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

Abstract

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

Contrast induced nephropathy

“…Recent data show that CIN is rarely seen in patients with an estimated glomerular filtration rate (eGFR) greater than 45 ml/min/1.73m 2 , although stage IV and V chronic kidney disease is one of the main risk factors for the development of CIN. 1,5,6 Other risk factors for CIN include: diabetes; congestive heart failure; age over 70 years; hypovolemia; concomitant use of nephrotoxic agents and non-steroidal anti-inflammatory drugs.…”

Assessment of the Hepatic Veins in Poor Contrast Conditions using Dual Energy CT: Evaluation of a Novel Monoenergetic Extrapolation Software Algorithm

“…Therefore, MEI+ images at 40 keV could be regarded as ideal for the depiction of intrahepatic vessels [17]. Furthermore, this algorithm-based post-processing is a promising candidate for calculated saving of contrast media, from which patients with reduced kidney function might benefit [3,4,18,19]. These improved post-processing capabilities at low virtual keV values might also increase the sensitivity for the detection of soft-tissue lesions, e. g. in melanoma.…”

Contrast-associated acute kidney injury is a myth: We are not sure

“…Most studies found no difference in the incidence of AKI among matched patients. Subgroup analyses based on baseline kidney function also did not show any differences, except for the study by Davenport that found a higher AKI incidence after contrast in advanced chronic kidney disease (CKD) [3]. McDonald found a greater need for dialysis in ICU patients with pre-CT eGFR ≤ 45 ml/l/BSA (6.7% vs 2.5%; OR 2.72 (1.44-6.46), however, without impact on the AKI creatinine criterion [4].…”