[Contrast-induced nephropathy: a real issue or a myth?]

Contrast-induced nephropathy or contrast-induced acute kidney injury (CI-AKI) has been regarded for decades as a relevant complication of iodinated contrast medium administration, particularly in perioperative and intensive care settings. However, recent epidemiological and clinical data increasingly challenge this presumed causal relationship and suggest that the associated risk is substantially overestimated.

The aim of this article is to critically appraise the current evidence and to reassess the clinical relevance of contrast medium administration within the context of multifactorial acute kidney injury development.

This editorial is based on a narrative and commentary-driven analysis of selected clinical studies, meta-analyses, and current recommendations regarding the use of iodinated contrast media in perioperative and intensive care settings. The published data were evaluated with a particular emphasis on patient-related risk factors and clinically relevant practical aspects.

The majority of contemporary studies demonstrate no or only a marginal causal association between the administration of iodinated contrast media and the development of AKI. Instead, the occurrence of AKI closely correlates with patient-related factors such as pre-existing chronic kidney disease, hemodynamic instability, sepsis, and systemic inflammation. Preventive measures beyond individualized volume therapy and hemodynamic optimization have not shown consistent effectiveness. Contrast medium administration frequently appears to be a marker of severe disease rather than a primary trigger for AKI.

The long-assumed nephrotoxicity of iodinated contrast media requires reevaluation. From an anesthesiological perspective, the focus should shift away from contrast avoidance towards ensuring adequate organ perfusion and hemodynamic stability. Unwarranted reluctance to perform urgently indicated imaging may lead to diagnostic delays and potentially compromises patient safety. A rational evidence-based approach to contrast medium administration within an interdisciplinary risk-benefit assessment is essential.