Con: Contrast-induced nephropathy—should we try to avoid contrast media in patients with chronic kidney disease?

Ewing, Michael J.; Eidt, John F.

doi:10.1093/ndt/gfy153

Cited by 13 publications

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The opponents declare that the risk of CI-AKI has been overestimated, and it is often caused by a combination of other risk factors including older age, sepsis, hemodynamic instability, and comorbid diseases, which is independent of CM administration. 38 The pros claim that CM-based imaging should be employed with great restraint in patients with CKD as diagnostic alternatives exist for various clinical scenarios. 37 We believe that all non-CM methods should be exhausted first in medical decision-making, and it is still preferable to apply iodinated CM if alternate options are comparatively ineffective or even hazardous, such as dealing with ST-elevation myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease: A Network Meta-Analysis

Zhou

Dai

et al. 2018

Angiology

View full text Add to dashboard Cite

Contrast-induced acute kidney injury (CI-AKI) is a common complication of iodinated contrast medium administration during cardiac catheterization. Statin treatment has been shown to be associated with reduced risk of CI-AKI; however, the results are inconsistent, especially for patients with chronic kidney disease (CKD). Thus, we conducted a network meta-analysis to evaluate the effects of statins in the prevention of CI-AKI. We systematically searched several databases (including, Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov ) from inception to January 31, 2018. The primary outcome was occurrence of CI-AKI in patients with CKD undergoing cardiac catheterization. Both pairwise and network meta-analysis were performed. Finally, 21 randomized controlled trials with a total of 6385 patients were included. Results showed that statin loading before contrast administration was associated with a significantly reduced risk of CI-AKI in patients with CKD undergoing cardiac catheterization (odds ratio: 0.46; P < .05). Atorvastatin and rosuvastatin administered at high dose may be the most effective treatments to reduce incidence of CI-AKI, with no difference between these 2 agents.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease: A Network Meta-Analysis

Zhou

Dai

et al. 2018

Angiology

View full text Add to dashboard Cite

show abstract

“…Contrast nephrotoxicity is practically nonexistent in isolation and usually develops in association with conco mitant insults such as hypotension, dehydration, admini stration of other nephrotoxins (e.g. antibiotics), and under lying comorbidities 4,5) . The coexistence of several such triggers is not uncommon, particularly in the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

Windpessl¹,

Kronbichler²

2019

Child Kidney Dis

View full text Add to dashboard Cite

Contrast-associated acute kidney injury (CA-AKI) is a major concern when iodinated contrast material is administered, especially in patients at risk. Efforts have been undertaken to understand the detrimental effects of contrast media (CM). With the use of low-osmolar or iso-osmolar CM the incidence of CA-AKI has steadily decreased within the past decade; however, especially in the pediatric population information is scarce. Incidence rates have been reported to range between 0% to 18.75%, particularly depending on indication, selection of population (i.e. preexisting co-morbidities), and definition of AKI. Different biomarkers have been proposed, but confirmatory studies are either lacking or have contributed to their lack of diagnostic power. Proteomic approaches have been employed and may pave the way to such discovery. Prevention strategies have been tested and proposed, but the recently published AMACING and PRESERVE trials have shown that commonly used strategies (such as systematic hydration or administration of N-acetylcysteine) have no role in the prevention of CA-AKI. We propose that thoughtful assessment of one's fluid state is the most appropriate approach and depending on the hydration status diuretics or fluid administration should be provided to achieve an euvolemic state ahead of contrast exposure.

show abstract

“…Although nephrotoxicity is evident in all iodine CM, the association between CM use and the development of AKI remains controversial [ 30 ]. Pre-existing renal insufficiency, acute hyperglycemia, nephrotoxic drugs, and other variables were also found to be important risk factors for AKI in patients exposed to CM [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Huang

et al. 2022

Cardiology

View full text Add to dashboard Cite

Background: The published researches regarding the use of contrast media(CM) in patients taking metformin were very scarce.we conducted a systematic review and meta-analysis to explore the relationship between metformin and contrast-induced acute kidney injury(CI-AKI). Methods: We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between metformin and CI-AKI, as well as the incidence of lactic acidosis(LA). Results: 7 studies met our eligibility criteria on associations between metformin and CI-AKI, consisting of 2,325 individuals, including 279 cases of new CI-AKI patients during CM exposure. The pooled analysis demonstrated no statistically elevated risk of development CI-AKI in patients with uninterrupted use of metformin (Random-effects OR: 1.15, 95%CI: 0.70, 1.90; P =0.57). No cases of LA occurred during CM exposure. Conclusion: Metformin can be safely applied in patients with moderate renal impairment as low as eGFR ≥30 ml/min/1.73 m2 during the exposure of the CM.

show abstract

Con: Contrast-induced nephropathy—should we try to avoid contrast media in patients with chronic kidney disease?

Cited by 13 publications

References 18 publications

Comparative Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease: A Network Meta-Analysis

Comparative Efficacy of Statins for Prevention of Contrast-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease: A Network Meta-Analysis

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About