Chapter 11
Iodinated Contrast and Acute Kidney Injury
Steven D. Weisbord,
Martin Gallagher,
Steven D. Weisbord
Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, USA
Search for more papers by this authorMartin Gallagher
Renal & Metabolic Division The George Institute for Global Health Newtown, NSW, Australia
Search for more papers by this authorSteven D. Weisbord,
Martin Gallagher,
Steven D. Weisbord
Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, USA
Search for more papers by this authorMartin Gallagher
Renal & Metabolic Division The George Institute for Global Health Newtown, NSW, Australia
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
Acute kidney injury (AKI) is a widely recognized complication of intravascular administration of iodinated contrast media. The primary patient-related risk factor for contrast-associated acute kidney injury (CA-AKI) is underlying kidney impairment, while absolute and effective circulating volume also increases risk. The resulting mismatch in oxygen supply and demand in an anatomical portion of the kidney with low baseline oxygen reserve leads to ischemia of tubular epithelial cells. Historically, AKI following the administration of iodinated contrast media was referred to as contrast nephropathy or contrast-induced nephropathy. Identifying patients at heightened risk for CA-AKI allows for the consideration of alternative imaging procedures that do not necessitate intravascular contrast, but that provide comparable diagnostic information. Iodinated contrast media are commonly categorized based on their osmolality. Iodinated contrast media remain largely in the extracellular space, have low protein binding, and are highly water soluble. Hence, they can be efficiently removed from the circulation by renal replacement therapies.
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