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Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines

Nyman, Ulf LU ; Ahlkvist, Joanna; Aspelin, Peter; Brismar, Torkel; Frid, Anders LU ; Hellström, Mikael; Liss, Per; Sterner, Gunnar LU and Leander, Peter LU (2018) In European Radiology 28(12). p.5384-5395
Abstract

Abstract: A side-by-side comparison of updated guidelines regarding contrast medium-induced acute kidney injury (CI-AKI) from the Swedish Society of Uroradiology (SSUR) and the European Society of Urogenital Radiology (ESUR) is presented. The major discrepancies include a higher glomerular filtration rate (GFR) threshold as a risk factor for CI-AKI and for discontinuation of metformin by SSUR, i.e., < 45 ml/min versus < 30 ml/min/1.73 m2 by ESUR, when intravenous or intra-arterial contrast media (CM) with second-pass renal exposure is administered. SSUR also continues to recommend consideration of traditional non-renal risk factors such as diabetes and congestive heart failure, while ESUR considers these factors as... (More)

Abstract: A side-by-side comparison of updated guidelines regarding contrast medium-induced acute kidney injury (CI-AKI) from the Swedish Society of Uroradiology (SSUR) and the European Society of Urogenital Radiology (ESUR) is presented. The major discrepancies include a higher glomerular filtration rate (GFR) threshold as a risk factor for CI-AKI and for discontinuation of metformin by SSUR, i.e., < 45 ml/min versus < 30 ml/min/1.73 m2 by ESUR, when intravenous or intra-arterial contrast media (CM) with second-pass renal exposure is administered. SSUR also continues to recommend consideration of traditional non-renal risk factors such as diabetes and congestive heart failure, while ESUR considers these factors as non-specific for CI-AKI and does not recommend any consideration. Contrary to ESUR, SSUR also recommends discontinuation of NSAID and nephrotoxic medication if possible. Insufficient evidence at the present time motivates the more cautionary attitude taken by SSUR. Furthermore, SSUR expresses GFR thresholds in absolute values in ml/min as recommended by the National Kidney Foundation for drugs excreted by glomerular filtration, while ESUR uses the relative GFR normalised to body surface area in ml/min/1.73 m2. CM dose/GFR ratio thresholds established for coronary angiography/interventions are also applied as recommendations for CM-enhanced CT by SSUR, since SSUR regards coronary procedures as a second-pass renal exposure of CM with no obvious difference in the incidence of AKI compared with IV CM administration. Finally, SSUR recommends reducing the gram-iodine dose/GFR ratio from < 1.0 in patients not at risk to < 0.5 in patients at risk of CI-AKI, while ESUR has no such recommendation. Key Points: • The more cautionary attitude taken by SSUR compared with that of ESUR is motivated by insufficient evidence regarding risk for contrast medium-induced acute kidney injuries (CI-AKI). • SSUR recommends that absolute and not relative GFR should be used when dosing drugs eliminated by the kidneys such as contrast media. • According to SSUR the gram-iodine dose/GFR ratio should be < 0.5 in patients at risk of CI-AKI, while ESUR has no such recommendation.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute kidney injury, Angiography, Contrast media, Tomography, spiral computed
in
European Radiology
volume
28
issue
12
pages
5384 - 5395
publisher
Springer
external identifiers
  • scopus:85052623130
ISSN
0938-7994
DOI
10.1007/s00330-018-5678-6
language
English
LU publication?
yes
id
c62ddc9a-bc02-43f1-9f16-50680b4cfb2d
date added to LUP
2018-10-04 09:34:11
date last changed
2019-01-14 07:38:52
@article{c62ddc9a-bc02-43f1-9f16-50680b4cfb2d,
  abstract     = {<p>Abstract: A side-by-side comparison of updated guidelines regarding contrast medium-induced acute kidney injury (CI-AKI) from the Swedish Society of Uroradiology (SSUR) and the European Society of Urogenital Radiology (ESUR) is presented. The major discrepancies include a higher glomerular filtration rate (GFR) threshold as a risk factor for CI-AKI and for discontinuation of metformin by SSUR, i.e., &lt; 45 ml/min versus &lt; 30 ml/min/1.73 m<sup>2</sup> by ESUR, when intravenous or intra-arterial contrast media (CM) with second-pass renal exposure is administered. SSUR also continues to recommend consideration of traditional non-renal risk factors such as diabetes and congestive heart failure, while ESUR considers these factors as non-specific for CI-AKI and does not recommend any consideration. Contrary to ESUR, SSUR also recommends discontinuation of NSAID and nephrotoxic medication if possible. Insufficient evidence at the present time motivates the more cautionary attitude taken by SSUR. Furthermore, SSUR expresses GFR thresholds in absolute values in ml/min as recommended by the National Kidney Foundation for drugs excreted by glomerular filtration, while ESUR uses the relative GFR normalised to body surface area in ml/min/1.73 m<sup>2</sup>. CM dose/GFR ratio thresholds established for coronary angiography/interventions are also applied as recommendations for CM-enhanced CT by SSUR, since SSUR regards coronary procedures as a second-pass renal exposure of CM with no obvious difference in the incidence of AKI compared with IV CM administration. Finally, SSUR recommends reducing the gram-iodine dose/GFR ratio from &lt; 1.0 in patients not at risk to &lt; 0.5 in patients at risk of CI-AKI, while ESUR has no such recommendation. Key Points: • The more cautionary attitude taken by SSUR compared with that of ESUR is motivated by insufficient evidence regarding risk for contrast medium-induced acute kidney injuries (CI-AKI). • SSUR recommends that absolute and not relative GFR should be used when dosing drugs eliminated by the kidneys such as contrast media. • According to SSUR the gram-iodine dose/GFR ratio should be &lt; 0.5 in patients at risk of CI-AKI, while ESUR has no such recommendation.</p>},
  author       = {Nyman, Ulf and Ahlkvist, Joanna and Aspelin, Peter and Brismar, Torkel and Frid, Anders and Hellström, Mikael and Liss, Per and Sterner, Gunnar and Leander, Peter},
  issn         = {0938-7994},
  keyword      = {Acute kidney injury,Angiography,Contrast media,Tomography, spiral computed},
  language     = {eng},
  number       = {12},
  pages        = {5384--5395},
  publisher    = {Springer},
  series       = {European Radiology},
  title        = {Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines},
  url          = {http://dx.doi.org/10.1007/s00330-018-5678-6},
  volume       = {28},
  year         = {2018},
}