Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

Abstract

Objective To examine the effect of intravenous iodinated contrast material administration on the subsequent development of acute kidney injury (AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of Computed Tomography (CT) scan recipients with chronic kidney disease (CKD). Patients and Methods In this IRB approved retrospective study, all CKD patients who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2000 to August 2013 were identified. Patients were subdivided into CKD Stage III (baseline eGFR 30–59 ml/min/1.73m2), and CKD Stage IV–V (baseline eGFR<30 ml/min/1.73m2), subgroups and separately underwent propensity score generation, stratification, and 1:1 matching. Rates of AKI and 30-day emergent dialysis and mortality were compared between contrast and noncontrast groups. Sensitivity analyses examining only patients with stable prescan serum creatinine (SCr) and incorporating IV fluid administration at the time of scan into the model were also performed. Results A total of 6902 patients (4496 CKD Stage III, matched: 1220 contrast/1220 noncontrast; 2086 CKD Stage IV–V, matched: 491 contrast/491 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI, emergent dialysis, and mortality were not significantly higher in the contrast group compared to the noncontrast group in either CKD subset (CKD Stage III OR 0.65–1.00, P<.001–.99, CKD Stage IV–V OR 0.93–2.33, P=.22–.99). Both sensitivity analyses had similar results. Conclusion Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function.

Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention

“…Patients in this study who developed renal injury within 48 hours of intervention did not have an increased risk for hemodialysis or mortality. These findings parallel those reported by McDonald et al who reported intravenous contrast material was not associated with increased risk of hemodialysis and mortality among 6,902 subjects (42). …”

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

“…These rates of AKI in this high-risk population are higher than the rates reported in the literature [3,7,8]. This is likely explained by 2 factors.…”

Noninvasive aortic imaging

“…Candidates for TAVR often have co-morbidities such as chronic renal failure that can adversely impact outcomes (20)(21)(22). There has been ongoing debate about the actual incidence, significance and even existence of acute kidney injury following intravenous iodinated contrast media injection during CT (23)(24)(25)(26)(27)). However, current guidelines recommend careful or limited use of iodinated contrast in patients with renal dysfunction (28), and reduction of contrast agent volume is desirable in patients with chronic renal failure.…”