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      Post-contrast acute kidney injury – Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines

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          Abstract

          Purpose

          The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.

          Areas covered in part 1

          Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs.

          Key Points

          PC-AKI is the preferred term for renal function deterioration after contrast medium.

          PC-AKI has many possible causes.

          The risk of AKI caused by intravascular contrast medium has been overstated.

          Important patient risk factors for PC-AKI are CKD and dehydration.

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          Most cited references77

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          AGREE II: advancing guideline development, reporting and evaluation in health care.

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            Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention.

            In patients undergoing percutaneous coronary intervention (PCI) in the modern era, the incidence and prognostic implications of acute renal failure (ARF) are unknown. With a retrospective analysis of the Mayo Clinic PCI registry, we determined the incidence of, risk factors for, and prognostic implications of ARF (defined as an increase in serum creatinine [Cr] >0.5 mg/dL from baseline) after PCI. Of 7586 patients, 254 (3.3%) experienced ARF. Among patients with baseline Cr 2.0, all had a significant risk of ARF. In multivariate analysis, ARF was associated with baseline serum Cr, acute myocardial infarction, shock, and volume of contrast medium administered. Twenty-two percent of patients with ARF died during the index hospitalization compared with only 1.4% of patients without ARF (P 2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.
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              Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines.

              The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN). Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points • Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed. • CIN risk is lower with intravenous than intra-arterial iodinated contrast medium. • eGFR of 45 ml/min/1.73 m (2) is CIN risk threshold for intravenous contrast medium. • Hydration with either saline or sodium bicarbonate reduces CIN incidence. • Patients with eGFR ≥ 60 ml/min/1.73 m (2) receiving contrast medium can continue metformin normally.
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                Author and article information

                Contributors
                A.J.van_der_Molen@lumc.nl
                Peter.Reimer@klinikum-karlsruhe.de
                I.A.Dekkers@lumc.nl
                gbongartz@uhbs.ch
                marie-france.bellin@pbr.ap-hop-paris.fr
                bertolot@units.it
                olivier.clement@aphp.fr
                ertraud.heinz@stpoelten.lknoe.at
                fulvio.stacul@asuits.sanita.fvg.it
                jawwebb@btopenworld.com
                Henrik.Thomsen@regionh.dk
                Journal
                Eur Radiol
                Eur Radiol
                European Radiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0938-7994
                1432-1084
                9 February 2018
                9 February 2018
                2018
                : 28
                : 7
                : 2845-2855
                Affiliations
                [1 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Radiology, C2-S, , Leiden University Medical Center, ; Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
                [2 ]ISNI 0000 0004 0391 0800, GRID grid.419594.4, Institute for Diagnostic and Interventional Radiology, , Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, ; Moltkestraße 90, D-76133 Karlsruhe, Germany
                [3 ]GRID grid.410567.1, Department of Diagnostic Radiology, , University Hospitals of Basel, ; Petersgaben 4, CH-4033 Basel, Switzerland
                [4 ]Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807 Villejuif, France
                [5 ]ISNI 0000 0001 1941 4308, GRID grid.5133.4, Department of Radiology, , University of Trieste, ; Strada di Fiume 447, I-34149 Trieste, Italy
                [6 ]GRID grid.414093.b, Department of Radiology, Assistance Publique-Hôpitaux de Paris, , Hôpital Européen Georges Pompidou, ; 20, rue Leblanc, Paris Cedex 15, F-71015 Paris, France
                [7 ]Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straße 4, AT-3100 St. Pölten, Austria
                [8 ]ISNI 0000 0004 4671 8595, GRID grid.417543.0, S.C. Radiologia Ospedale Maggiore, ; Piazza Ospitale 1, I-34129 Trieste, Italy
                [9 ]ISNI 0000 0001 2161 2573, GRID grid.4464.2, Department of Radiology, St. Bartholomew’s Hospital, , University of London, ; West Smithfield, London, EC1A 7BE UK
                [10 ]ISNI 0000 0004 0646 8325, GRID grid.411900.d, Department of Diagnostic Radiology 54E2, , Copenhagen University Hospital Herlev, ; Herlev Ringvej 75, DK-2730 Herlev, Denmark
                Article
                5246
                10.1007/s00330-017-5246-5
                5986826
                29426991
                8d346c97-aa3c-415f-9bab-b0404f36d62b
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 3 October 2017
                : 22 November 2017
                : 5 December 2017
                Categories
                Contrast Media
                Custom metadata
                © European Society of Radiology 2018

                Radiology & Imaging
                contrast media,acute kidney injury,glomerular filtration rate,risk factors,practice guidelines as topic

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