Long-term safety of withholding standard prophylaxis in patients with moderate chronic kidney disease

In the latest ESUR contrast media guidelines, standard prophylaxis is no longer recommended for patients with moderate chronic kidney disease (CKD). In the absence of solid evidence, guideline updates are often based on indirect evidence and expert opinion. Likewise, evidence supporting the withdrawal of standard prophylaxis in moderate CKD patients was scarce and mostly indirect, but did include one randomised controlled trial evaluating guideline-recommended standard prophylactic intravenous hydration against a group receiving no prophylaxis (A MAastricht Contrast-Induced Nephropathy Guideline (AMACING) trial). Since then, benefits of the updated guideline recommendation for patient and hospital burden have been numerated and were shown to be substantial. The current special report provides data on long-term safety from the AMACING randomised controlled trial. KEY POINTS: • In the latest version of ESUR clinical practice guidelines for safe use of contrast media, standard prophylaxis is no longer recommended for patients with moderate chronic kidney disease. • Benefits of this change in recommendations for patient and hospital burden have been numerated. The current report provides data on long-term safety from the AMACING randomised controlled trial. • No disadvantage of withholding prophylaxis could be discerned. Results suggest that, in this population, underlying disease is more relevant for survival and prognosis than contrast administration itself.