Amy Thompson: Journal Club

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Fishbone diagram

This article, Contrast-Induced Kidney Injury Risk Low in Chronic Kidney Disease, May Be Preventable, discusses how the risk of death and adverse kidney outcomes from contrast-associated acute kidney injury in patients with chronic kidney disease may be lower than previously thought.

Through a trial that was performed, they found that  in almost 4500 patients, there was a low increased risk for death, the need for dialysis, or persistent kidney impairment  at 90 days.  They also found that AKI did not mediate the relationship between baseline kidney function and the development of those serious adverse outcomes.

The main key they are looking at with this study is that the incidence of clinically significant CA-AKI in those patients with CKD who are undergoing non-emergent angiography and who receive periprocedural isotonic intravenous fluid is very low.

The trial showed that CA-AKI was not found to mediate the association between baseline kidney function and the primary outcome.  The pre-angiography eGFR was significantly associated with the development of CA-AKI.  Pre-angiography eGFR and CA-AKI were both significantly associated with the primary outcome.

Providers should typically perform clinically indicated angiographic procedures in  these patients using appropriate preventive care without undue excessive concern for causing AKI.  The risk of serious complications following the intra-arterial administration of contrast media is very low, so angiographies should not be withheld in patients with impaired renal function.  However, even though the risk is low, there is still a subgroup of patients that may still benefit from interventions aimed at protecting the kidneys during angiography.

Previous research had shown a substantially increased relative risk for serious outcomes with CA-AKI, including mortality, stroke, myocardial infarction and/or end-stage kidney disease.


Swift Yasgur, B., MA, LSW.  (04/06/2020).  Contrast-Induced Kidney Injury Risk Low in CKD, May Be Preventable.  Medscape Nurses.






3 Responses

  1. crtownsend2 at |

    Hey Amy! When I click on your fishbone diagram, it pulls up my fishbone project. I am not sure if its a problem with my computer or if the wrong form got uploaded on yours. But this is a good topic. I work with Oncology patients and so many of our patients have kidney issues anyway. Some of them have a hard time getting back to normal after they have the contrast dye. Their creatinine levels stay high. Some of them have too high of creatinine to begin with and cannot use the contrast. I can see how these tests could be useful on these patients. Thanks for sharing!

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