Annals for Hospitalists Inpatient Notes - Preventing Contrast-Associated Acute Kidney Injury—Putting the Issue to Rest
Authors: Steven D. Weisbord, Martin Gallagher
Journal: Annals of Internal Medicine (2019)

Web Exclusives16 July 2019Annals for Hospitalists Inpatient Notes - Preventing Contrast-Associated Acute Kidney Injury—Putting the Issue to RestSteven D. Weisbord, MD, MSc and Martin Gallagher, MD, PhDSteven D. Weisbord, MD, MScRenal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (S.D.W.)Search for more papers by this author and Martin Gallagher, MD, PhDThe George Institute for Global Health, Sydney Australia (M.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1846 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail It has long been recognized that intravascular administration of iodinated contrast can precipitate an abrupt decline in kidney function, particularly among patients with underlying chronic kidney disease (CKD). This iatrogenic complication, contrast-associated acute kidney injury (CA-AKI), has been associated with increased risk for serious adverse outcomes, including short- and long-term mortality, progressive decline in kidney function, and need for dialysis. However, these observed associations, which derive principally from retrospective observational studies, have not been confirmed to be causal. Most commonly defined by small increments in serum creatinine levels, CA-AKI may simply be a marker for, rather than a mediator of, ...References1. Chertow GM, Normand SL, McNeil BJ. “Renalism”: inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency. J Am Soc Nephrol. 2004;15:2462-8. [PMID: 15339996] CrossrefMedlineGoogle Scholar2. Tepel M, van der Giet M, Schwarzfeld C, et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343:180-4. [PMID: 10900277] CrossrefMedlineGoogle Scholar3. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291:2328-34. [PMID: 15150204] CrossrefMedlineGoogle Scholar4. Weisbord SD, Gallagher M, Kaufman J, et al. Prevention of contrast-induced AKI: a review of published trials and the design of the prevention of serious adverse events following angiography (PRESERVE) trial. Clin J Am Soc Nephrol. 2013;8:1618-31. [PMID: 23660180] doi:10.2215/CJN.11161012 CrossrefMedlineGoogle Scholar5. Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med. 2018;378:603-614. [PMID: 29130810] doi:10.1056/NEJMoa1710933 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (S.D.W.)The George Institute for Global Health, Sydney Australia (M.G.)Disclaimer: The opinions expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or U.S. government.Disclosures: Disclosures can also viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1846.Corresponding Author: Steven Weisbord, MD, MSc, VA Pittsburgh Healthcare System, Mailstop 111F-U, University Drive, Pittsburgh, PA 15240; e-mail, steven.[email protected]gov. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 16 July 2019 David H. Wesorick and Vineet Chopra Metrics Cited byAnnals for Hospitalists Inpatient Notes - What Hospitalists Need to Know About Risk for Contrast-Induced Acute Kidney Injury From Contrast-Enhanced Computed TomographyMatthew S. Davenport, MD and Jeffrey C. Weinreb, MDDiagnostic management of acute pulmonary embolism in special populations 16 July 2019Volume 171, Issue 2Page: HO2-HO3KeywordsAngiographyBicarbonatesChronic kidney diseaseClinical trialsCreatinineHospitalistsIsotonicityKidneysOdds ratioSodium ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...