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Preventing contrast medium-induced acute kidney injury: Side-by-side comparison of Swedish-ESUR guidelines
Lund Univ, Dept Translat Med, Div Med Radiol, Malmo, Sweden.
Nykoping Hosp, Dept Radiol, Nykoping, Sweden.
Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol CLINTEC, Div Med Imaging & Technol, Stockholm, Sweden.
Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol CLINTEC, Div Med Imaging & Technol, Stockholm, Sweden;Karolinska Univ Hosp Huddinge, Dept Radiol, Stockholm, Sweden.ORCID-id: 0000-0002-3409-1938
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2018 (Engelska)Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, nr 12, s. 5384-5395Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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 m(2) 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 anyconsideration. 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 m(2). 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 withIV 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 center dot 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).center dot SSUR recommends that absolute and not relative GFR should be used when dosing drugs eliminated by the kidneys such as contrast media.center dot 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.

Ort, förlag, år, upplaga, sidor
SPRINGER , 2018. Vol. 28, nr 12, s. 5384-5395
Nyckelord [en]
Contrast media, Acute kidney injury, Tomography, spiral computed, Angiography
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
URN: urn:nbn:se:uu:diva-372385DOI: 10.1007/s00330-018-5678-6ISI: 000451353500052PubMedID: 30132106OAI: oai:DiVA.org:uu-372385DiVA, id: diva2:1275977
Tillgänglig från: 2019-01-07 Skapad: 2019-01-07 Senast uppdaterad: 2019-01-24Bibliografiskt granskad

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