Call it...Time of death?— Joel Topf, MD FACP (@kidney_boy) February 21, 2017
6:29 AM.
It had a long full life. RIP contrast nephropathy. https://t.co/wNZNnGA1Hh
The article just published in Lancet proves in a RCT that fluids don't help in high risk patients in preventing contrast nephropathy (CIN).
http://www.sciencedirect.com/science/article/pii/S0140673617300570
This comes after many recent papers that have questioned the very existence of this entity. While it exists, perhaps the incidence has been over sized. This was nicely shown by Chertow's team in 2016
https://www.ncbi.nlm.nih.gov/pubmed/27688297
Bigger questions will arise as we move forward in the era of Cardiac-Nephrology. Discussions with cardiologists are going to be essential. While the Lancet paper will get it's share of supporters and opposers, the debate will continue as now the question has arisen- does CIN even exist? Is this the death of CIN?
1. Does intra-arterial vs intra-venous contrast make the kidneys worse?
2. Does giving NAC matter?
3. Does giving IV fluids matter?- pre and post and or based on wedge pressure
4. Does holding ACEi/ARB matter?
5. Does holding diuretics matter?- Might so if they are planning to do a TAVR.
Tough road ahead as - what can the Nephrologist do then for these patients? I guess - Nothing! and perhaps doing nothing might be beneficial to the patient. We shall see!
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