One common concern emergency medicine professionals face is the risk for acute kidney injury (AKI) secondary to the use of intravenous (IV) contrast for CT studies. Currently, emergency medicine professionals typically avoid the use of CT scans with IV contrast before checking renal function, and the use of IV contrast is discouraged for patients who have abnormal renal function. There have been studies in the literature recently that have evaluated this circumstance and have suggested that perhaps AKI related to IV contrast may not be as much of an issue as we have all thought.
In a meta-analysis published in Annals of Emergency Medicine ,[1] researchers scrutinized 28 articles including 107,335 patients to ascertain the risk for AKI secondary to IV contrast exposure, the possible need for renal replacement therapy, and total mortality comparing noncontrast CT and contrast CT. All reviewed studies were observational, and most were retrospective chart reviews. Only five were prospective observational studies. Six studies evaluated only emergency department patients, while seven evaluated only intensive care unit patients. Most studies included low or iso-osmolar contrast material, and only one study used high osmolar contrast.
The primary outcome of the study was the development of AKI in patients exposed to contrast CT.
