Thank you for this most welcome comment. We greatly appreciate it. Two years ago, Prof. Erley highlighted in an editorial for the Drug Commission of the German Medical Association that preliminary data, casting doubt on the nephrotoxicity of iodine-based contrast agents, had become available (1).
Nevertheless, the guidelines of various societies continue to contain a warning that iodine-based contrast agents may cause acute kidney injury.
Over the next years, further data will need to be collected to enable full clarification of the conflicting evidence on this subject. This is why we decided—also after consultation with the experts—to include this point in our list (2).
We deliberately decided to not differentiate between iodine-based and gadolinium-based contrast agents, because the safety of gadolinium-based contrast agents in case of an acute kidney injury has yet to be demonstrated, too.
Examples of safety concerns include reduced excretion and prolonged circulation with potential deposits and tissue binding as well as the extensive fibrosis observed with certain products.
Prof. Dr. med. Mark Dominik Alscher
Abteilung für Allgemein Innere Medizin
und Nephrologie am Zentrum für Innere Medizin (Abteilung ZIM IV)
des Robert-Bosch-Krankenhauses Stuttgart
Prof. Dr. med. Christiane Erley
Medizinische Klinik II mit Dialyse des St. Joseph Krankenhauses, Berlin, Germany
Prof. Dr. med. Martin K. Kuhlmann
Klinik für Innere Medizin – Nephrologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
Conflict of interest
The authors of both contributions declare that no conflict of interest exists.
|1.||Erley C: Akutes Nierenversagen nach Kontrastmittel. Arzneiverordnung in der Praxis 2017; 4: 173-6.|
|2.||Alscher MD, Erley C, Kuhlmann MK: Acute renal failure of nosocomial origin. Dtsch Arztebl Int 2019; 116: 149–58 VOLLTEXT|