Over 80 million doses of intravenous (IV) contrast media are administered every
year, and in the emergency department it can be essential to accurately
diagnose certain acute critical conditions.
But physicians have had concerns that the contrast
media causes serious kidney problems later on, with some studies showing
contrast-induced nephropathy occurring in as many as 14% of
patients receiving it.
‘Intravenous contrast media (typically iohexol or iodixanol) used in computed tomography (CT) does not appear to be associated with chronic kidney disease, dialysis, kidney transplant or acute kidney injury.’
The results of the largest
controlled study of acute kidney injury following contrast media
administration in the emergency department were published online
yesterday in Annals of Emergency Medicine
("Risk of Acute Kidney Injury Following Intravenous Contrast Media Administration").
Intravenous contrast media (typically iohexol or iodixanol) used in
computed tomography (CT) does not appear to be associated with chronic
kidney disease, dialysis, kidney transplant or acute kidney injury,
despite long-held fears to the contrary.
Lead study author
Jeremiah Hinson of Johns Hopkins University School of Medicine
in Baltimore, Md, said, "Studies used to establish this risk were
performed prior to the development of modern contrast reagents or
without adequate controls. Using a controlled design in current context,
we could not find an association between intravenous contrast media use
and acute kidney injury."
Researchers studied five years of records for patients receiving CT
with or without contrast-enhancement in the emergency department. Of all
CT scans, 57.2% were contrast-enhanced. The probability of
developing acute kidney injury was 6.8% for patients undergoing
contrast-enhanced CT, 8.9% for patients receiving unenhanced CT
and 8.1% for patients not receiving CT at all.
"While a well-controlled randomized prospective study is required to
fully determine the contribution of intravenous contrast media to the
development of acute kidney injury, our results clearly demonstrate that
in emergency departments such as ours where practice patterns have
evolved to protect patients' kidneys, contrast media is not associated
with increased risk of kidney injury," said Dr. Hinson.
"Our data also
suggest that in cases where contrast-enhanced CT is indicated to avoid
delayed or missed diagnosis of critical disease, the potential morbidity
and mortality resulting from a failure to diagnose potentially
life-threatening conditions likely outweigh any potential risk of kidney