Consensus Report from Oncology Advisory Board Meeting

26 • Strategies for Prevention and Management of CI-AKI and the Role of Contrast in Oncology CT Settings  Oncology patients are at heightened risk of acute kidney injury (AKI) due to the disease per se, chemotherapy, comorbidities, and frequent use of contrast- based imaging studies.  Most of the anti-cancer drugs, including methotrexate, cisplatin, ifosfamide, epirubicin, gemcitabine, carboplatin, doxorubicin, paclitaxel, oxaliplatin, irinotecan, bevacizumab, and trastuzumab, are nephrotoxic.  The most recent guidelines define contrast-induced AKI (CI-AKI) as an increase in serum creatinine (Cr) of ≥ 0.3 mg/dl, or of ≥ 1.5–1.9 times baseline (KDIGO definition of AKI) in the 48–72 h following contrast media (CM) administration.  Damage to kidneys can occur even when the serum Cr levels do not rise. Subclinical AKI, with no rise in serum Cr but raised biomarkers, is still AKI and needs attention.  Estimated glomerular filtration rate (eGFR) is the best marker of renal functions, since serum Cr may vary based on various factors such as age, sex, muscle mass, drug inhibitions, inter laboratory variations, etc.  Patients must not be denied necessary procedures because of the fear of CI-AKI. CM exposure can be tailored to GFR.  Adequate hydration is one of the major factors in preventing CI-AKI. Decision on use of nephrotoxic and other concomitant drugs during contrast based- imaging, should be carefully evaluated.  The choice of CM should be based on various factors such as demographics and disease condition, comorbidities, concomitant medications, risk of CI-AKI, complications, etc.  Isosmolar contrast media (IOCM) have osmolality as that of blood and benefit the patients by improving tolerability and reducing the risk of CI-AKI in high risk patients. Hence in patients with high risk of CI-AKI, IOCM can be preferred over low osmolar contrast media (LOCM).  The incremental cost of IOCM over LOCM is well-justified among high-risk patients. Expert Opinion/Recommendations to Prevent CI-AKI in Oncology Patients. Expert Opinion