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Preventing contrast...
Preventing contrast medium-induced acute kidney injury: Side-by-side comparison of Swedish-ESUR guidelines
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- Nyman, Ulf (author)
- Lund University,Lunds universitet,Diagnostisk radiologi, Malmö,Forskargrupper vid Lunds universitet,Radiology Diagnostics, Malmö,Lund University Research Groups
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- Ahlkvist, J. (author)
- Nykoping Hosp, Dept Radiol, Nykoping, Sweden,Nyköping Hospital
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- Aspelin, P. (author)
- Karolinska Institute,Karolinska Institutet,Karolinska University Hospital
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- Brismar, T. (author)
- Karolinska Institute,Karolinska Institutet,Karolinska University Hospital
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- Frid, Anders (author)
- Skane Univ Hosp, Dept Diabetol, Malmo, Sweden,Skåne University Hospital
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- Hellström, Mikael, 1950 (author)
- University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för radiologi,Institute of Clinical Sciences, Department of Radiology,Gothenburg Univ, Sahlgrenska Univ Hosp, Dept Radiol, Gothenburg, Sweden;Gothenburg Univ, Sahlgrenska Acad, Gothenburg, Sweden,Sahlgrenska University Hospital
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- Liss, Per, 1960- (author)
- Uppsala University,Uppsala universitet,Radiologi
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- Sterner, Gunnar (author)
- Skane Univ Hosp, Dept Nephrol, Malmo, Sweden,Skåne University Hospital
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- Leander, Peter (author)
- Lund University,Lunds universitet,Diagnostisk radiologi, Malmö,Forskargrupper vid Lunds universitet,Radiology Diagnostics, Malmö,Lund University Research Groups
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Contrast Media Comm Swedish Soc; Swedish Soc, Diabetology (author)
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(creator_code:org_t)
- 2018-08-21
- 2018
- English.
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In: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 28:12, s. 5384-5395
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Abstract
Subject headings
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- 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 m(2) 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 anyconsideration. 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(2). 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 withIV 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 center dot 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).center dot SSUR recommends that absolute and not relative GFR should be used when dosing drugs eliminated by the kidneys such as contrast media.center dot 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
Keyword
- Contrast media
- Acute kidney injury
- Tomography
- spiral computed
- Angiography
- glomerular-filtration-rate
- residual renal-function
- creatinine
- clearance ratio
- gfr estimating equations
- standardized cystatin c
- induced nephropathy
- serum creatinine
- lund-malmo
- risk stratification
- older-adults
- Contrast media
- Tomography, spiral computed
Publication and Content Type
- ref (subject category)
- art (subject category)
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To the university's database
- By the author/editor
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Nyman, Ulf
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Ahlkvist, J.
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Aspelin, P.
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Brismar, T.
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Frid, Anders
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Hellström, Mikae ...
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show more...
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Liss, Per, 1960-
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Sterner, Gunnar
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Leander, Peter
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Contrast Media C ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Radiology Nuclea ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Gastroenterology ...
- Articles in the publication
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European Radiolo ...
- By the university
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University of Gothenburg
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Uppsala University
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Karolinska Institutet
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Lund University