Risk of acute kidney injury in cancer patients after iodinated contrast medium administration and prophylactic strategies: Summary from the most recent guidelines

2021 ◽  
pp. 239936932110285
Author(s):  
Pirovano Marta ◽  
Minei Silvia ◽  
Re Sartò Giulia Vanessa ◽  
Cosmai Laura
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Medium ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Post Contrast ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast ◽  
Contrast Enhanced ◽  
Nephrotoxic Drugs ◽  
Enhanced Computed Tomography

Post-contrast acute kidney injury (PC-AKI) is a serious complication that primarily affects people with multiple comorbidities who undergo imaging examination with iodinated contrast medium (CM), worsening their outcome and prognosis. This is particularly true for cancer patients, for whom contrast enhanced computed tomography (CECT) is of considerable value in diagnosis and management of the tumor and who are frequently subjected to dehydration and administration of nephrotoxic drugs. The debate on the real prevalence and severity of acute kidney injury (AKI) due to CM administration is still ongoing and the lack of controlled studies and reliable evidence has generated wide heterogeneity in patient management and prophylaxis. The whole idea of this protocol is to analyze most up-to-date guidelines on preventing AKI due to CM administration trying to provide a practical guide.

scholarly journals Oral Hydration as a Safe Prophylactic Measure To Prevent Post-Contrast Acute Kidney Injury in Oncologic Patients with Chronic Kidney Disease (IIIb) Referred for Contrast-Enhanced Computed Tomography: Subanalysis of The Oncological Group of The NICIR Study.

2021 ◽  
Author(s):  
Carmen Sebastia ◽  
Alfredo Páez-Carpio ◽  
Elena Guillen ◽  
Blanca Paño ◽  
JoanAlbert Arnaiz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Oral Hydration ◽  
Post Contrast ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract Background The objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). Material and Methods We performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water two hours before and 2000 mL during the 24 hours after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L)3 mL/kg/h starting one hour before and 1 mL/kg/h during the first hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the first 48 to 72 hours after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis in each group. Results Of 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no significant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. Conclusion In oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not significantly differ from that of patients receiving i.v. hydration.

scholarly journals Acute kidney injury after contrast-enhanced examination among elderly

2014 ◽  
Vol 22 (4) ◽  
pp. 637-644 ◽  
Author(s):  
Beatriz Bonadio Aoki ◽  
Dayana Fram ◽  
Mônica Taminato ◽  
Ruth Ester Sayad Batista ◽  
Angélica Belasco ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
The Elderly ◽  
Post Contrast ◽  
Hospitalized Elderly ◽  
Contrast Enhanced ◽  
Before And After ◽  
N 93 ◽  
Enhanced Computed Tomography

OBJECTIVES: to assess renal function in elderly patients undergoing contrast-enhanced computed tomography and identify the preventive measures of acute kidney injury in the period before and after the examination.METHOD: longitudinal cohort study conducted at the Federal University of São Paulo Hospital, from March 2011 to March 2013. All hospitalized elderly, of both sexes, aged 60 years and above, who performed the examination, were included (n=93). We collected sociodemographic data, data related to the examination and to the care provided, and creatinine values prior and post exam.RESULTS: an alteration in renal function was observed in 51 patients (54%) with a statistically significant increase of creatinine values (p<0.04), and two patients (4.0%) required hemodialysis.CONCLUSION: There is an urgent need for protocols prior to and post contrast-enhanced examination in the elderly, and other studies to verify the prognosis of this population.

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