Controversies in Contrast Material-Induced Acute Kidney Injury

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 17, 2023:

Cardiac-Interventional Radiography: 1.25
Patient Care: 1.25
Patient Interactions and Management: 1.25

Computed Tomography: 1.25
Patient Care: 1.25
Patient Interactions and Management: 1.25

Magnetic Resonance Imaging: 1.25
Patient Care: 1.25
Patient Interactions and Management: 1.25

Radiography: 1.25
Patient Care: 1.25
Patient Interactions and Management: 1.25

Registered Radiologist Assistant: 1.25
Patient Care: 1.25
Pharmacology: 1.25

Radiation Therapy: 1.25
Patient Care: 1.25
Patient Interactions and Management: 1.25

Vascular-Interventional Radiography: 1.25
Patient Care: 1.25
Patient Interactions and Management: 1.25

Outline

1. Introduction
2. Meta-Analysis
3. Recent Studies
4. Ongoing Controversies
5. Point-Counterpoint

Objectives

Upon completion of this course, students will:

1. know how long IV iodinated contrast has been causally associated with the development of CIN
2. state the number of doses of iodinated contrast administered on an annual basis
3. recall the most salient criticism of existing literature in regard to human studies of CIN
4. explain the need for an appropriate control group in order to properly discern causation
5. list causes of contrast material-independent elevations in SCr levels that are most likely to obscure a diagnosis of CIN
6. state the patient population at greatest risk of CIN
7. list the studies demonstrating that the incidence of acute kidney injury in the contrast material–naive control cohorts was often significantly higher than that observed in the contrast material–exposed cohorts
8. state limitations in systematic reviews of existing literature on CIN
9. list the years when Davenport et al and McDonald et al published large controlled retrospective studies of post-contrast acute kidney injury after CT
10. name the factors used in order to publish risk stratified results from both the Davenport et al and McDonald et al studies
11. identify the study that was unable to identify a significant difference in the incidence of acute kidney injury between contrast-exposed and control groups in patients with baseline estimated GFR less than 30mL/min per 1.73m2
12. list the reasons for divergent results in patients with baseline estimated GFR less than 30mL/min per 1.73m2
13. state findings that provide evidence noting the incidence of CIN after intravenous iodinated contrast material administration being lower than previously suggested by other studies
14. note the outcomes for the separate propensity score adjusted study performed by McDonald and colleagues
15. give the sample size for Davenport et al and McDonald et al retrospective studies
16. choose which study contained sensitivity analysis that demonstrated the observed findings were highly reproducible and not likely the result of anomalous logistic regression results
17. list the factors that help minimize potential bias as associated with the McDonald et al studies
18. discuss the limitations of retrospective studies
19. list the variance factors associated with SCr level-based assays of renal function
20. state the limitations inherent to measuring SCr levels
21. list the measurement tools for GFR
22. discern which GFR measurement tool is the most common measure of renal function in clinical work and in prospective trials
23. state the most direct method of determining renal function
24. recall the standard of care and essential components of CIN studies
25. name the agency that confirms intravascular contrast material significantly improves diagnostic sensitivity for many serious diseases