Contrast-associated acute kidney injury is a myth: Yes

Excerpt

Contrast medium (CM) administration is widely cited as a leading cause of hospital-acquired acute kidney injury (AKI) [1]. Concern over precipitation of AKI by CM is pervasive, and has influenced clinical decision-making related to diagnostic imaging and therapeutic interventions for more than half a century. So-called contrast-induced AKI (CI-AKI) is defined as an acute impairment in renal function occurring within 3 days of CM administration that is not attributable to any other etiology [1, 2]. Yet, nearly all studies establishing CI-AKI as a clinical entity were performed in the absence of control populations not exposed to CM. These studies assumed causality from association, and considered all cases of AKI in CM-exposed patients as CI-AKI, even when alternative explanations were obvious (Fig. 1) [3‐5]. A growing body of evidence, derived from studies that include adequate control populations and discussed in more detail below, now suggests that risk for AKI attributable to CM administration is modest at most. Yet, outsized fear of CI-AKI persists.

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