The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review

Abstract

Iodinated contrast media (ICM) during contrast-enhanced computed tomography (CECT) in the emergency department (ED) is essential to diagnose acute conditions, despite risks of contrast-induced nephropathy (CIN) development and its associated complications. This systematic review aims to evaluate the incidence of CIN and CIN-induced complications, and to explore the relevance of classical risk factors for CIN among ED patients receiving ICM. PubMed, Cochrane, and Web of Science were used on 30 August 2021 to search for peer-reviewed English articles reporting on CIN incidence among ED patients aged ≥18 years who underwent an intravenous CECT. The inclusion criteria included studies that were in English, peer-reviewed, and involved ED patients aged ≥18 years who underwent single intravenous CECT. Studies on intra-arterial procedures and preventive strategies, meta-analyses, clinical guidelines, review articles, and case reports were excluded. The JBI critical appraisal checklist was applied to assess the risk of bias. In total, 18 studies were included wherein 15 were retrospective studies while three were prospective studies. We found a relatively higher CIN incidence in the ED, with variations owing to the CIN definitions. Several classical risk factors including acute hypotension remain linked to CIN onset in ED settings unlike factors such as age and diabetes. While risk of adverse renal events due to CIN is low, there is higher risk of CIN-induced mortality in the ED. Therefore, with the higher incidence of CIN and CIN-induced mortality rates in the ED, ICM administration during CECT in the ED should still be clinically justified after assessing both benefits and risks.

Contrast-induced acute kidney injury and its contemporary prevention

“…Anemia Systematic review and meta-analysis Wei et al (191) Hypotension Systematic review and meta-analysis Ong et al (192) Volume Depletion and Hemodynamic Instability Systematic review and meta-analysis Tea et al (193) NSAID, diuretics and other nephrotoxic drugs Systematic review and meta-analysis Zhang et al (194) ACE-I/ARB usage Randomized trial parallel-group, single-center CAPTAIN trial (195) Acute heart failure NYHA III-IV Multicenter retrospective study Tian et al (196) Hypoalbuminemia Systematic review and meta-analysis Liwei et al (197) Peri-procedural hyperglycemia Systematic review and meta-analysis Jakrin et al (198) Patient…”

Rosiglitazone Alleviates Contrast-Induced Acute Kidney Injury in Rats via the PPARγ/NLRP3 Signaling Pathway

“…Contrast-induced acute kidney injury (CI-AKI) remains the third most common cause of acute renal insufficiency [1]. The occurrence of CI-AKI seriously affects the rehabilitation of patients and is considered as one of the important complications after interventional therapy, which was reported to be associated with acute hypo-tension, age, diabetes, dehydration, and others [2][3][4]. At present, there is still a lack of effective measures to reverse the injury process of CI-AKI.…”

A Feasibility Study to Evaluate Replacing Conventional Computed Tomography at 120 KVP with Low Radiation Dose and Low Iodine Intake Based on Body Mass Index-Adapted Abdominal Computed Tomography Angiography in 291 Patients

“…Our study found that BMI-based individualized kVp abdominal CTA imaging significantly reduces overall radiation dose and contrast media intake, which can replace conventional abdominal CTA at 120 kVp and provided excellent image quality in 291 patients. With the rapid development of CT imaging technology, CT imaging parameters (eg, tube voltage, tube current, layer thickness, reconstruction algorithm) are continuously updated to improve image quality and scanning efficiency [ 13 , 14 ]. Abdominal CTA is superior for showing the structure of the tumor’s feeding arteries and abdominal vessels.…”