Consensus statement | Authors’ comments |
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The risk of contrast-induced acute kidney injury is substantially less than the risk of contrast-associated acute kidney injury, but the actual risk remains uncertain. However, necessary contrast-enhanced CT without an alternative should not be withheld. | We believe this statement should be extrapolated to patients in whom coronary angiographic procedures are deemed necessary. |
Patients at risk for contrast-induced acute kidney injury include those with recent acute kidney injury or those with eGFR < 30 mL/min/1.73 m2 (including nonanuric dialysis patients). | Age, diabetes, hypertension, and proteinuria are absent from the risk classification. We believe patients with an eGFR < 45 mL/min/1.73 m2, particularly those with the above noted risk factors, should also be considered at increased risk. |
Prophylaxis with intravenous isotonic saline is indicated for patients with eGFR < 30 mL/min/1.73 m2 not undergoing dialysis and in patients with acute kidney injury. | We believe that prophylaxis is also warranted in nonanuric patients on hemodialysis or peritoneal dialysis to preserve residual kidney function. Careful attention to volume status is required to avoid hypervolemia. |
Prophylaxis should be individualized for high-risk patients with eGFR between 30 and 44 mL/min/1.73 m2. | We support prophylaxis in this population, particularly in the presence of traditional risk factors (diabetes, hypertension, proteinuria). |
Prophylaxis is not indicated for patients with stable eGFR ≥ 45 mL/min/1.73 m2. | We concur that the risk of contrast-induced acute kidney injury in this population is low. |
ACR = American College of Radiology; CT = computed tomography; eGFR = estimated glomerular filtration rate; NKF = National Kidney Foundation
Based on information in Davenport et al, reference 28.