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Home | Articles | Renal | Contrast Associated AKI

Contrast Associated AKI

Last updated 1st March 2022

Contrast Associated AKI

  1. An acute deterioration in renal function that occurs within 48 hours of IV radiographic contrast media.
  2. The risk of AKI after procedures involving arterial contrast is higher than that for venous contrast and most common following coronary angiography.
  3. Creatinine usually peaks at 3-4 days and returns to baseline within 1-2 weeks
  4. Usually mild and self limiting but can be associated with increased risk of coronary events, ESRD and mortality
  5. With low-osmolar contrast agents it is very difficult to prove whether a patient’s AKI is due entirely to the underlying illness that prompted the contrast enhanced investigation or whether IV contrast plays a role. There are many observational studies that attempt to address this question but have not succeeded.

Risk Factors for Contrast Associated AKI

  1. Under hydration/hypovolaemia.
  2. Pre-existing renal impairment (eGFR<45)
  3. Diabetes Mellitus
  4. Multiple Myeloma
  5. Contrast in preceding 72 hours

Prevention of Contrast Associated AKI

  1. If possible avoid use of contrast media. If it is required to establish the diagnosis and plan treatment of a life threatening illness do not wait/delay contrast enhanced scan.
  2. If patient clinically dry aim for euvolaemia. If euvolaemic, hydrate patient with 500ml normal saline or balanced solution over 1-4 hours pre and post procedure. If CCF then reduce volume to 250ml pre & post.
    • Temporarily withhold NSAIDs, ACEI, ARBs, diuretics, SGLT2s and Metformin.
  3. N-acetylcysteine & sodium bicarbonate have been shown to have no benefit over IV saline to mitigate contrast associated AKI.
  4. There is no role for prophylactic haemodialysis after contrast exposure.

Atheroembolism

  1. Caused by showers of cholesterol microemboli displaced by surgery or angiography in patients with widespread atheroma
  2. Characterised by subacute kidney injury developing over 3-4 weeks, livedo reticularis & purple toes (so called trash foot)
  3. No specific treatment exists but anticoagulation may be harmful and should be avoided if possible

Nephrogenic Systemic Fibrosis

  1. Chronic progressive sclerosis of skin, deeper tissues and internal organs that is associated with linear gadolinium based contrast agents used for MRI.
  2. Only reported in patients with renal impairment, typically on dialysis or with eGFR <15ml/min & multiple MR contrast doses.
  3. No specific treatment exists, very few patients experienced good outcomes.
  4. No cases have been reported associated with the cyclic gadolinium used in DGRI. There have been no new cases reported in literature since 2009.

Content by Dr Michael Kelly