media and the newer formulations used today
• Interpret recent studies that demonstrate no association between contrast administration and increased risk for AKI
• Apply current evidence & the ACR-NKF consensus recommendations to achieve ideal diagnostic imaging selection
Learning Objectives
• Summarize the limitations of the historical literature that established contrast-induced AKI as a clinical entity
• Describe the important differences between older contrast media and the newer formulations used today
• Interpret recent studies that demonstrate no association between contrast administration and increased risk for AKI
• Apply current evidence & the ACR-NKF consensus recommendations to achieve ideal diagnostic imaging selection