Produits de contraste iodés et gadolinés chez les patients atteints de maladie rénale chronique : revue des recommandations internationales (SFNDT/SFR, ESUR, ACR/NKF, CAR)

Introduction: The renal risks of iodinated contrast media (ICM) and the association of gadolinium-based contrast agents (GBCAs) with nephrogenic systemic fibrosis (NSF) have been recently reassessed. Methods: International guidelines (Société francophone de néphrologie, dialyse et transplantation/Société française de radiologie [SFNDT/SFR], European Society of Urogenital Radiology [ESUR], American College of Radiology/National Kidney Foundation [ACR/NKF], Canadian Association of Radiologists [CAR] 2018–2025) were reviewed, focusing on risk stratification, preventive measures, and the use of ICM and GBCAs in patients with chronic kidney disease (CKD). Results: Post-contrast acute kidney injury risk is low for eGFR ≥ 30 mL/min/1.73 m². Hydration is recommended only for eGFR < 30 mL/min/1.73 m² or first-pass intra-arterial injections. Group II GBCAs are considered safe even in advanced CKD or dialysis, with a single unconfirmed NSF case reported. Discussion: Differences between guidelines reflect their timing and limited evidence. Preventive measures should focus on the highest-risk situations. Conclusion: Clinical indication should guide imaging, which should not be delayed, and recent guidelines support a rational, risk-based approach to contrast media use.