Summary
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1.
The terms CA-AKI or PC-AKI are recommended for use in clinical practice due to the large proportion of AKI events correlated with but not necessarily caused by contrast media administration.
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a.
ACR: Similar recommendation to distinguish generic PC-AKI from CI-AKI
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b.
KDIGO: No recommendation regarding terminology, although it is acknowledged that AKI may be caused by other things
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2.
CI-AKI is only feasible to diagnose in the context of a well-matched controlled study.
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3.
KDIGO AKI criteria are recommended for the diagnosis of AKI, and KDIGO CKD criteria are recommended for the diagnosis of CKD.
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4.
The risk of CI-AKI from intravenous iodinated contrast media is lower than previously thought. Necessary contrast material–enhanced CT without a suitable alternative should not be avoided solely on the basis of CI-AKI risk.
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5.
CI-AKI risk should be determined primarily by using CKD stage and AKI. Patients at high risk include those with recent AKI and those with eGFR less than 30 mL/min/1.73 m 2, including nonanuric patients undergoing maintenance dialysis.
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a.
ACR: Similar recommendation
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b.
KDIGO: Similar recommendation, but eGFR threshold is less than 45 mL/min/1.73 m2 instead of less than 30 mL/min/1.73 m2
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6.
Kidney function screening is indicated to identify patients at high risk for CI-AKI. Personal history of kidney disease (CKD, remote AKI, kidney surgery or ablation) is the strongest risk factor indicating the need for kidney function assessment.
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a.
ACR: Similar recommendation, but also includes age, diabetes mellitus, and hypertension as potential risk factors to indicate kidney function assessment
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b.
KDIGO: Similar recommendation, but also includes age, diabetes mellitus, hypertension, multiple myeloma, gout, and proteinuria as potential risk factors to indicate kidney function assessment
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7.
Radiologist-clinician discussions about risks and benefits of contrast-enhanced imaging can be helpful in patients at high risk for CI-AKI.
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8.
There are no clinically relevant differences in CI-AKI risk between iso-osmolality and low-osmolality iodinated contrast media.
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9.
Prophylaxis with intravenous normal saline is indicated for patients not undergoing dialysis who have eGFR less than 30 mL/min/1.73 m 2 or AKI. In individual high-risk circumstances, prophylaxis may be considered in patients with eGFR of 30–44 mL/min/1.73 m 2 at the discretion of the ordering clinician.
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a.
ACR: Prophylaxis with normal saline recommended for patients not undergoing dialysis with eGFR less than 30 mL/min/1.73 m2; no exception for patients with eGFR of 30–44 mL/min/1.73 m2 and multiple risk factors
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b.
KDIGO: Prophylaxis with normal saline or sodium bicarbonate recommended for patients not undergoing dialysis with eGFR less than 45 mL/min/1.73 m2; prophylaxis may include N-acetylcysteine
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10.
Prophylaxis is not indicated for patients with stable eGFR greater than or equal to 45 mL/min/1.73 m 2.
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11.
Kidney replacement therapy should not be initiated or have the schedule adjusted solely on the basis of contrast media administration.
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12.
The presence of a solitary kidney should not independently influence decision making regarding the risk of CI-AKI.
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13.
In patients at high risk of CI-AKI, ad hoc lowering of contrast media dose below a known diagnostic threshold should be avoided. Rather, the minimum routine clinical diagnostic dose should be used.
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14.
When feasible, nephrotoxic medications should be withheld by the referring clinician in patients at high risk.
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15.
Data on risk of CI-AKI in pediatric patients is extrapolated from data in adult patients. Pediatric-specific research in this area is a major unmet need.
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