Table 2 Key messages

Nephrotoxicity directly attributable to iodinated CM has been probably exaggerated. One should not refrain from administering CM if deemed necessary

On the other hand, CM is not totally devoid of risks and its use still requires to be wisely weighted

The vast majority of risk factors for CA-AKI are frequent among critically ill patients

Whatever the causal link with iodinated CM, the development of AKI should be anticipated or at least diagnosed early in order to withhold nephrotoxic medications and to adjust the dosage of medications cleared by the kidneys

For the prevention of CA-AKI, as for other causes of AKI, avoiding concomitant renal insults (including withholding nephrotoxic drugs and ensuring correct volemic status) is more effective than initiating specific pharmacological measures which are of no or doubtful utility

Prophylactic RRT seems not justified

There is no need for adapting the schedule of RRT or of the imaging procedure in patients with chronic RRT for end-stage renal disease

Whether intra-arterial administration of modern CM with second-pass exposure is more toxic to the kidney than intravenous CM is unlikely. Uncertainty remains for CM administration with first-pass exposure. Importantly, intra-arterial procedures expose to renal complications which are unrelated to CM toxicity (embolism, circulatory failure, etc.)