Preventing a nonexistent entity: the curious case of contrast and acute kidney injury

In recent years, doubt has been cast on the existence of contrast-induced acute kidney injury. The skepticism has stemmed from observational studies from large administrative healthcare databases. Although they correctly call that contrast-induced acute kidney injury is less common than previously thought, they cannot completely exclude selection bias.

Though less common than previously thought, contrast-induced acute kidney injury still exists. The only prophylactic method that remains valid is that of isotonic volume expansion, which is still deemed beneficial in high-risk patients. N-acetylcysteine and sodium bicarbonate are ineffective and their use should be abandoned.

Contrast-induced kidney injury should be defined based on clinical grounds, not merely on biochemical numbers. More research to validate a clinical definition is necessary in order to accurately re-examine its incidence.