title: Contrast-associated AKI in the critically ill: relevant or irrelevant?
abstract: OBJECTIVE
  Iodinated contrast media are frequently administered in ICU patients. Recent studies challenge the relevance of contrast media toxicity in ICU patients and relate occurrence of acute kidney injury to baseline characteristics and severity of illness.
  
  
  RESULTS
  Various findings in studies with kidney biomarkers indicate the causal relationship between contrast media exposure and kidney damage. Contrast media exposure not only causes direct tubular damage and renal hypoperfusion but also initiates the formation of reactive oxygen species in its turn causing tissue damage. The route of administration determines the incidence of contrast-induced acute kidney injury with a higher incidence when contrast media are administered by intra-arterial route versus intravenous route. The impact of contrast-associated acute kidney injury on hospital length of stay, the need for renal replacement therapy and survival remains a matter of debate because of discrepancies between observational versus case-matched studies and limitations of the individual studies.
  
  
  CONCLUSIONS
  There are diverse pathophysiologic mechanisms explaining the causal relationship between the administration of contrast media and the development of acute kidney injury. Some studies challenge the relevance of contrast media toxicity in ICU patients. However, limitations of the available studies in ICU patients preclude firm conclusions. A precautionary approach in the administration of contrast media is justified.
authors.affiliation: aDepartment of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent bDepartment of Anesthesiology and Intensive Care Medicine, AZ Groenige, Kortrijk cResearch Foundation-Flanders (FWO), Brussels, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Vandenberghe
authors.forename: Wouter
authors.initials: W
authors.lastname: De Corte
authors.forename: Eric A J
authors.initials: EA
authors.lastname: Hoste
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000075202:Contraindications; D003287:Contrast Media; D016638:Critical Illness; D006801:Humans; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media