Journal Jam 11 Post Contrast Acute Kidney Injury – PCAKI

Lauren Westafer joins Justin Morgenstern, Rory Spiegel and Anton Helman in a deep dive discussion on the world's literature on Post Contrast Acute Kidney Injury (PCAKI) in this Journal Jam podcast. Hospitals continue to insist on time consuming and potentially dangerous protocols for administration of fluids to patients with renal dysfunction prior to CT IV contrast despite the lack of evidence that Contrast Induced Nephropathy (CIN) even exists. Would you choose a different imaging modality if your radiologist suggested that a patient with renal dysfunction who required a CT with IV contrast should forgo the contrast risking a missed diagnosis?



Podcast production by Justin Morgenstern, Rory Spiegel and Anton Helman, editing and sound design by Anton Helman,

Written summary by Anton Helman, November 2017

Cite this podcast as: Westafer, L, Morgenstern, J, Spiegel, R, Helman, A. Post Contrast Acute Kidney Injury - PCAKI. Emergency Medicine Cases. November, 2017. https://emergencymedicinecases.com/journal-jam-post-contrast-acute-kidney-injury-pcaki/. Accessed [date].

Key points on Post Contrast Acute Kidney Injury (PCAKI) discussed in this Journal Jam



* There is no consistent definition of PCAKI or CIN.

* There are no RCTs comparing IV contrast to placebo showing any significant difference in patient oriented outcomes.

* There are many confounding variables in all the studies to date.

* Anywhere from 1-20% of patients admitted to hospital will develop AKI whether or not they received IV contrast with 0.5% requiring dialysis.

* There are potential harms associated with foregoing IV contrast when it is indicated including missed diagnoses.

* Standardized preventative treatments such as normal saline administration, NAC and bicarb are not effective.

* Patients with a GFR