What is the risk of AKI following contrast CT in septic patients?

 

Background

 

The concept of contrast-induced nephropathy (CIN) came from a 1954 paper​[1]​ and has been widely taught over the last 60 years. However, recent studies have questioned the true incidence of CIN, and even whether it exists at all. There are in fact many robust RCTs​[2,3]​ now showing no association between contrast administration and acute kidney injury (AKI). The earlier confusion seems to have arisen for several reasons:​[4]​

 

  • Older contrast dyes had a higher osmolarity than modern ones and possibly were nephrotoxic. They were also used in larger volumes
  • Older studies rarely used control groups, so although some patients developed an AKI after contrast CT, it is impossible to know whether this would have happened anyway (without the CT)
  • Many studies take small fluctuations in creatinine as evidence of 'kidney injury' but it is debatable whether these equate to actual patient-centred outcomes like need for dialysis

 

 

The paper

 

Hinson JS, Al Jalbout N, Ehmann MR, Klein EY. Acute kidney injury following contrast media administration in the septic patient: a retrospective propensity-matched analysis. J Crit Care. 2019;51:111-116​[5]​

 

 

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