Still waiting on that creatinine before giving IV contrast? Letβs dive into the evidence to see if weβre delaying important diagnostic workups unnecessarily.
American College of Radiology (ACR) Recommendations
ACR Contrast Media Manual 2024 - An updated comprehensive guide from the American College of Radiology detailing the safe use of contrast media. Their recommendations on IV contrast and AKI are summarized in the FAQ below.
CA/CI-AKI: A Real Phenomenan or a Product of Statistical Bias?
There has been robust literature debunking the myth of contrast associated or induced acute kidney injury. Please review the following literature and FOAMed reviews to prepare for your next argument with your local radiologist.
Hinson et al 2017 (Pubmed π)
- emDOCs: Contrast-Induced Nephropathy: Confounding Causation (by Dr. Rich Sinert)
- Core EM (by Dr. Richard Sinert): Acute Kidney Injury is not Associated with IV Contrast Use in the ED
Aycock et al 2018 (Pubmed π)
- Core EM: Acute Kidney Injury After Computed Tomography: A Meta-analysis
- RebelEM: Is Contrast Induced Nephropathy (CIN) Really Not a Thing?
- SGEM: Contrast Induced Nephropathy β A Unicorn?
Hinson et al 2019 (Pubmed π)
Williams et al 2019 (Pubmed π)
Goulden et al 2021 (Pubmed π)
- JournalFeed: Is IV Contrast Nephrotoxic? Best Study Yet Findsβ¦
More narrative and critical reviews on FOAMed
- First10 EM: Does contrast cause kidney injury? The evidence
- PulmCrit IBCC: Contrast Nephropathy, myth thereof
- Rebel EM: Kidneys and Contrast
- First10EM: Canadian Guidelines on Contrast-Associated AKI (2022)
Prehydration before CT - An Unnecessary Delay
How can you prevent something that unlikely exists?
AMACING Trial (Pubmed π)
- The Bottom Line: AMACING Trial (2017)
- Rebel EM: The AMACING Trial: Prehydration to Prevent Contrast Induced Nephropathy (CIN)?
KOMPAS Trial (Pubmed π)