Risk of contrast-induced nephropathy for patients receiving intravenous vs. intra-arterial iodixanol administration

Tong, Gregory E.; Kumar, Sant; Chong, Karen; Shah, Neha D.; Wong, Margaret J.; Zimmet, Jeffrey; Wang, Zhen Jane; Yee, Judy; Fu, Yanjun; Yeh, Benjamin M.

doi:10.1007/s00261-015-0611-9

Cited by 26 publications

(20 citation statements)

References 21 publications

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“…In our study, the rates of CIN after IA contrast were numerically greater than IV contrast (16.5 vs. 12%), but this was not statistically significant, which is consistent with previous literature [11,14]. However, results from older clinical trials comparing different contrast media suggest that IV contrast carries a lower risk of CIN than IA contrast administration [12,15].…”

Section: Discussionsupporting

confidence: 80%

“…The rate of CIN AKI in patients who received IA contrast (16.5%) is similar to the rates described in CKD populations [9]. On the other hand, the rate of CIN AKI after IV contrast (12.5%) was higher than previously reported rates of 2-4% [11,12] in the general population and closer to those reported in CKD populations, ranging from 2.5 to 11% [2,7,13]. This slightly higher incidence can be explained by the higher risk population analyzed in this study (inpatient CKD) along with the more conservative definition of AKI used for our analysis (0.3 mg/dL rather than 0.5 mg/dL).…”

Section: Discussioncontrasting

confidence: 39%

See 1 more Smart Citation

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

Chaudhury

Armanyous

Harb

et al. 2018

Nephron

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Background/Aims: contrast-induced nephropathy (CIN) is well described following an administration of intraarterial contrast, but its occurrence after intravenous (IV) contrast is being questioned. We evaluated the incidence of acute kidney injury (AKI), post-contrast AKI (PC-AKI), CIN, dialysis and mortality in patients with chronic kidney disease (CKD) undergoing non-contrast computed tomography (NCCT) or contrast CT (CCT) or coronary angiography (CoA). Methods: We identified individuals who had CoA or CCT or NCCT between 2010 and 2015 in the Cleveland Clinic CKD registry. We used propensity scores to match patients in the 3 groups. We evaluated the proportion of patients that developed AKI and CIN across the groups with chi-square tests. We generated Kaplan-Meier plots comparing mortality and ESRD among patients who developed AKI (in the NCCT group), PC (multifactorial AKI, CIN) AKI and no AKI. Results: Out of 251 eligible patients, 200 who had CoA were matched to each of the other CT scan groups. The incidence of AKI was 27% in CoA, 24% in CCT and 24% in NCCT (p = 0.72). The incidence of CIN AKI was 16.5% in CoA and 12.5% in CCT (p = 0.26). The Kaplan-Meier survival at 2 years was 74.8 (95% CI 63.8–87.7) for those with CIN and 53.2 (95% CI 39.7–71.4) for those with multifactorial AKI and 56.5 (95% CI 43.4–73.6) for those with AKI-NCCT and 71.4 (95% CI 67.2–76.0) for those without AKI. The Kaplan-Meier ESRD-free estimates at 2 years were 89.9 (95% CI 80.8–100) for those with CIN and 89.4 (95% CI 78.7–100) for those with multifactorial AKI and 77.4 (95% CI 63.6–94.3) for those with AKI-NCCT and 94.4 (95% CI 91.9–97.1) for those without AKI. Conclusion: The administration of both IV and intra-arterial contrast is associated with a risk of AKI. Multifactorial AKI was associated with worse outcomes, while CIN was associated with better outcomes.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 39%

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

Chaudhury

Armanyous

Harb

et al. 2018

Nephron

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“…As background, there were a number of cases that satisfied the diagnostic criteria for CIN due to natural fluctuations of SCr, including patients who did not receive contrast media [145]. After the publication of the CIN guideline 2012, a number of large-scale researches have been published that retrospectively analyzed the risk factors for CIN by applying strict statistical methods and using non-contrast media groups as controls, and they showed that the risk of developing CIN with intravenous administration of contrast media was lower than previously thought [24,102,[146][147][148][149][150][151][152][153][154][155][156][157][158].…”

Section: Level Of Evidence: Iva/grade Of Recommendation: B (Minds 201mentioning

confidence: 99%

“…Therefore, when a patient in an intensive care unit develops AKI after contrast-enhanced CT, it is very difficult to determine whether it has been caused by contrast media or not. In recent years, several reports have been conducted to verify the risk of developing CIN in intensive care and emergency outpatient patients [102,152,154,156,[164][165][166][167][168][169][170].…”

Section: Rationale Cq6-2mentioning

confidence: 99%

Guideline on the use of iodinated contrast media in patients with kidney disease 2018

et al. 2019

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“…Furthermore, PC-AKI may be associated with increased risk for hemodialysis, mortality, longer hospital admissions and greater healthcare costs (4–6). However, other studies have questioned these implications by asserting a lack of causal evidence between contrast and renal injury as well as an overestimation of PC-AKI in the presence of physiologic creatinine fluctuations (7–10). …”

Section: Introductionmentioning

confidence: 99%

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

Takahashi

Kallmes

Fleming

et al. 2017

Journal of Vascular and Interventional Radiology

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Purpose To determine the incidence, predictors and clinical outcomes of post-contrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis. Materials and Methods This retrospective study reviewed 1,052 patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis. In total, 437 patients with follow-up were included in this study. Mean age was 73.6 ± 8.3 years. Post-contrast acute kidney injury was defined as an absolute serum creatinine increase ≥0.3 mg/dL or percentage increase in serum creatinine ≥50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis. Results Mean follow-up was 71.1±68.4 months. Twenty-six patients (5.9%) developed PC-AKI. Patients who developed PC-AKI had significantly higher levels of baseline proteinuria compared to those who did not (Odds ratio 1.38; 95% CI 1.11–1.72; P=0.004). Prehydration, chronic kidney disease stage, baseline GFR, statin medications, contrast volume and iodine load were not associated with higher rates of PC-AKI. Dialysis-free survival and mortality rates were not significantly different between patients with and without PC-AKI (P=0.50 and P=0.17, respectively). Conclusion Elevated baseline proteinuria was the only predictor for PC-AKI in patients undergoing renal artery stent placement. Patients who developed PC-AKI were not at greater risk for hemodialysis or death.

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Risk of contrast-induced nephropathy for patients receiving intravenous vs. intra-arterial iodixanol administration

Abstract: Elevation in serum creatinine due to intravenous and intra-arterial iodixanol administration is infrequent and is not more common than after unenhanced CT scans.

Cited by 26 publications

References 21 publications

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

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

Guideline on the use of iodinated contrast media in patients with kidney disease 2018

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

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