Is intravenous iodinated contrast medium administration really harmful in hospitalized acute kidney injury patients: a propensity score–matched study

Yan, Ping; Zhang, Ning-Ya; Luo, Xiao-Qin; Wang, Mei; Deng, Ying-Hao; Wu, Ting; Wu, Xiaoxiang; Liu, Qian; Wang, Hongshen; Wang, Lin; Kang, Yixin; Duan, Shao‐Bin

doi:10.1007/s00330-021-08192-2

Cited by 7 publications

(9 citation statements)

References 30 publications

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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%

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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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Section: Resultsmentioning

confidence: 99%

“…In three studies, the window for post-contrast SCr measurement reached from 48 to 72 h [ 33 , 34 , 41 ], one of which added a second time point between 48 h and 1 week. One group measured the SCr levels for 1 month after index CT [ 40 ], while one study refrained from defining the time period [ 39 ].…”

Section: Resultsmentioning

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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“…In critically ill ICU patients, it was found that contrast is not a risk factor for the development of AKI 18 . For nontrauma medical patients, it has been shown that contrast is not a risk factor for the development of AKI, that contrast exposure does not worsen outcomes for those admitted for AKI, and that transient rises of serum creatinine meeting the criteria of CI-AKI occur sporadically in hospitalized medical patients without contrast exposure 19–22 . These findings are important to consider when reevaluating the concern for contrast administration in trauma patients.…”

Section: Discussionmentioning

confidence: 99%

“…The mean age of the study population was 45 years (SD, 19.1 years), 497 patients (75%) were male, and the median ISS was 25. 8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] Characteristics of the overall cohort are shown in Table 1. A total of 75 patients (11%) developed MOF.…”

Section: Population Characteristicsmentioning

confidence: 99%

Acute kidney injury development in polytrauma and the safety of early repeated contrast studies: A retrospective cohort study

Giles

Weaver

Varghese

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The role of repeat intravenous contrast doses beyond initial contrast imaging in the development of acute kidney injury (AKI) for multiple injury patients admitted to the intensive care unit (ICU) is not fully understood. We hypothesized that additional contrast doses are potentially modifiable risk factors for worse outcomes. METHODS:An 8-year retrospective study of our institutional prospective postinjury multiple organ failure database was performed. Adult ICU admissions that survived >72 hours with Injury Severity Score (ISS) of >15 were included. Patients were grouped based on number of repeat contrast studies received after initial imaging. Initial vital signs, resuscitation data, and laboratory parameters were collected. Primary outcome was AKI (Kidney Disease: Improving Global Outcomes criteria), and secondary outcomes included contrast-induced acute kidney injury (CI-AKI; >25% or >44 μmol/L increase in creatinine within 72 hours of contrast administration), multiple organ failure, length of stay, and mortality. RESULTS:Six-hundred sixty-three multiple injury patients (age, 45.3 years [SD, 9.1 years]; males, 75%; ISS, 25 (interquartile range, 20-34); mortality, 5.4%) met the inclusion criteria. The incidence of AKI was 13.4%, and CI-AKI was 14.5%. Multivariate analysis revealed that receiving additional contrast doses within the first 72 hours was not associated with AKI (odds ratio, 1.33; confidence interval, 0.80-2.21; p = 0.273). Risk factors for AKI included higher ISS ( p < 0.0007), older age ( p = 0.0109), higher heart rate ( p = 0.0327), lower systolic blood pressure ( p = 0.0007), and deranged baseline blood results including base deficit ( p = 0.0042), creatinine ( p < 0.0001), lactate ( p < 0.0001), and hemoglobin ( p = 0.0085). Acute kidney injury was associated with worse outcomes (ICU length of stay: 8 vs. 3 days, p < 0.0001; mortality: 16% vs. 3.8%, p < 0.0001; MOF: 42% vs. 6.6%, p < 0.0001). CONCLUSION:There is a limited role of repeat contrast administration in AKI development in ICU-admitted multiple injury patients. The clinical significance of CI-AKI is likely overestimated, and it should not compromise essential secondary imaging from the ICU. Further prospective studies are needed to verify our results.

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“…However, patients with AKI may need vigorous evaluation as to the necessity of the study based on the benefit and risk ratio. In a propensity score matched study, Yan et al 16 showed no difference in the risks of further decrease in kidney function, requirement for kidney replacement therapy, and mortality in 7 and 30 days among AKI patients who received either intravenous iodinated contrast (enhanced) or no contrast (unenhanced) CT scans within 7 days after the diagnosis of AKI.…”

Section: Risk Factors For Ci-akimentioning

confidence: 99%

Contrast-Induced Acute Kidney Injury: Evidence in Support of Its Existence and a Review of Its Pathogenesis and Management

Chaudhari¹,

Mahendrakar²,

Baskin³

et al. 2022

IJNRD

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The role of contrast-induced nephropathy (CIN) remains controversial. Many experts contend that CIN does not exist or is extremely rare. The diagnosis was previously made too frequently and inappropriately in the presence of coexisting and confounding comorbidities and risk factors making it difficult to singularly isolate the etiologic role of intravenous contrast media in acute kidney injury (AKI). It is probable that many patients were denied important diagnostic information from radiocontrast studies for fear of CIN. Recently, a new terminology for CIN was introduced, and the term CIN was replaced by two interrelated new terms: one is contrast-associated acute kidney injury (CA-AKI), and the second one is contrast-induced acute kidney injury (CI-AKI). CA-AKI occurs in association with risk factors or comorbidities, therefore, it is a correlative diagnosis. On the other hand, CI-AKI is a subtype of CA-AKI that results directly from iodinated contrast media. In this review, we present evidence from various studies that argue against CI-AKI and also those that suggest its existence but with much lower frequency. We will also provide the current status of the pathophysiology and management of CA-AKI/CI-AKI.

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Is intravenous iodinated contrast medium administration really harmful in hospitalized acute kidney injury patients: a propensity score–matched study

Cited by 7 publications

References 30 publications

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

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

Acute kidney injury development in polytrauma and the safety of early repeated contrast studies: A retrospective cohort study

Contrast-Induced Acute Kidney Injury: Evidence in Support of Its Existence and a Review of Its Pathogenesis and Management

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