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Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines.
Eur Radiol 2018; 28(12):5384-5395ER

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.

Authors+Show Affiliations

Department of Translational Medicine, Division of Medical Radiology, University of Lund, Malmö, Sweden. ulf.nyman@bredband.net.Department of Radiology, Nyköping Hospital, Nyköping, Sweden.Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute/Karolinska University Hospital, Stockholm, Sweden.Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute/Karolinska University Hospital, Stockholm, Sweden. Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.Department of Diabetology, Skåne University Hospital, Malmö, Sweden.Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden.Department of Nephrology, Skåne University Hospital, Malmö, Sweden.Department of Translational Medicine, Division of Medical Radiology, University of Lund, Malmö, Sweden.No affiliation info available

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

30132106

Citation

Nyman, Ulf, et al. "Preventing Contrast Medium-induced Acute Kidney Injury : Side-by-side Comparison of Swedish-ESUR Guidelines." European Radiology, vol. 28, no. 12, 2018, pp. 5384-5395.
Nyman U, Ahlkvist J, Aspelin P, et al. Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines. Eur Radiol. 2018;28(12):5384-5395.
Nyman, U., Ahlkvist, J., Aspelin, P., Brismar, T., Frid, A., Hellström, M., ... Leander, P. (2018). Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines. European Radiology, 28(12), pp. 5384-5395. doi:10.1007/s00330-018-5678-6.
Nyman U, et al. Preventing Contrast Medium-induced Acute Kidney Injury : Side-by-side Comparison of Swedish-ESUR Guidelines. Eur Radiol. 2018;28(12):5384-5395. PubMed PMID: 30132106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventing contrast medium-induced acute kidney injury : Side-by-side comparison of Swedish-ESUR guidelines. AU - Nyman,Ulf, AU - Ahlkvist,Joanna, AU - Aspelin,Peter, AU - Brismar,Torkel, AU - Frid,Anders, AU - Hellström,Mikael, AU - Liss,Per, AU - Sterner,Gunnar, AU - Leander,Peter, AU - ,, Y1 - 2018/08/21/ PY - 2018/05/18/received PY - 2018/07/23/accepted PY - 2018/07/05/revised PY - 2018/8/23/pubmed PY - 2019/1/10/medline PY - 2018/8/23/entrez KW - Acute kidney injury KW - Angiography KW - Contrast media KW - Tomography, spiral computed SP - 5384 EP - 5395 JF - European radiology JO - Eur Radiol VL - 28 IS - 12 N2 - 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. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/30132106/Preventing_contrast_medium_induced_acute_kidney_injury_:_Side_by_side_comparison_of_Swedish_ESUR_guidelines_ L2 - https://dx.doi.org/10.1007/s00330-018-5678-6 DB - PRIME DP - Unbound Medicine ER -