Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

Insights into Imaging - 2024
Jingyu Zhong1, Liwei Chen1, Yue Xing1, Junjie Lu2, Yuping Shi3, Yibin Wang4, Yi Deng5, Run Jiang6, Wenjie Lu1, Silian Wang1, Yangfan Hu1, Xiang Ge1, Defang Ding1, Huan Zhang7, Ying Zhu1, Weiwu Yao1
1Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
2Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
3Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
4Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
5University of Washington School of Pharmacy, Seattle, USA
6Department of Pharmacovigilance, Shanghai Hansoh BioMedical Co., Ltd, Shanghai, China
7Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, China

Tóm tắt

To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them. We searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool. Ten guidelines were included, with a median STAR score of 46.0 (range 28.5–61.5). The guidelines performed well in “Recommendations” domain (31/40, 78%), while poor in “Registry” (0/20, 0%) and “Protocol” domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means. Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols. The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow. • Guidelines concerning iodinated contrast media use in kidney disease patients vary. • Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols. • Investigations are encouraged to establish a safer iodinated contrast media use workflow.

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