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Cumulative iodinated contrast exposure for computed tomography during acute kidney injury and major adverse kidney events

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Abstract

Objectives

To determine if contrast-enhanced CT imaging performed in patients during their episode of AKI contributes to major adverse kidney events (MAKE).

Methods

A propensity score–matched analysis of 1127 patients with AKI defined by KDIGO criteria was done. Their mean age was 63 ± 16 years with 56% males. A total of 419 cases exposed to CT contrast peri-AKI were matched with 798 non-exposed controls for 14 covariates including comorbidities, acute illnesses, and initial AKI severity; outcomes including MAKE and renal recovery in hospital were compared using bivariate analysis and logistic regression. MAKE was a composite of mortality, renal replacement therapy, and doubling of serum creatinine on discharge over baseline; renal recovery was classified as early versus late based on a 7-day timeline from AKI onset to nadir creatinine or cessation of renal replacement therapy in survivors.

Results

Sixty-two patients received cumulatively > 100 mL of CT contrast, 143 patients had > 50–100 mL, and 214 patients had 50 mL or less; MAKE occurred in 34%, 17%, and 21%, respectively, as compared with 20% in non-exposed controls (p = 0.008 for patients with > 100 mL contrast versus none). More contrast-exposed patients experienced late renal recovery (27% versus 20%) and longer hospital days (median 10 versus 8) than non-exposed patients (all p < 0.01). On multivariate analysis, cumulative CT contrast > 100 mL was independently associated with MAKE (odds ratio 2.39 versus non-contrast, adjusted for all confounders, p = 0.005); cumulative CT contrast under 100 mL was not associated with MAKE.

Conclusions

High cumulative volume of CT contrast administered to patients with AKI is associated with worse short-term renal outcomes and delayed renal recovery.

Key Points

• Cumulative intravenous iodinated contrast for CT imaging of more than 100 mL, during an episode of acute kidney injury, was independently associated with worse renal outcomes and less renal recovery.

• These adverse outcomes including renal replacement therapy were not more frequent in similar patients who received cumulatively 100 mL or less of CT contrast, compared with non-exposed patients.

• More patients with CT contrast exposure during acute kidney injury experienced delayed renal recovery.

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Abbreviations

AKI:

Acute kidney injury

CKD:

Chronic kidney disease

GFR:

Glomerular filtration rate

KDIGO:

Kidney Disease: Improving Global Outcomes (organisation)

MAKE:

Major adverse kidney events

RRT:

Renal replacement therapy

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Funding

This study has received funding by National Kidney Foundation of Singapore Research Grant (NKFRC2014/01/14).

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, National University Hospital, Level 10, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore, Singapore

    Horng-Ruey Chua, Emmett Tsz-Yeung Wong, Boon-Wee Teo, K. Akalya & Anantharaman Vathsala

  2. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Horng-Ruey Chua, Emmett Tsz-Yeung Wong, Boon-Wee Teo & Anantharaman Vathsala

  3. Division of Renal Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore

    Sanmay Low

  4. Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Tanusya Murali Murali

  5. Department of Nephrology, Shanghai Minhang District Central Hospital, Shanghai, People’s Republic of China

    Hai-Dong He

  6. Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore

    Yee-Liang Thian

Authors
  1. Horng-Ruey Chua
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  2. Sanmay Low
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  8. K. Akalya
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  9. Anantharaman Vathsala
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Corresponding author

Correspondence to Horng-Ruey Chua.

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Guarantor

The scientific guarantor of this publication is the first author, Dr. Horng-Ruey Chua.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Study subjects or cohorts have been previously reported in Low S, Vathsala A, Murali TM, et al Electronic health records accurately predict renal replacement therapy in acute kidney injury. BMC Nephrol 2019;20(1):32. Epub 2019/02/02. doi: https://doi.org/10.1186/s12882-019-1206-4.

Methodology

• Retrospective

• Observational study

• Performed at one institution

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Chua, HR., Low, S., Murali, T.M. et al. Cumulative iodinated contrast exposure for computed tomography during acute kidney injury and major adverse kidney events. Eur Radiol 31, 3258–3266 (2021). https://doi.org/10.1007/s00330-020-07428-x

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  • DOI: https://doi.org/10.1007/s00330-020-07428-x

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