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Post by Bjs04f on Jan 8, 2015 15:51:02 GMT -5
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Post by pbruss on Jan 9, 2015 8:37:00 GMT -5
i rmember reading the second paper when it first came out. good paper but a few things.
1. they excluded people on dialysis and a GFR<60.
2. they looked only a people who had a CT of the chest OR the abd/pelvis, not both
3. both paper's outcome was AKI which was defined as an increase in the Cr of 25%. neight paper measured or looked at the need for dialysis eigther temporrary fo permnant which is what I am more interested in. technically you can say that pts with AKI have a higher risk of progession to dialysis but it would have been noce to see exactly how many people in these studies needed dialysis.
i have always sucked at statistics so honestly i get lost in the first paper and can not give a good interpirtation of the data and conclusions. they did not exclude patiens with pre-exsisting renal insufency un like the second paper. i found it interesting that the data did not show increased risk of AKI in higher risk patients.
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Post by Bjs04f on Jan 9, 2015 10:33:07 GMT -5
As far as not using pt on dialysis I think this helps as we dont care about their kidneys and do whatever anyways, so this focuses on the patients we truly try to avoid nephrotoxic agents on. Its ok to only have one CT as we usually dont do both, only trauma and at that point urgency supercedes concern over kidneys. Point 3 is valid, however I would feel OK saying look the risk of kidney injury is low, so ther risk of needing dialysis should be lower as I would assume a less than 100% AKI to dialysis conversion. Overall interesting, especially as we are seeing less adverse effects with new contrast agents. Had a pleasant "discussion" with a radiologist who wanted a 5hr pretreatment for an iodine allergic pt. Told him 10 you cant be allergic to iodine, 2- her reaction was hives, and 20 yrs ago which would involve a different contrast agent, the new ones have very low risk of allergy, even in historic contrast allergic pts.
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