Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

Ohno, Iwao; Hayashi, Hiromitsu; Aonuma, Kazutaka; Horio, Masaru; Kashihara, Naoki; Okada, Hirokazu; Komatsu, Yasuhiro; Tamura, Shozo; Awai, Kazuo; Yamashita, Yasuyuki; Kuwatsuru, Ryohei; Hirayama, Atsushi; Saito, Yoshihiko; Murohara, Toyoaki; Tamaki, Nagara; Sato, Akira; Takayama, Tadateru; Imai, Enyu; Yasuda, Yoshinari; Koya, Daisuke; Tsubakihara, Yoshiharu; Horie, Shigeo; Korogi, Yukunori; Narumi, Yasuo; Hayakawa, Katsumi; Daida, Hiroyuki; Node, Koichi; Kubota, Isao

doi:10.1007/s10157-013-0843-3

Cited by 23 publications

(10 citation statements)

References 182 publications

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“…Finally, our study showed that using a lower concentration leads to a higher injected volume of contrast. One could argue, therefore, that this could lead to an increased risk of CIN, since studies already have shown that a larger volume of contrast increases the risk of CIN [ 9 , 26 , 27 ]. However, as the number of milligrams iodine injected is a derivative of the volume injected, our opinion is that it is not the volume injected which increases the risk of CIN, but merely the milligrams of iodine injected.…”

Section: Discussionmentioning

confidence: 99%

“…In 1992, Ugolotti et al showed that with concentrations of 150 mg iodine per mL (mgI/mL) adequate images of the lower limb could be acquired [ 8 ]. With improved technical specifications for angiographic equipment achieved during the last few decades, such as a higher image resolution, lowering the iodinated contrast concentration might be an appropriate way to prevent CIN, especially since a higher volume use of iodinated contrast is associated with the risk of CIN [ 9 ]. Currently, many interventional radiologists use a contrast concentration of about 300 mg iodine per mL (mgI/mL) for lower limb angiography and interventions.…”

Section: Introductionmentioning

confidence: 99%

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Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized controlled non-inferiority trial

et al. 2015

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ObjectivesTo determine the influence of lowering iodinated contrast concentration on confidence of interventional radiologists in diagnosing and treating lesions during endovascular interventions in patients with symptomatic peripheral arterial disease (PAD).MethodsA randomized controlled non-inferiority trial was performed in 60 patients. Intervention was performed with contrast concentrations (in mg of iodine per mL, mgI/mL) of 300 (standard), 240, or 140 mgI/mL. Primary outcome was confidence (score 0-100 %) of radiologists in diagnosing and treating arterial lesions. Secondary outcomes were procedural iodine load and image quality (i.e. non-diagnostic, limited, diagnostic, exemplary).ResultsMedian confidence scores in diagnosing lesions were 100 % (range 81-100 %) for the 300 group (n = 21), 100 % (range 82-100 %) for the 240 group (n = 19), and 100 % (range 91-100 %) for the 140 group (n = 20) (both p = 1.00 compared to the 300 group). Median scores for treating lesions in the 240 and 140 groups, 100 % (range 79-100 %, p = 0.40), and 100 % (range 63-100 %, p = 0.25), respectively, were not lower compared to the 300 group (median 100 %, range 78-100 %). Procedural iodine load was lower in the 240 (24.3 ± 7.6 g, p = 0.022) and 140 groups (17.8 ± 5.6 g, p < 0.001) compared to the 300 group (29.7 ± 6.3 g). Image quality was diagnostic for all groups.ConclusionUsing iodine contrast of 140 mgI/mL for diagnosis and interventions in PAD patients significantly reduces administered iodine load without compromising image quality. Future use of lower iodine dose is recommended.Key Points• Lower iodinated contrast concentration during endovascular intervention does not decrease radiologist’s confidence.• Image quality of standardized angiographies remains diagnostic using 140 mgI/mL iodinated contrast concentration.• Iodine load during intervention can be decreased by >40 % when using 140 mgI/mL.• Implementing the use of a lower iodinated contrast concentration will reduce the costs of the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized controlled non-inferiority trial

et al. 2015

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“…A previous report revealed that the incidence of CIN among patients with a baseline estimated glomerular filtration rate (eGFR) of 45-59 mL/min/1.73 m 2 was 0%, whereas a rate of 30-44 mL/min/1.73 m 2 was 2.9%, and <30 mL/min/1.73 m 2 was 12.1% [1] . Available guidelines use a baseline eGFR of < 45 mL/min/1.73 m 2 as a cutoff for the risk of CIN after CECT [2] , [3] . In Japan, the incidence of chronic kidney disease is among the highest in the world because a Japanese person has, on average, a much lower nephron count than a Westerner because of the smaller body size and various genetic factors [4] .…”

Section: Introductionmentioning

confidence: 99%

Reduced iodinated contrast media for abdominal imaging by dual-layer spectral detector computed tomography for patients with kidney disease

Saito¹,

Noda²,

Ogasawara³

et al. 2018

Radiology Case Reports

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Contrast-enhanced computed tomography using iodinated contrast media is useful for diagnosis of gastrointestinal diseases. However, contrast-induced nephropathy remains problematic for kidney diseases patients. Although current guidelines recommended the use of a minimal dose of contrast media necessary to obtain adequate images for diagnosis, obtaining adequate images with sufficient contrast enhancement is difficult with conventional computed tomography using reduced contrast media. Dual-layer spectral detector computed tomography enables the simultaneous acquisition of low- and high-energy data and the reconstruction of virtual monochromatic images ranging from 40 to 200 keV, retrospectively. Low-energy virtual monochromatic images can enhance the contrast of images, thereby facilitating reduced contrast media. In case 1, abdominal computed tomography angiography at 50 keV using 40% of the conventional dose of contrast media revealed the artery that was the source of diverticular bleeding in the ascending colon. In case 2, ischemia of the transverse colon was diagnosed by contrast-enhanced computed tomography and iodine-selective imaging using 40% of the conventional dose of contrast media. In case 3, advanced esophagogastric junctional cancer was staged and preoperative abdominal computed tomography angiography could be obtained with 30% of the conventional dose of contrast media. However, the texture of virtual monochromatic images may be a limitation at low energy.

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“…A Insuficiência Renal Aguda Pós-Contraste (IRA-PC) é definida como um aumento na creatinina sérica (CrS) superior a 0,5 mg/dL ou de 25% comparado ao valor basal dentro de aproximadamente 72 horas após a injeção do meio de contraste, na ausência de outras causas 1,2 . Embora geralmente breve e reversível, a IRA-PC pode acarretar doença renal crônica (DRC), necessidade de diálise, prolongamento da internação hospitalar, aumento dos custos dos serviços de saúde e até mesmo a morte 3,4 .…”

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“…Vários são os fatores considerados de risco para a IRA-PC, como grandes volumes e administração intravascular do contraste, idade avançada, presença de comorbidades (diabetes mellitus, doenças cardiovasculares, entre outras), desidratação e uso concomitante de medicamentos nefrotóxicos 1,5,7,9,10 . Entretanto, um dos fatores de risco mais importantes é a presença de DRC, definida como uma taxa de filtração glomerular estimada (TFGe) inferior a 60 mL/min/1,73m 2 1,4,7,9 .…”

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Risco de insuficiência renal aguda pós-contraste em tomografia computadorizada: estamos atentos à função renal?

et al. 2019

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Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

Cited by 23 publications

References 182 publications

Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized controlled non-inferiority trial

Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized controlled non-inferiority trial

Reduced iodinated contrast media for abdominal imaging by dual-layer spectral detector computed tomography for patients with kidney disease

Risco de insuficiência renal aguda pós-contraste em tomografia computadorizada: estamos atentos à função renal?

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