1/ This is the 4th #tweetorial #MedThread on contrast nephropathy from my grand rounds. For more information take a look here: pbfluids.com/2019/11/contra…
2/ The 1st #Tweetorial dealt with the lack of evidence tying contrast to AKI. The 2nd looked at the outcomes of patients who develop AKI after contrast. The 3rd looked at cholesterol emboli as an etiology of AKI after cath. Links to all the tweetorials are at the blog post above
3/ This #tweetorial is a response to the concern that “All of that epidemiology information showing contrast is okay is fine and well but I’d rather be safe than sorry so I will avoid contrast in my CKD patients anyways”
4/ This desire to be extra careful can backfire on your patients and put them at increased risk of misdiagnosis. This under-treatment of kidney patients is called "Renalism" 
5/ Renalism. Look at the % receiving contrast. As soon as the Cr turns red or gets marked with an "H" contrast use drops off a cliff. No reason to think the patient with a Cr of 1.6 has a less of an indication for contrast than a patient with a creatinine of 0.6.
6/ Even more powerful evidence comes from myocardial infarction patients. Chertow showed that CKD patients were less likely to get angiograms with acute myocardial infarction. And this translated to higher mortality n patients where an angiogram was indicated.
7/ This pattern of CKD patients getting fewer angiograms has been repeated multiple times.
8/ These two images are from @PulmCrit and his excellent post on contrast nephropathy in the Internet Book of Critical Care (emcrit.org/ibcc/contrast/). I think they are self-explanatory and are where we should be moving in the discussion of contrast nephropathy.
