Radiology: Volume 277: Number 3 - December 2015 Reviews and Commentary: Controversies
Ulf Nyman, MD, PhD; Peter Aspelin,MD, PhD; Jarl Jakobsen, MD, PhD; Jonas Bjork, PhD
Two large retrospective observational studies recently published in Radiology have led to questioning or downgrading the risk of contrast material-induced nephropathy (CIN) from intravenous administration of low- and iso-osmolality contrast material (LOCM and IOCM) at, for example, computed tomography (CT) (1-5), compared with that stated in guidelines (6-8). However, we believe that CIN still must be regarded as a real phenomenon and that existing guidelines should not be changed. There are several methodologic concerns regarding the two mentioned studies that may render the conclusions farfetched: (a) the use of relative rather than absolute glomerular filtration rate (GFR) in risk stratification, (b) the use of unenhanced CT as comparison group, (c) contrast material dose in relation to renal function was not used in the risk evaluation, and (d) limited attention to results stratified according to nonrenal risk factors. In addition, meta-analyses of randomized controlled trials between LOCM and IOCM after intra-arterial coronary procedures show clear evidence that at least LOCM is nephrotoxic (9, 10).