Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

Zhong, Jingyu; Chen, Liwei; Xing, Yue; Lu, Junjie; Shi, Yuping; Wang, Yibin; Deng, Yi; Jiang, Run; Lu, Wenjie; Wang, Silian; Hu, Yangfan; Ge, Xiang; Ding, Defang; Zhang, Huan; Zhu, Ying; Yao, Weiwu

doi:10.1186/s13244-024-01644-5

Insights into Imaging

Table 3 Summary of key recommendations

From: Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

Questions and answers	Guidelines
Who should undergo renal function test before contrast media administration?
History of renal disease or renal surgery	ESUR_2018 [33], RANZCR_2018 [34], UCSF-USC_2020 [36], ACR, NKF_2021 [37], CSR_2021 [38], CAR_2022 [41], ACR_2023 [42]
Heart failure	ESUR_2018 [33]
Diabetes	ESUR_2018 [33], RANZCR_2018 [34], UCSF-USC_2020 [36]
Proteinuria	ESUR_2018 [33]
Hypertension	ESUR_2018 [33], UCSF-USC_2020 [36]
Gout	ESUR_2018 [33]
Metformin	RANZCR_2018 [34], ACR-NKF_2021 [37], ACR_2023 [42]
Aging	UCSF-USC_2020 [36], CSCP-CPA-CSN_2022 [39]
Against Aging	RANZCR_2018 [34]
How long is the time interval between renal function test and administration acceptable?
Within 7 days for patient has an acute disease; within 3 months for patient has a chronic disease with stable renal function	ESUR_2018 [33], JRS-JCS-JSN_2018 [35], CSR_2021 [38], SIRM-SIN-AIOM_2022 [40]
Within 6 weeks for outpatients, within 7 days for inpatients with renal impairment.	UCSF-USC_2020 [36]
Within 7 days for non-emergency patients.	CSCP-CPA-CSN_2022 [39]
Within 7 days for inpatients or emergency patients.	CAR_2022 [41]
Depends on clinical judgment.	RANZCR_2018 [34], ACR_2023 [42]
What is the eGFR cutoff for patients at risk for PC-AKI/ needs referring/ further treatment?
Patients with eGFR < 30 mL/min/1.73 m²	ESUR_2018 [33], RANZCR_2018 [34], JRS-JCS-JSN_2018 [35], UCSF-USC_2020 [36], ACR-NKF_2021 [37], CSCP-CPA-CSN_2022 [39], SIRM-SIN-AIOM_2022 [40], CAR_2022 [41], ACR_2023 [42]
Patients with eGFR < 45 mL/min/1.73 m² in ICU or with high-risk factors	ESUR_2018 [33], CSR_2021 [38], SIRM-SIN-AIOM_2022 [40]
What kind of contrast media is recommended for high-risk patients?
Support the use of iso-osmolar ICM and low-osmolar ICM.	ESUR_2018 [33], JRS-JCS-JSN_2018 [35], ACR-NKF_2021 [37], CSR_2021 [38], CSCP-CPA-CSN_2022 [39], CAR_2022 [41], ACR_2023 [42]
Against the use of ionic high-osmolar ICM.	ESUR_2018 [33], ACR-NKF_2021 [37], CSR_2021 [38], CSCP-CPA-CSN_2022 [39]
Is reduced contrast media dosage recommended for high-risk patients?
Use the minimum amount of contrast media necessary for diagnostic efficacy.	ESUR_2018 [33], JRS-JCS-JSN_2018 [35], CSR_2021 [38], CSCP-CPA-CSN_2022 [39], SIRM-SIN-AIOM_2022 [40]
Use standard diagnostic dose.	ACR-NKF_2021 [37], CAR_2022 [41], ACR_2023 [42]
How long is the suitable time interval between scan and repeated scan?
Repeated CM injections should be avoided within 72 h.	CSR_2021 [38]
Repeated CM injections should be avoided within 48-72 h.	ESUR_2018 [33], CSCP-CPA-CSN_2022 [39]
Repeated CM injections should be avoided within 48 h.	CAR_2022 [41]
Repeated CM injections should be avoided within 24-48 h.	JRS-JCS-JSN_2018 [35]
Repeated CM injections should be avoided within 24 h.	ACR_2023 [42]
Is the hydration recommend for high-risk patients?
Support hydration to prevent PC-AKI in patients at-risk.	ESUR_2018 [33], RANZCR_2018 [34], JRS-JCS-JSN_2018 [35], UCSF-USC_2020 [36], ACR-NKF_2021 [37], CSR_2021 [38], CSCP-CPA-CSN_2022 [39], SIRM-SIN-AIOM_2022 [40], ACR_2023 [42]
Against oral hydration as the sole means of prevention for PC-AKI.	ESUR_2018 [33], JRS-JCS-JSN_2018 [35], CSCP-CPA-CSN_2022 [39]
Is any drug recommend for high-risk patients, and what are they?
Not recommend any drugs to prevent PC-AKI in patients at-risk.	ESUR_2018 [33], RANZCR_2018 [34], JRS-JCS-JSN_2018 [35], ACR-NKF_2021 [37], CSR_2021 [38], CSCP-CPA-CSN_2022 [39], SIRM-SIN-AIOM_2022 [40], CAR_2022 [41], ACR_2023 [42]
Is the blood purification therapy recommend for high-risk patients?
Not recommend to initiate blood purification therapy.	ESUR_2018 [33], JRS-JCS-JSN_2018 [35], UCSF-USC_2020 [36], ACR-NKF_2021 [37], CSR_2021 [38], CSCP-CPA-CSN_2022 [39], CAR_2022 [41], ACR_2023 [42]
Not recommend to change the schedule of blood purification therapy.	ACR-NKF_2021 [37], SIRM-SIN-AIOM_2022 [40]
The use of ICM can be synchronized with scheduled blood purification therapy.	CSR_2021 [38]

ACR American College of Radiology, ACR-NKF American College of Radiology, and National Kidney Foundation, CAR Canadian Association of Radiologists, CSCP-CPA-CSN Chinese Society of Clinical Pharmacy, Chinese Pharmaceutical Association, and Chinese Society of Nephrology, CSR Chinese Society of Radiology, ESUR European Society of Urogenital Radiology, JRS-JCS-JSN Japan Radiological Society, Japanese Circulation Society, and Japanese Society of Nephrology, RANZCR Royal Australian and New Zealand College of Radiologists, SIRM- SIN-AIOM Italian College of Radiology, Italian College of Nephrology, and Italian Association of Medical Oncology, UCSF-USC University of California San Francisco, and University of Southern California

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