Contrast-Induced Nephropathy in Elderly Trauma Patients

McGillicuddy, Edward A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maung, Adrian A.; Lui, Felix Y.; Maerz, Linda L.; Johnson, Dirk C.; Davis, Kimberly A.

doi:10.1097/ta.0b013e3181cf7e40

Cited by 65 publications

(64 citation statements)

References 23 publications

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“…Our conclusions differed from those in recently published reports (21)(22)(23)(24)(25)(26), perhaps because of the different methodologic parameters used in this study. Patients with a stable SCr level that was less than 1.5 mg/dL (132.60 mmol/L) did not have a significantly increased risk of post-CT AKI (P = .25).…”

Section: Discussioncontrasting

confidence: 57%

“…However, there are many other factors that contribute to the development of post-CT AKI, and not all cases of post-CT AKI are due to CIN. These factors likely account for the equivalence in post-CT AKI rates after unenhanced and contrast-enhanced CT shown in recent reports (21)(22)(23)(24)(25)(26). If these factors are not controlled, it is impossible to isolate the role of contrast material in the development of post-CT AKI.…”

Section: Discussionmentioning

confidence: 97%

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Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material

Davenport¹,

Khalatbari²,

Dillman³

et al. 2013

Radiology

192

156

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Purpose:To determine whether intravenous low-osmolality iodinated contrast material is associated with post-computed tomography (CT) acute kidney injury (AKI). 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 in adult inpatients with sufficient serum creatinine (SCr) data were identified. A one-to-one propensity-matched matched cohort analysis with multivariate analysis of effects was performed with post-CT AKI as the primary outcome measure (10 121 unenhanced and 10 121 intravenous contrast-enhanced CT examinations in 20 242 patients). Propensity matching was performed with respect to likelihood of patient receiving intravenous contrast material (36 tested covariates). The primary endpoint was post-CT AKI by using Acute Kidney Injury Network SCr criteria; the secondary endpoint was post-CT AKI by using traditional SCr criteria for contrast material-induced nephrotoxicity (CIN Results:Intravenous low-osmolality iodinated contrast material had a significant effect on the development of post-CT AKI for patients with pre-CT SCr levels of 1.6 mg/dL (141.44 mmol/L) or greater (odds ratio, 1.45; 95% confidence interval [CI]: 1.11, 1.89;P = .007). This effect strengthened as pre-CT SCr increased. Patients with stable SCr less than 1.5 mg/dL (132.60 mmol/L) were not at risk for developing CIN (P = .25, power . 95%). Both endpoints demonstrated similar results (eg, SCr 1.6 mg/dL [141.44 mmol/L] by using traditional CIN criteria: odds ratio, 1.64; 95% CI: 1.18, 2.28; P = .003). Post-CT AKI was prevalent in both the unenhanced and contrast-enhanced CT subgroups, and it increased with increases in pre-CT SCr. Many risk factors contributed to development of post-CT AKI, regardless of iodinated contrast material. Conclusion:Intravenous low-osmolality iodinated contrast material is a nephrotoxic risk factor, but not in patients with a stable SCr level less than 1.5 mg/dL. Many factors other than contrast material can affect post-CT AKI rates.q RSNA, 2013

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 97%

Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material

Davenport¹,

Khalatbari²,

Dillman³

et al. 2013

Radiology

192

156

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“…In addition, it is known that estimated glomerular filtration rate (eGFR) is more accurate than SCr at T he incidence of contrast materialinduced nephrotoxicity (CIN) in the setting of intravenously (IV) administered low-osmolality contrast material (LOCM) (ie, that administered routinely for contrast-enhanced computed tomography [CT] studies) is controversial (1)(2)(3)(4). In recent years, retrospective studies have shown similar rates of post-CT acute kidney injury (AKI) in nonenhanced and contrast-enhanced CT populations (2,(5)(6)(7)(8)(9)(10), which led some to question the incidence of CIN in this setting and whether it occurs at all (3,4). This topic has considerable clinical relevance because concern for renal toxicity is a main reason to avoid IV contrast material in some patients (11)(12)(13)(14)(15).…”

Section: Subjectsmentioning

confidence: 99%

“…This contributes noise to any CIN analysis, and many patients may be assigned a diagnosis of CIN when other nephrotoxic agents or conditions are to blame (16,17). The nonenhanced CT population has been used as a way to control for baseline post-CT AKI risk (2,(5)(6)(7)(8)(9)(10), but this is insufficient because it does not address the numerous risk factors for CIN (eg, diabetes mellitus or pre-CT AKI), in addition to chronic renal insufficiency, that may cause iodinated contrast material to be withheld. Because a large fraction of patients who are examined with nonenhanced CT have nephrotoxic risk factors that are directly responsible for the clinical avoidance of contrast material, the nonenhanced and contrast-enhanced CT populations are fundamentally different.…”

Section: Subjectsmentioning

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

315

224

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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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“…[1][2][3][4] RCN is a leading cause of hospital-acquired renal insufficiency 5 and is associated with increased mortality both during hospitalization and after discharge. 1,4,[6][7][8] The rate of RCN after ED CECT varies greatly by study and has been reported as 2% to 3% in patients undergoing computed tomography (CT) angiography for stroke, 9-11 2% to 5% in trauma patients undergoing various studies, [12][13][14][15] 4.5% in patients undergoing …”

mentioning

confidence: 99%

Risk Factors for Radiocontrast Nephropathy After Emergency Department Contrast‐enhanced Computerized Tomography

Traub

Kellum

Tang

et al. 2013

Academic Emergency Medicine

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Objectives: Radiocontrast nephropathy (RCN) is a known complication of procedures in which intravascular iodinated contrast material is used. The authors sought to determine the risk factors for RCN after emergency department (ED) contrast-enhanced computerized tomography (CECT).Methods: This was a retrospective case-control study of patients presenting to a tertiary care ED between January 1, 2004, and December 31, 2006. Inclusion criteria were CECT performed in the ED, serum creatinine measured prior to CECT, and serum creatinine measured 48 to 96 hours after CECT. Exclusion criterion was dialysis-dependent renal failure prior to CECT. The outcome of RCN was defined as an absolute creatinine increase of greater than or equal to 0.5 mg/dL, or a 25% increase above baseline. The charts of all RCN patients and a random sample of non-RCN patients were reviewed to document the presence or absence of potential risk factors. Univariate analysis was performed using chisquare and multiple logistic regression applying a weighted technique to account for sampling of non-RCN patients.Results: Among the 5,006 patients meeting inclusion criteria, 349 (7%) developed RCN. Multiple regression analysis demonstrated that serum creatinine > 2 mg/dL, liver disease, heart failure, hematocrit < 30%, hypertension, and diabetes were risk factors for RCN, whereas age > 75 years, vascular disease, and serum creatinine > 1.5 mg/dL were not. The area under the curve (AUC) for the model was 0.65. Although the risk of RCN increased with the number of risk factors present, we could not develop a model with sufficient diagnostic accuracy to guide clinical decision-making. Conclusions:The authors report risk factors for RCN in a large case-control study, but could not develop an accurate decision tool to identify patients at increased risk for RCN after ED CECT.ACADEMIC EMERGENCY MEDICINE 2013; 20:40-45 © 2013 by the Society for Academic Emergency Medicine R adiocontrast nephropathy (RCN) is a known complication of procedures that use intravascular radiocontrast media. Although most of the medical literature regarding RCN describes patients undergoing coronary procedures, RCN may occur after emergency department (ED) contrast-enhanced computerized tomography (CECT) as well. RCN is usually defined as an absolute increase in serum creatinine of 0.5 mg/dL or a relative increase of 25% above baseline value several days after contrast administration. [1][2][3][4] RCN is a leading cause of hospital-acquired renal insufficiency 5 and is associated with increased mortality both during hospitalization and after discharge. 1,4,[6][7][8] The rate of RCN after ED CECT varies greatly by study and has been reported as 2% to 3% in patients undergoing computed tomography (CT) angiography for stroke, 9-11 2% to 5% in trauma patients undergoing various studies, [12][13][14][15] 4.5% in patients undergoing

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Contrast-Induced Nephropathy in Elderly Trauma Patients

Abstract: IV contrast media in elderly trauma patients is not associated with an increased risk of AKI. Development of AKI within 72 hours of admission is associated with mortality and increased length of stay.

Cited by 65 publications

References 23 publications

Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material

Contrast Material–induced Nephrotoxicity and Intravenous Low-Osmolality Iodinated Contrast Material

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

Risk Factors for Radiocontrast Nephropathy After Emergency Department Contrast‐enhanced Computerized Tomography

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