Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: Incidence and outcome

Lakhal, Karim; Ehrmann, Stéphan; Chaari, Anis; Laissy, Jean-Pierre; Régnier, B.; Wolff, Michel; Pajot, Olivier

doi:10.1016/j.jcrc.2011.05.010

Cited by 93 publications

(74 citation statements)

References 11 publications

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“…In accordance with recent smaller published series using different case-mix populations [2,3], they found a 16 to 22% incidence of AKI according to the definition used. They also identified risk factors and underlined the negative impact of such subsequent AKI on patient outcomes, including the need for renal replacement therapy, length of ICU and hospital stays, and mortality.…”

supporting

confidence: 89%

Contrast “induced” versus “associated” acute kidney injury: take care with the definition

Valette

Cheyron

2012

Intensive Care Med

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supporting

confidence: 89%

Contrast “induced” versus “associated” acute kidney injury: take care with the definition

Valette

Cheyron

2012

Intensive Care Med

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“…In the matched control group, not receiving CM, only 1% only 1% had a sCr elevation >25%. In another study on critically ill patients renal replacement therapy was needed within 7 days in 21% of the patients developing CIN after a CM-enhanced CT [29]. Furthermore, CIN was independently associated with ICU mortality.…”

Section: Severity Of Cin and Mortalitymentioning

confidence: 94%

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

et al. 2012

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We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, 5) roughly the same gramiodine/GFR ratio (≈1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and 6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points• Most intra-arterial injections of contrast media are intravenous relative to the kidneys.• No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial.• Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. • Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies.

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“…AKIN criteria (21) are a standardized definition of AKI that have been used in other studies that evaluated CIN (18,22,23). AKIN criteria were used in our study for several reasons: (a) post-CT AKI is not always because of CIN; (b) use of this definition allows comparison of AKI rates because of CIN-to-AKI rates that result from other nephrotoxic agents or conditions; (c) AKIN criteria were recently compared in a large, similarly conducted, propensity-matched study (18) and found to be similar to the more traditional definition of CIN (absolute SCr increase  0.5 mg/dL or increase in SCr 1.25-fold above baseline); and (d) the American College of Radiology recently advocated use of the AKIN criteria as a way to standardize the historically varied definitions of CIN in the literature (12).…”

Section: Advances In Knowledgementioning

confidence: 99%

Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material: Risk Stratification by Using Estimated Glomerular Filtration Rate

Davenport¹,

Khalatbari²,

Cohan³

et al. 2013

Radiology

317

225

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Purpose:To determine the effect of intravenous (IV) low-osmolality iodinated contrast material (LOCM) on the development of post-computed tomography (CT) acute kidney injury (AKI), stratified by pre-CT estimated glomerular filtration rate (eGFR), in patients with stable renal function. Materials and Methods:Institutional review board approval was obtained and patient consent waived for this HIPAA-compliant, retrospective study. CT examinations performed over a 10-year period on unique adult inpatients with sufficient serum creatinine (SCr) data and stable renal function (difference between baseline and pre-CT SCr within 0.3 mg/dL and 50% of baseline) were identified. A 1:1 propensity score matched cohort analysis with multivariate analysis of effects was performed with post-CT AKI as the primary outcome measure (8826 nonenhanced and 8826 IV contrast agent-enhanced CT studies in 17 652 patients). Propensity matching was performed with respect to likelihood of receiving IV contrast material (19 tested covariates). Post-CT AKI with Acute Kidney Injury Network SCr criteria was the primary endpoint. A stepwise multivariate conditional logistic regression model was performed to identify the effect of IV LOCM on post-CT AKI. Results:After 1:1 propensity matching, IV LOCM had a significant effect on the development of post-CT AKI (P = .04). This risk increased with decreases in pre-CT eGFR (60 mL/ min/1.73 m 2 : odds ratio, Conclusion:IV LOCM is a nephrotoxic risk factor in patients with a stable eGFR less than 30 mL/min/1.73 m 2 , with a trend toward significance at 30-44 mL/min/1.73 m 2 . IV LOCM does not appear to be a nephrotoxic risk factor in patients with a pre-CT eGFR of 45 mL/min/1.73 m 2 or greater.q RSNA, 2013

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Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: Incidence and outcome

Cited by 93 publications

References 11 publications

Contrast “induced” versus “associated” acute kidney injury: take care with the definition

Contrast “induced” versus “associated” acute kidney injury: take care with the definition

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material: Risk Stratification by Using Estimated Glomerular Filtration Rate

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