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This prospective clinical study looked at 42 diabetic patients with chronic kidney disease (CKD) stages 3a through 5 to determine whether fundus fluorescein angiography (FA) causes any worsening of kidney function. The researchers compared serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR) before the procedure and again 48 to 72 hours afterward. They found no statistically significant changes in any of these markers, suggesting that low-dose fluorescein angiography does not cause contrast-induced acute kidney injury or worsen underlying kidney disease in this high-risk population.
One of the biggest takeaways for me was learning that sodium fluorescein is a non-iodinated dye. Before reading this article, I automatically associated any type of contrast with nephrotoxicity because we are constantly taught to be cautious with iodinated contrast in patients with CKD. This study reminded me that not all contrast agents behave the same way. I also thought it was interesting that the authors were able to use a half-dose of fluorescein while still producing high-quality retinal images, showing that reducing the dose may further improve safety without sacrificing diagnostic value.
I also appreciated how the authors addressed the conflicting literature. Some older studies reported much higher rates of acute kidney injury after fluorescein angiography, but this paper suggested those findings may have been related to the larger doses that were used in the past. At the same time, I think it is important to recognize the study’s limitations. The sample size was fairly small, especially since only two patients had stage 5 CKD. In addition, patients taking medications such as ACE inhibitors, ARBs, and intravenous diuretics were excluded, even though these are medications many diabetic CKD patients take every day. Because of that, I do not think the results can automatically be applied to every patient we see in clinical practice.
Overall, I think this study has important implications for patient care. If additional research continues to support these findings, low-dose fluorescein angiography could potentially be performed without unnecessary nephrology consultations or repeated renal function testing in many patients. That could reduce healthcare costs, prevent delays in diagnosing diabetic retinopathy, and allow patients to receive treatment sooner. While I would still like to see larger studies with more patients who have advanced CKD, this article definitely gave me more confidence that fluorescein angiography appears to be much safer for the kidneys than I initially assumed.
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