Last week at the end of a morning conferance there was an impromptu discussion of the problem of residents ordering IV contrast for patients with acute kidney injury. The residents see a patient on dialysis and feel that its open season for contrast.
As part of the discussion one of the attendings mentioned this is also a problem with his PD patients with residual renal function and the residents need to know that contrast should be avoided in these patients to preserve residual renal function. I mentioned that actually the data doesn't support the common sense notion that contrast accelerates the loss of residual renal function. Immediately all eyes were on me and the consensus was that no one else had seen that data and that I was way off the reservation. Pretty uncomfortable place to be.
I had buttoned holed Paul Palevsky at the 2006 ASN Renal Week after a talk on contrast nephropathy and in that hallway conversation he had mentioned that he had just finished research on this vary question. he only reason I remember it was that the results were so counter intuitive. Contrast has no measurable affect on residual renal function. I had actually never seen the article but now I had put up or shut up.
Tim Hortons (the best thing to come out of Canada since Douglas Coupland) and fired up PubMed on Tap (PMT).
PMT is an app dedicated to adapting the PubMed database to the constraints of a mobile platform. I used an app by the same name on my old Treo. Adding Palevsky as author, and then contrast and residual renal function as text words.
Bingo! One article:
You can pull up the abstract:
and the PubMed listing:
I then did a less specific search by dropping the author name and found a higher quality study:
I was able to send the references to my colleagues right from the application. Sweet.