Iodinated contrast media in patients with kidney disease: Key points from the ACR-NKF consensus statement

Consensus statementAuthors’ comments
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.