[Iodinated and gadolinium-based contrast agents in patients with chronic kidney disease: A review of international guidelines (SFNDT/SFR, ESUR, ACR/NKF, CAR)].

INTRODUCTION

The renal risks of iodinated contrast media (ICM) and the association of gadolinium-based contrast agents (GBCAs) with nephrogenic systemic fibrosis (NSF) have been recently reassessed.

METHODS

International guidelines (Société francophone de néphrologie, dialyse et transplantation/Société française de radiologie [SFNDT/SFR], European Society of Urogenital Radiology [ESUR], American College of Radiology/National Kidney Foundation [ACR/NKF], Canadian Association of Radiologists [CAR] 2018–2025) were reviewed, focusing on risk stratification, preventive measures, and the use of ICM and GBCAs in patients with chronic kidney disease (CKD).

RESULTS

Post-contrast acute kidney injury risk is low for eGFR ≥ 30 mL/min/1.73 m². Hydration is recommended only for eGFR < 30 mL/min/1.73 m² or first-pass intra-arterial injections. Group II GBCAs are considered safe even in advanced CKD or dialysis, with a single unconfirmed NSF case reported.

DISCUSSION: Differences between guidelines reflect their timing and limited evidence. Preventive measures should focus on the highest-risk situations.

CONCLUSION

Clinical indication should guide imaging, which should not be delayed, and recent guidelines support a rational, risk-based approach to contrast media use.