Evidence does not currently support the use of topiramate to improve treatment retention for cocaine use disorder, although it may extend cocaine abstinence with a similar risk of adverse events compared with placebo.

In an ambulatory outpatient population, many patients presenting for outpatient CECT studies will have risk factors for CIN or for kidney function impairment (low eGFR) at baseline. Kidney function assessment, therefore, is indicated in this patient population before CECT.

No abstract

Fox et al [1] have addressed dehydration as an important risk factor in the development of contrast-induced nephrotoxicity (CIN). We share their appreciation for this well-recognized risk factor and acknowledge hydration as an accepted strategy for the prevention of CIN in North American radiology departments [2,3]. Outpatients are unique from inpatients in that their renal function and hydration status are not routinely assessed before they may be submitted to iodinated contrast medium injections. With this in mind, our study [4] focused on a population of outpatients and the identification of risks for developing CIN that they carry into a radiology department in the absence of known renal functional parameters or hydration status. Based upon our results, almost half of the outpatients studied (43%) possessed more than one risk factor for developing CIN. Almost two-thirds of patients with no recent renal function assessment (64%) had multiple risk factors. These risks might certainly be compounded by dehydration. Although Fox et al [1] have considered our study a ''lost opportunity,'' our study simply was not designed to assess the impact of computed tomography preparation and aftercare protocols as they pertain to dehydration or any other risk factors for the development of CIN. However, in knowing that significant numbers of outpatients, with or without recent renal function assessment, have multiple risk factors for CIN, radiology departments can target protocols with referring physicians to ensure that renal functional status is assessed before computed tomography and that steps are taken to ensure adequate hydration before an outpatient scan.