From the Guidelines
It is not recommended to take iodine for a PET scan if you have acute kidney injury (AKI), as it may worsen kidney function and cause contrast-induced nephropathy. The use of iodinated contrast agents in patients with AKI is generally avoided unless there is an overriding clinical question that cannot be answered with an alternative imaging modality or when an intravascular intervention is required 1. If iodine-based contrast is necessary, your healthcare provider should take measures to minimize the risk of kidney damage, such as using the lowest possible dose of contrast, avoiding high osmolar agents, and providing adequate hydration with saline before, during, and after the procedure 1.
The decision to use iodine-based contrast in a patient with AKI should be made on a case-by-case basis, taking into account the severity of the AKI, its cause, and the patient's overall health status 1. Alternative imaging approaches, such as non-contrast PET scans or ultrasound, may be considered to minimize the risk of kidney damage.
In patients with AKI, it is essential to assess kidney function through blood tests, including creatinine levels and estimated glomerular filtration rate, before making a decision about the use of iodine-based contrast 1. The healthcare provider should also consider the potential benefits and risks of the procedure and discuss these with the patient to make an informed decision.
The most recent and highest quality study recommends that patients with AKI should be managed according to the KDIGO Clinical Practice Guideline for AKI, which includes avoidance of high osmolar agents, use of the lowest possible radiocontrast dose, withdrawal of potentially nephrotoxic agents, and adequate hydration with saline before, during, and after the procedure 1.
- Key considerations for patients with AKI undergoing PET scans include:
- Avoiding high osmolar agents
- Using the lowest possible dose of contrast
- Providing adequate hydration with saline
- Withdrawing potentially nephrotoxic agents before and after the procedure
- Assessing kidney function through blood tests before making a decision
- Considering alternative imaging approaches to minimize the risk of kidney damage 1.
From the Research
Contrast-Induced Acute Kidney Injury (AKI) and Iodine Use
- The use of iodinated contrast media in patients with acute kidney injury (AKI) has been a topic of concern due to the potential risk of contrast-induced AKI 2, 3.
- However, recent studies suggest that the risk of contrast-induced AKI may be overestimated for many conditions 4, 5, 6.
- The American College of Radiology and the National Kidney Foundation have issued consensus statements indicating that the risk of AKI developing in patients with reduced kidney function following exposure to intravenous iodinated contrast media has been overstated 5, 6.
Prevention and Management of Contrast-Induced AKI
- Prophylaxis with intravenous normal saline is indicated for patients who have AKI or an estimated glomerular filtration rate less than 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis 5, 6.
- In individual high-risk circumstances, prophylaxis may be considered in patients with an estimated glomerular filtration rate of 30-44 mL/min/1.73 m2 at the discretion of the ordering clinician 5, 6.
- Awareness campaigns and education for health-care professionals on diagnosis and management of AKI, including avoidance of volume depletion, hypotension, and nephrotoxic interventions, can improve outcomes 4.
Use of Iodine for PET Scan in Patients with AKI
- There is no direct evidence to suggest that patients with AKI should not undergo a PET scan with iodine contrast 2, 4, 3, 5, 6.
- However, it is essential to weigh the benefits and risks of using iodinated contrast media in patients with AKI and to consider alternative imaging modalities or contrast agents when possible 5, 6.