Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter                     Emergency Department–based Study

Su, Tse‐Hsuan; Hsieh, Chih-Huang; Chan, YC; Wong, Yon-Cheong; Kuo, Chang‐Fu; Li, Chih-Huang; Lee, Cheng‐Chia; Chen, Hsien-Yi

doi:10.1148/radiol.2021204446

Cited by 26 publications

(19 citation statements)

References 35 publications

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“…Patients with CKD, particularly diabetic kidney disease, are most susceptible to CIN [ 6 , 25 , 26 ]. Contrast-enhanced computed tomography (CECT) was associated with higher risk of AKI in patients with estimated GFR (eGFR) less than 30 mL/min/1.73 m 2 (OR 1.36, 95% CI 1.09–1.70, p = 0.007), but not in patients with an eGFR greater than 45 mL/min/1.73 m 2 [ 27 ]. Similarly, in cancer patients who underwent CECT using a reduced dose of iodixanol, the incidence of CIN was reported to increase according to eGFR: 4.6% for eGFR 45–60 mL/min/1.73 m 2 , 7.4% for eGFR 30–45 mL/min/1.73 m 2 , and 16.7% for eGFR < 30 mL/min/1.73 m 2 [ 28 ].…”

Section: Risk Factorsmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

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Section: Risk Factorsmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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“…Two studies focused on critically ill [28,29] and two on pediatric patients [30,31]. Four studies consisted of patients admitted via emergency department [32][33][34][35]; one study examined nephrotic syndrome patients [36]; two focused on patients with chronic kidney disease (CKD) [37,38]; and two on patients hospitalized with AKI [39,40]. Two groups studied septic [38,41] and one cancer patients [42].…”

Section: Resultsmentioning

confidence: 99%

“…Eight groups reported more than one SCr measurement without disclosing the exact number [24,26,32,39,[43][44][45][46]. For the remaining studies, the number of measurements was not disclosed [23,25,27,30,31,34,35,38].…”

Section: Serum Creatinine Measurements For Aki Diagnosismentioning

confidence: 99%

Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score–matched cohort studies

et al. 2022

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Objectives Intravenous application of contrast media is part of a wide spectrum of diagnostic procedures for better imaging quality. Clinical avoidance of contrast-enhanced imaging is an ever-present quandary in patients with impaired kidney function. The objective of this study was to estimate the risk for acute kidney injury (AKI), dialysis and mortality among patients undergoing contrast-enhanced CT compared to propensity score–matched controls (i.e. contrast-unenhanced CT). Selected cohort studies featured high-risk patients with advanced kidney disease and critical illness. Methods This review was designed to conform to the Preferred Reporting Items in Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed was searched from August 2021 to November 2021 for all-language articles without date restriction. A random-effects model (DerSimonian and Laird method) was used for meta-analysis. Results Twenty-one articles were included, comprising data of 169,455 patients. The overall risk of AKI was similar in the contrast-enhanced and unenhanced groups (OR: 0.97 [95% CI: 0.85; 1.11], p = 0.64), regardless of baseline renal function and underlying disease. Substantial heterogeneity was detected (I2 = 90%, p ≤ 0.0001). Multivariable logistic regression identified hypertension (p = 0.03) and estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 (p = 0.0001) as factors associated with greater risk of post-contrast AKI. Conclusions Based on propensity score–matched pairs obtained from 21 cohort studies, we found no evidence for increased risk for AKI, dialysis or mortality after contrast-enhanced CT among patients with eGFR ≥ 45 mL/min/1.73 m2. In congruence with the emerging evidence in the literature, caution should be exercised in patients with hypertension and eGFR ≤ 30 mL/min/1.73 m2. Key Points • The application of contrast media for medical imaging is not associated with higher odds for AKI, induction of renal replacement therapy, or mortality. Many comorbidities traditionally associated with greater risk for acute kidney injury do not appear to predispose for renal decline after contrast media exposure. • Underlying hypertension and eGFR less than or equal to 30 mL/min/1.73 m2seem to predispose for post-contrast acute kidney injury. • Propensity score matching cannot account for unmeasured influences on AKI incidence, which needs to be addressed in the interpretation of results.

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“…Patients with serious AKI frequently have worse renal function at the time of hospital discharge [ 4 ]. The common risk factors for AKI include sepsis, cardiogenic shock, acute heart failure, surgeries (i.e., cardiac, abdominal, and organ transplantation), trauma, nephrotoxic medications, contrast agents, and chronic kidney disease [ 6 – 10 ]. At present, hemodynamic and fluid status optimization and avoidance of nephrotoxins are the principal therapeutic approaches [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Molecular mechanisms underlying the renal protective effects of coenzyme Q10 in acute kidney injury

Zhao

Wu²,

Liao

et al. 2022

Cell Mol Biol Lett

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Coenzyme Q10 (CoQ10), an endogenous antioxidant, has been reported frequently to exert an outstanding protective effect on multiple organ injury, including acute kidney injury (AKI). In this study, we aim to summarize all the current evidence of the protective action of CoQ10 against AKI as there are presently no relevant reviews in the literature. After a systematic search, 20 eligible studies, either clinical trials or experimental studies, were included and further reviewed. CoQ10 treatment exhibited a potent renal protective effect on various types of AKI, such as AKI induced by drugs (e.g., ochratoxin A, cisplatin, gentamicin, L-NAME, and nonsteroidal anti-inflammatory drug), extracorporeal shock wave lithotripsy (ESWL), sepsis, contrast media, and ischemia–reperfusion injury. The renal protective role of CoQ10 against AKI might be mediated by the antiperoxidative, anti-apoptotic, and anti-inflammatory potential of CoQ10. The molecular mechanisms for the protective effects of CoQ10 might be attributed to the regulation of multiple essential genes (e.g., caspase-3, p53, and PON1) and signaling cascades (e.g., Nrf2/HO-1 pathway). This review highlights that CoQ10 may be a potential strategy in the treatment of AKI.

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Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department–based Study

Cited by 26 publications

References 35 publications

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score–matched cohort studies

Molecular mechanisms underlying the renal protective effects of coenzyme Q10 in acute kidney injury

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