R.E.B.E.L.EM - September 25, 2017
"Background: One of the most common imaging modalities used in the emergency department (ED) today is computed tomography (CT) scans using intravenous radiocontrast agents. Use of IV contrast can help increase visualization of pathology as compared to non-contrast CTs. However, many patients do not get IV contrast due to fear of contrast induced nephropathy. Furthermore, waiting for renal function values delays the care of patients and prolongs time spent in the ED with a potential to increase adverse effects on patient centered outcomes due to delays...
Author Conclusion: “We found no significant differences in our principal study outcomes between patients receiving contrast-enhanced CT versus those receiving noncontrast CT. Given similar frequencies of acute kidney injury in patients receiving noncontrast CT, other patient- and illness-level factors, rather than the use of contrast material, likely contribute to the development of acute kidney injury.”
Clinical Take Home Point: While a prospective, multi center RCT would put this question to rest, it’s unlikely to be feasible to perform. Based on the best available evidence, use of IV low- and iso-osmolar contrast media does not appear to be associated with increased risk of AKI, need for renal replacement therapy, or mortality."