Clinically significant contrast-associated acute kidney injury after emergent computed tomography angiography of the cerebral arteries.

Contrast associated acute kidney injury (CA-AKI) is defined as a sudden deterioration in renal function within 48 h following the intravascular administration of iodinated contrast medium[ [1] Rivers B. ACR manual on contrast media. 2021. Google Scholar ]. CA-AKI may occur whether or not contrast medium was the cause of the deterioration, therefore being a correlative diagnosis. There is increasing evidence that the nephrotoxicity directly attributable to iodinated contrast media - i.e. contrast-induced AKI (CI-AKI) - has been exaggerated, and cardiac angiography studies likely overestimate the risk of CI-AKI for patients undergoing intravenous contrast-enhanced studies [ [2] Katzberg R.W. Newhouse J.H. Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe?. Radiology. Jul 2010; 256: 21-28https://doi.org/10.1148/radiol.10092000 Crossref PubMed Scopus (190) Google Scholar ]. In one meta-analysis [ [3] Kooiman J. Pasha S.M. Zondag W. et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. Oct 2012; 81: 2554-2561https://doi.org/10.1016/j.ejrad.2011.11.020 Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar ], CI-AKI incidence was 6%, but it varied as much as 1–20%. Other meta-analyses [ [4] McDonald J.S. McDonald R.J. Comin J. et al. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. Apr 2013; 267: 119-128https://doi.org/10.1148/radiol.12121460 Crossref PubMed Scopus (290) Google Scholar , [5] Aycock R.D. Westafer L.M. Boxen J.L. Majlesi N. Schoenfeld E.M. Bannuru R.R. Acute kidney injury after computed tomography: a meta-analysis. Ann Emerg Med. Jan 2018; 71 (e4): 44-53https://doi.org/10.1016/j.annemergmed.2017.06.041 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar ] sought to analyze contrast-associated AKI instead and found no difference in the incidence of AKI between exposed and unexposed patients.