Believe it or not, well done retrospective trials are unable to demonstrate renal risk from IV contrast. This goes against decades of clinical practice. This needs to be adjudicated once and for all.
This trial will enroll stable outpatients with CKD stage 3b-4 to receive contrast or not. There would be no associated imaging. Serum creatinine would be measured pre-exposure and daily for up to one week post-exposure. In this setting, a rise in creatinine is far less likely to be due to alternative explanations for AKI, which are numerous in unstable hospitalized patients.
The primary outcome would be development of AKI as determined by an increase of 0.3 mg/dl or 50% increase in creatinine.
So there you have it. Contrast nephropathy - is it real? Or just a #DreamRCT?