Acute Kidney Injury in the Critically Ill

Ehrmann, Stéphan; Badin, J; Savath, Laurent; Pajot, Olivier; Garot, Denis; Pham, Tài; Capdevila, Xavier; Perrotin, D.; Lakhal, Karim

doi:10.1097/ccm.0b013e318275871a

Cited by 50 publications

(29 citation statements)

References 30 publications

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“…Our findings corroborate prior propensity score studies that also found similar rates of AKI, emergent dialysis, and short-term mortality between contrast-enhanced and unenhanced CT scan recipients, even in patients with renal insufficiency 7,10,11,19 . Our current study builds upon these findings in multiple ways.…”

Section: Discussionsupporting

confidence: 90%

Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

McDonald

Lieske

et al. 2015

Mayo Clinic Proceedings

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Objective To examine the effect of intravenous iodinated contrast material administration on the subsequent development of acute kidney injury (AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of Computed Tomography (CT) scan recipients with chronic kidney disease (CKD). Patients and Methods In this IRB approved retrospective study, all CKD patients who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2000 to August 2013 were identified. Patients were subdivided into CKD Stage III (baseline eGFR 30–59 ml/min/1.73m2), and CKD Stage IV–V (baseline eGFR<30 ml/min/1.73m2), subgroups and separately underwent propensity score generation, stratification, and 1:1 matching. Rates of AKI and 30-day emergent dialysis and mortality were compared between contrast and noncontrast groups. Sensitivity analyses examining only patients with stable prescan serum creatinine (SCr) and incorporating IV fluid administration at the time of scan into the model were also performed. Results A total of 6902 patients (4496 CKD Stage III, matched: 1220 contrast/1220 noncontrast; 2086 CKD Stage IV–V, matched: 491 contrast/491 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI, emergent dialysis, and mortality were not significantly higher in the contrast group compared to the noncontrast group in either CKD subset (CKD Stage III OR 0.65–1.00, P<.001–.99, CKD Stage IV–V OR 0.93–2.33, P=.22–.99). Both sensitivity analyses had similar results. Conclusion Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function.

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Section: Discussionsupporting

confidence: 90%

Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

McDonald

Lieske

et al. 2015

Mayo Clinic Proceedings

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“…Arguably, the cardiac catheterization could have been delayed for several weeks, as necessary, following the first exposure during the iodinated CAT scan examination to avoid this double contrast exposure that arguably led to the precipitation of her dialysis-requiring AKI. Although, there is some doubt suggested in the literature whether contrast-induced nephropathy is a significant contributor to hospital-acquired AKI (17,18), the overriding evidence supports such a role, more so with repeated exposure and/ or intra-arterial iodinated contrast as occurs during cardiac catheterization (19)(20)(21). Case III: The 46-year old morbidly obese hypertensive Caucasian male inpatient, stage II CKD, baseline serum creatinine of 1.21 mg/dL eGFR 70 mL/min/1.73 m 2 BSA had a relatively low susceptibility to renal injury at the time of the elective procedure.…”

Section: Discussionmentioning

confidence: 99%

Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury – A case series analysis and a call for more preventative nephrology practices

Onuigbo¹,

Samuel²,

Agbasi³

2017

J Nephropharmacol

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“…Three among them [20,21,41] used propensity matching methods guaranteeing that the group exposed to IV contrast material and unexposed group had similar baseline characteristics and had a same likelihood of being exposed to IV contrast material. Moreover, two studies [20,21] among the three that used propensity matching methods used data collected over 10 years (from 2000 to 2010) and recruited 41,614 patients.…”

Section: Discussionmentioning

confidence: 99%

Does intravenous contrast-enhanced computed tomography cause acute kidney injury? Protocol of a systematic review of the evidence

et al. 2014

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BackgroundContrast-induced acute kidney injury is a common cause of iatrogenic acute kidney injury (AKI). Most of the published estimates of AKI after contrast use originate from the cardiac catheterization literature despite contrast-enhanced computed tomography (CT) scans being the more common setting for contrast use. This systematic review aims to summarize the current evidence about (1)the risk of AKI following intravenous (IV) contrast-enhanced CT scans and(2) the risk of clinical outcomes (i.e. death, hospitalization and need for renal replacement therapy) due to IV contrast-enhanced CT scans.Methods/DesignA systematic literature search for published studies will be performed using MEDLINE, EMBASE and The COCHRANE Library databases. Unpublished studies will be identified by searching through grey literature. No language restriction will be applied.The review will consider all studies that have examined the association between IV contrast media and AKI. To be selected, the study should include two arms: one group of exposed patients who received IV contrast material before CT scans and one group of unexposed group who did not receive contrast material before CT scans. Two authors will independently screen titles and abstracts obtained from electronic databases, extract data and will assess the quality of the studies selected using the Cochrane's ‘Risk of Bias’ assessment tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. A random-effects meta-analysis will be performed if there is no remarkable heterogeneity between studies.DiscussionThis systematic review will provide synthesis of current evidence around the effect of IV contrast material on AKI and other clinical outcomes. Results will be helpful for making evidence-based recommendations and guidelines for clinical and radiologic settings.Systematic review registrationPROSPERO CRD42013003799.

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Acute Kidney Injury in the Critically Ill

Cited by 50 publications

References 30 publications

Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury – A case series analysis and a call for more preventative nephrology practices

Does intravenous contrast-enhanced computed tomography cause acute kidney injury? Protocol of a systematic review of the evidence

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