Zhong Jingyu, Chen Liwei, Xing Yue, Lu Junjie, Shi Yuping, Wang Yibin, Deng Yi, Jiang Run, Lu Wenjie, Wang Silian, Hu Yangfan, Ge Xiang, Ding Defang, Zhang Huan, Zhu Ying, Yao Weiwu
Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Insights Imaging. 2024 Mar 18;15(1):77. doi: 10.1186/s13244-024-01644-5.
To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them.
We searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool.
Ten guidelines were included, with a median STAR score of 46.0 (range 28.5-61.5). The guidelines performed well in "Recommendations" domain (31/40, 78%), while poor in "Registry" (0/20, 0%) and "Protocol" domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means.
Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols.
The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow.
• Guidelines concerning iodinated contrast media use in kidney disease patients vary. • Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols. • Investigations are encouraged to establish a safer iodinated contrast media use workflow.
评估肾病患者静脉注射碘化造影剂（ICM）使用指南的质量，并比较各指南之间的推荐意见。
我们检索了四个文献数据库、八个指南库以及十个放射学会的主页，以查找2018年1月至2023年6月期间发表的关于肾病患者静脉注射ICM使用的英文和中文指南。使用科学、透明和适用排名（STAR）工具评估指南的质量。
纳入了十份指南，STAR评分中位数为46.0（范围28.5 - 61.5）。这些指南在“推荐意见”领域表现良好（31/40，78%），而在“登记”（0/20，0%）和“方案”领域表现不佳（0/20，0%）。九份指南推荐将估算肾小球滤过率（eGFR）<30 mL/min/1.73 m²作为转诊患者讨论ICM给药风险 - 获益平衡的临界值。三份指南进一步建议，eGFR<45 mL/min/1.73 m²且有高危因素（原文此处未完整给出高危因素具体内容）的患者也需要转诊。在肾功能检查与ICM给药之间以及扫描与重复扫描之间的可接受时间间隔方面，各指南的推荐意见存在差异。九份指南推荐使用等渗或低渗ICM，但在ICM给药剂量方面尚未达成共识。九份指南支持ICM使用后进行水化，但它们的方案各不相同。不推荐使用药物或血液净化疗法作为预防手段。
肾病患者静脉注射ICM使用指南的质量参差不齐。科学学会可能需要考虑就有争议的推荐意见（如不同的时间安排和方案）发表联合声明。
指南质量参差不齐及其有争议的推荐意见，在肾病患者增强CT扫描的工作流程时间安排、给药剂量以及给药后水化方案方面留下了空白，需要更多证据来建立更安全、更可行的工作流程。
• 关于肾病患者使用碘化造影剂的指南各不相同。
• 在工作流程时间安排、造影剂给药剂量以及给药后水化方案方面仍存在争议。
• 鼓励开展研究以建立更安全的碘化造影剂使用工作流程。
