Abstract
Recent advances in medical sciences, especially in imaging, have dramatically increased the use of contrast agents. The constantly changing nature of medicine and the availability of new information, such as new pharmaceutical formulations, have necessitated periodic revisions and drafting of new guidelines for the safe use of intravenous contrast agents in radiology. This study examined the majority of guidelines, articles, and authoritative references available on the use of intravenous contrast agents in adults to reduce the risk of contrast-induced nephropathy. The search engines of PubMed, Web of Science, Scopus, and Google Scholar were used, and relevant English articles cited at least twice between 1979 and 2014 were studied. Review of the collected papers showed no consensus among them for guidelines on the incidence of contrast-induced nephropathy in patients at risk. Different formulas were used to calculate estimated glomerular filtration rate, which could be problematic in some cases. Further studies are needed for unification of existing guidelines.
Highlights
Injection of contrast agents is used for computed tomography, body and coronary angiography, interventional radiology and cardiology procedures, and excretory urography
Intravenous contrast agents are divided into three main categories—hyper-osmolar, hypo-osmolar, and iso-osmolar contrast media
The incidence of acute kidney injury (AKI) ranges from 3% to 7% in patients with no risk factors and 50% in patients moderate to advanced chronic kidney disease (CKD) [6]
Summary
Injection of contrast agents is used for computed tomography, body and coronary angiography, interventional radiology and cardiology procedures, and excretory urography. Dehghan media are ionic monomers highly hyper-osmolar to plasma (~1400 - 1800 mOsmol/kg). Low-osmolar contrast media are non-ionic monomers with lower osmolarity than hyper-osmolar contrast media but still hyper-osmolar to plasma (~500 - 850 mOsmol/kg). Iso-osmolar contrast media are the most recent non-ionic contrast agents. They involve dimers with an osmolarity of 290 mOsmol/kg. Non-ionic hypo-osmolar or iso-osmolar contrast agents are usually five to ten times safer than previous hyperosmolar types [1]. Few isolated studies have been conducted on the effects of contrast agents on the kidneys [2]. Some studies have reported a direct or indirect association between contrast agents and the incidence of acute kidney injury (AKI), with an 11% - 14.5% increased risk factor [3]-[5]. The incidence of AKI ranges from 3% to 7% in patients with no risk factors and 50% in patients moderate to advanced chronic kidney disease (CKD) [6]
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