Chapter 3 Contrast-associated nephropathy

Large observational studies have defined the risk of contrast-associated nephropathy with conventional CT-scanning protocols.

Aycock et al. (2018): : meta-analysis of risk of AKI after contrast CT.

Wilhelm-Leen et al (2017): : data-linkage to estimate risk of contrast-associated AKI in USA hospitals.

A really clever trial design (regression discontinuity analysis) showed that radiocontrast for CTPA is highly unlikely to cause meaningful kidney problems in most patients.

Goulden et al. (2021): - no difference in eGFR to 6 months after assessment for VTE, comparing patients just above vs just below d-dimer threshold triggering CTPA.

RCTs have tested strategies for prevention of contrast-associated nephropathy:

AMACING (2017): - IV 0.9% NaCl vs. placebo as contrast prophylaxis in a low-risk group. No prophylaxis was non-inferior.

PRESERVE (2018): with factorial design - 1.26% NaHCO₃ vs. 0.9% NaCl and oral NAC vs. placebo as contrast prophylaxis in angiography. No benefit of NaHCO₃ over NaCl, nor of NAC over placebo.