Contrast-induced acute kidney injury (CI-AKI) is defined as a rise in serum creatinine by what threshold within 48 hours of contrast administration, according to the 2023 KDIGO AKI guidelines?
- A ≥ 0.5 mg/dL (44 µmol/L) or ≥ 25% increase from baseline
- B ≥ 0.3 mg/dL (26.5 µmol/L) or ≥ 50% increase from baseline ✓
- C ≥ 1.0 mg/dL regardless of baseline
- D Any creatinine rise requiring dialysis within 72 hours
Correct answer: B. ≥ 0.3 mg/dL (26.5 µmol/L) or ≥ 50% increase from baseline
Explanation
CI-AKI (now termed post-contrast AKI per newer KDIGO 2023 guidance) uses the standard AKI definition: creatinine rise ≥0.3 mg/dL (26.5 µmol/L) within 48 hours OR ≥1.5× baseline within 7 days. Risk is significantly higher in baseline CKD (especially eGFR <30), diabetes, dehydration, and with high-osmolality contrast volumes. Pre-hydration with IV isotonic saline remains the principal preventive strategy; N-acetylcysteine is no longer recommended (PRESERVE trial). The older 0.5 mg/dL threshold is outdated.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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