Consensus Report from Oncology Advisory Board Meeting

Strategies for Prevention and Management of CI-AKI and the Role of Contrast in Oncology CT Settings • 13 Summary It needs to be clearly emphasized that patients must not be denied necessary procedures because of the fear of CI-AKI. CM exposure can be tailored to GFR. Developments in imaging modalities are already offering improved image quality without the need for high dose of CM or radiation exposure. If possible, a nephrologist should be involved in managing patients with AKI; there is evidence that mortality and complications are reduced if a nephrologist is involved. However, it is acknowledged that such support may not be acutely available; as an alternative, non-nephrologists need resources to help them understand and manage AKI themselves. Management of CI-AKI should be based on locally-agreed protocols. Hemodialysis (using a high-flux membrane) might be useful to remove CM after the procedure, although it may be too late to prevent some kidney damage. The timing of follow-up assessments for AKI needs to be highlighted. Serum Cr should be measured within 48–72 hours, although ideally, a biomarker of damage that can be used within 4-6 hours, before patient is discharged, is awaited. The patient should also be followed up after 90 days to identify whether acute kidney damage has progressed to CKD. The young residents should be made aware that AKI, a previously neglected disease, has attained mammoth proportions and needs to be tackled at an early stage. it was found that these prophylactic therapies offered no beneficial effects against CI-AKI. In fact, hemodialysis rather appeared to increase the risk of CI-AKI [1]. Reference 1. Cruz DN, Goh CY, Marenzi G, et al . Renal replacement therapies for prevention of radiocontrast-induced nephropathy: a systematic review. Am J Med . 2012 Jan;125(1):66-78.e3.