DÄ internationalArchive25/2019Contrast Agents Better Than the General Perception

Correspondence

Contrast Agents Better Than the General Perception

Dtsch Arztebl Int 2019; 116: 434. DOI: 10.3238/arztebl.2019.0434a

Klaus, H

LNSLNS

In their review (Figure 1) on the management of acute kidney injury (AKI), the authors recommend to “avoid contrast medium”, which, I assume, refers to X-ray contrast agents (1). However, the role of iodine-based contrast agents is undergoing a reevaluation process in the more recent literature. For example, in their meta-analysis McDonald et al. (2) arrived at the conclusion that increases in creatinine levels among inpatients were rather related to causes other than contrast agent administration. Similarly, the 2018 guideline of the European Society of Urogenital Radiology (ESUR) (3) takes this into account. The current state of knowledge on contrast-induced nephropathy is summarized by the scientific expert committee of the German Medical Association, stating that the risk of contrast-induced nephropathy (CIN)—if this condition really exists—is significantly smaller than previously assumed and may even be zero in the low-risk group with an eGFR >30 mL/min/1.73 m2 (4). In high-risk patients with an eGFR <30 mL/min/1.73 m2, the benefits should be weighed against the risks, as a precaution, even though no differences in mortality were found between AKI and CIN. The categorical rejection of the use of X-ray contrast agents should not be accepted without comment. If the use of a contrast agent is indicated, patients will rather benefit from the diagnostic result of radiography with contrast agent than from not using a contrast agent because of nephroprotective considerations.

Dr. med. Hubertus Klaus

Leipzig, Germany; hubertus-klaus@t-online.de

1.
Alscher MD, Erley C, Kuhlmann MK: Acute renal failure of nosocomial origin. Dtsch Arztebl Int 2019; 116: 149–58 VOLLTEXT
2.
McDonald JS, McDonald RJ, Comin J, et al.: Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology 2013; 267: 119–28 CrossRef MEDLINE
3.
van der Molen AJ, Reimer P, Dekkers IA, et al.: Post-contrast acute kidney injury—Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28: 2845–55 CrossRef CrossRef MEDLINE PubMed Central
4.
Michaely H: Wertung des aktuellen Wissensstands zur CIN. Fortschr Röntgenstr 2018; 190: 74–5 CrossRef MEDLINE

by Prof. Dr. med. Mark Dominik Alscher, Prof. Dr. med. Christiane Erley, and Prof. Dr. med. Martin K. Kuhlmann in issue 9/2019

1.Alscher MD, Erley C, Kuhlmann MK: Acute renal failure of nosocomial origin. Dtsch Arztebl Int 2019; 116: 149–58 VOLLTEXT
2.McDonald JS, McDonald RJ, Comin J, et al.: Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology 2013; 267: 119–28 CrossRef MEDLINE
3.van der Molen AJ, Reimer P, Dekkers IA, et al.: Post-contrast acute kidney injury—Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28: 2845–55 CrossRef CrossRef MEDLINE PubMed Central
4.Michaely H: Wertung des aktuellen Wissensstands zur CIN. Fortschr Röntgenstr 2018; 190: 74–5 CrossRef MEDLINE

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