What is the risk of acute kidney injury, renal replacement therapy, and mortality after computed tomography with intravenous contrast compared with computed tomography without use of contrast?
BEEM Bottom Line
Why is this study important?
Contrast induced nephropathy (CIN) or postcontrast acute kidney injury (PCAKI) is an ill-defined entity with little evidence supporting its clinical relevance. Multiple definitions have been published of which the most common in recent use appear to be the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) and the AKIN (Acute Kidney Injury Network) classifications.[1] These definitions have been combined by the Kidney Disease Improving Global Outcomes workgroup to establish a single classification of AKI. Regardless, due to multiple varying definitions, a true appreciation for the actual risk to patients undergoing contrast enhanced computed tomography (CT) is unknown. Also, whether the postcontrast rise in creatinine is coincidental (i.e., PCAKI) or caused by contrast exposure (i.e., CIN) is likely arguable in most cases. Confounding this is the multitude of patient associated factors (medications, diabetes, chronic renal insufficiency [CRI], etc.) that may underlie the true risk of clinically relevant CIN. This study attempts to delineate the true risk for CIN utilizing a systematic review of the literature through 2016.
Which, if any, threats to validity are most likely to have an impact on the results and how?
Thank you for your interest in the BEEM Journal!
To read the rest of this article or to access the entire collection of BEEM Critical Appraisals, please purchase a subscription at the link below.
If you would like a pre-view, click here to view some sample articles
- Article Number
- 170501
- Research Question
- Is it safe to rule out acute pulmonary embolism with stand-alone D-dimer testing below 750 µg/L?
- Article Number
- 160404
- Research Question
- What are the latest recommendations for the management of venous thromboembolism?
- Article Number
- 160205
- Research Question
- How well does oblique angle chest X-ray identify occult pneumothorax in trauma patients?
- Article Number
- 160101
- Research Question
- Is continuous positive airway pressure by helmet effective in the treatment of infants with bronchiolitis?
Premium Content Available Through Subscription
BEEM is a knowledge translation project which aims to extract the most recent, EM relevant, and valid evidence from the volumes of available medical research and deliver it to EM practitioners in an easily consumable format to help guide their clinical practice. This valuable distilled information provided by BEEM is available through BEEM's accredited CME courses or through our online journal.
A BEEM Journal Subscription will provide you with unlimited access to our entire collection of Critical Appraisals for 1 year.