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To the Editor:

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The adverse effects of intravenous contrast on renal function have been of major concern to practitioners such as myself. In recent years contrast has been spotlighted as a direct cause of nephrotoxicity1 and as such it has been targeted by health regulatory bodies for the establishment of closer monitoring. When I spotted the article “Immediate Complication of Intravenous Contrast for Computed Tomography Imaging in the Outpatient Setting Are Rare” in the September issue of the Journal,2 I was only too eager to read it.

In a busy urban emergency department, contrast CT scan is a very common diagnostic study. I think it is appropriate to address two important points not mentioned in the study. First, I am concerned with the use of serum creatinine to measure renal function, versus the more sensitive test GFR.3 Second, a focus on adequate hydration, both pre- and poststudy, was not mentioned.4 This is important because dehydration is a major cause of contrast-induced nephropathy and subsequent chronic renal failure resulting in dialysis. It would be optimal if at discharge patients were given an instruction sheet imploring extra fluid intake, in a manner that those with health literacy issues would be able to comprehend.

Contrast-enhanced CT scans cause several immediate complications that would undoubtedly be attributed to the imaging procedure. The precise contribution of the contrast load as a cause of renal failure remains a matter of debate. Many patients who develop contrast-induced nephropathy followed by renal failure have multiple potential causes. The article highlighted the dilemma faced with administering intravenous contrast to patients. As a concerned clinician, and as a consumer, it is my hope that very soon we will have nontoxic contrast material. We can then confidently discharge patients from the outpatient setting, without the fear of delayed renal damage.

References

  1. Top of page
  2. To the Editor:
  3. References
  • 1
    Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media–associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002; 162:32936.
  • 2
    Mitchell AM, Jones AE, Tumlin JA, Kline JA. Immediate complications of intravenous contrast for computed tomography imaging in the outpatient setting are rare. Acad Emerg Med. 2011; 18:10059.
  • 3
    Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. 2006; 354:247383.
  • 4
    Kohli A. Contrast induced nephropathy (CIN): can we minimize its effects? Indian J Radiol Imag. 2005; 15:1614.