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Safety of Iodinated Contrast Use for Kidney CT Reaffirmed

By MedImaging International staff writers
Posted on 06 Feb 2020

New consensus statements declare that concerns over potential harms associated with intravenous (IV) contrast use for computerized tomography (CT) for kidney disease have been overstated.

The statements, issued by the American College of Radiology (ACR; Reston, VA, USA) and the National Kidney Foundation (New York, NY, USA), suggest that this is primarily to a historic lack of control groups sufficient to separate between contrast-induced acute kidney injury (CI-AKI) and contrast-associated AKI (CA-AKI), which is coincident to contrast media administration. The new consensus statements underscore the differences between them, and suggest properly distinguishing between the two in order to minimize overstating the risk of contrast use.

The ACR and National Kidney Foundation concluded that the use of intravenous contrast CT was safe for patients who have AKI, or have an estimated glomerular filtration rate (eGFR) of less than 30 mL/min per 1.73 m2; prophylaxis with intravenous normal saline is recommended. In individual high-risk circumstances, prophylaxis may be considered in patients with a higher estimated glomerular filtration, at the discretion of the ordering clinician. Contraindications include patients suffering from heart failure (HF), or if they are not undergoing maintenance dialysis.

Other key recommendations in the consensus statements are to avoid lowering IV contrast media dose below the diagnostic threshold; to avoid initiating or altering renal replacement therapy based solely on contrast media administration; to not allow the presence of a solitary kidney to influence the decision-making process regarding contrast-induced kidney injury; and to withhold prescribing toxic medications to high-risk patients. The statements were published on January 21, 2020, in Radiology.

“Whereas contrast-induced acute kidney injury suggests a causal relationship between contrast use and nephrotoxicity, contrast-associated injury indicates that there is no direct causal relationship between the two. Yet these two concepts are often incorrectly interlinked,” said Matthew Davenport, MD, of the University of Michigan (Ann Arbor, USA), who led the two consensus groups. “Modern data clarify that this perceived risk has been overstated. Our intent is to provide multidisciplinary guidance regarding the true risk to patients and how to apply a consideration of that risk to modern clinical practice.”

IV iodinated contrast media are commonly used with CT to evaluate disease and to determine treatment response. Radiologists and clinicians are routinely charged with balancing the potential risks of contrast media administration with diagnostic benefits, but this is often fraught with confusion, uncertainty, and heterogeneity, especially in AKI patients. As a result, iodinated contrast media is often denied or delayed in patients with reduced kidney function due to perceived risks of CI-AKI, creating potential for indirect harm related to delayed diagnosis and misdiagnosis.

Related Links:
American College of Radiology
National Kidney Foundation

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67 (272.98927307129): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

68 (51.975250244141): select jos_twitters.link from jos_twitters where cat=10

69 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

70 (28.848648071289): select jos_google_plus.link from jos_google_plus where cat=10

71 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

72 (!!!!! 2817.8691864014): SELECT fid FROM jos_deeppockets WHERE id=294780788 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294780788 AND published='1' LIMIT 1

73 (61.03515625): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

74 (342.13066101074): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (339.03121948242): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (46.968460083008): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

77 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (28.848648071289): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (32.901763916016): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

94 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

109 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

110 (61.988830566406): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294780788 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (422.00088500977): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294780788 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

113 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

114 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294780788 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (493.04962158203): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294780788 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (586.98654174805): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (347.13745117188): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

119 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

120 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

121 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

122 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

123 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

124 (273.9429473877): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 36013.126373291): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

127 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

128 (419.85511779785): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780788 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780788 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 935407.16171265): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (123.97766113281): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (432.01446533203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (60.081481933594): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (254.15420532227): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (270.12825012207): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (85.115432739258): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (349.04479980469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (312.08992004395): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (126.12342834473): SELECT name FROM jos_deeppockets WHERE id=211

140 (34.093856811523): SELECT name FROM jos_deeppockets WHERE id=211

141 (421.04721069336): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (389.09912109375): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

144 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

145 (!!!!! 4364.9673461914): TRUNCATE TABLE jos_trademed_module

146 (146.86584472656): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294780788 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (93.936920166016): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294780788 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (375.98609924316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (194.78797912598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

151 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

152 (!!!!! 1000.8811950684): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

154 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

155 (36.954879760742): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780788 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780788 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (31.948089599609): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

157 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

158 (28.133392333984): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (134.94491577148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

160 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780788 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780788 AND published='1' LIMIT 1

161 (138.99803161621): select jos_twitters.link from jos_twitters where cat=10

162 (49.114227294922): select jos_facebook.link from jos_facebook where cat=10

163 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

164 (46.014785766602): select jos_linkedin.link from jos_linkedin where cat=10

165 (299.93057250977): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 6593.9426422119): insert into jos_banners_delta values (14615,'2025-05-02 14:48:20','3.128.78.139','view'),(14202,'2025-05-02 14:48:20','3.128.78.139','view'),(14203,'2025-05-02 14:48:20','3.128.78.139','view')

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