IV Contrast and AKI - No Association

Short Attention Span Summary

Unicorns and contrast nephropathy - both mythical creatures?
There was no association with IV contrast administration for CT and acute kidney injury at 48-72 hours or progression to dialysis at 6 months.  All patients had an abnormal GFR, but none had a creatinine over 4. The incidence of AKI was about 10% in each group: CT with contrast, CT without contrast, or no CT at all.  The way this changes my practice is that when a patient really needs a contrasted scan but has a marginally elevated creatinine, I can now have a discussion with radiology and the patient and reassure them that it's not likely to cause harm.

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There was no association with IV contrast and short-term acute kidney injury or progression to dialysis at 6 months in patients with a creatinine < 4.  Journal Watch had a free summary of this article as does EM Lit of Note.


Abstract

Ann Emerg Med. 2017 Jan 19. pii: S0196-0644(16)31388-9. doi: 10.1016/j.annemergmed.2016.11.021. [Epub ahead of print]

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration.

Hinson JS1, Ehmann MR2, Fine DM3, Fishman EK4, Toerper MF2, Rothman RE2, Klein EY5.

Author information:

1Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jhinson4@jhmi.edu.

2Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

3Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.

4Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.

5Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Center for Disease Dynamics, Economics & Policy, Washington, DC.

Abstract

STUDY OBJECTIVE:

The study objective was to determine whether intravenous contrast administration for computed tomography (CT) is independently associated with increased risk for acute kidney injury and adverse clinical outcomes.

METHODS:

This single-center retrospective cohort analysis was performed in a large, urban, academic emergency department with an average census of 62,179 visits per year; 17,934 ED visits for patients who underwent contrast-enhanced, unenhanced, or no CT during a 5-year period (2009 to 2014) were included. The intervention was CT scan with or without intravenous contrast administration. The primary outcome was incidence of acute kidney injury. Secondary outcomes included new chronic kidney disease, dialysis, and renal transplantation at 6 months. Logistic regression modeling and between-groups odds ratios with and without propensity-score matching were used to test for an independent association between contrast administration and primary and secondary outcomes. Treatment decisions, including administration of contrast and intravenous fluids, were examined.

RESULTS:

Rates of acute kidney injury were similar among all groups. Contrast administration was not associated with increased incidence of acute kidney injury (contrast-induced nephropathy criteria odds ratio=0.96, 95% confidence interval 0.85 to 1.08; and Acute Kidney Injury Network/Kidney Disease Improving Global Outcomes criteria odds ratio=1.00, 95% confidence interval 0.87 to 1.16). This was true in all subgroup analyses regardless of baseline renal function and whether comparisons were made directly or after propensity matching. Contrast administration was not associated with increased incidence of chronic kidney disease, dialysis, or renal transplant at 6 months. Clinicians were less likely to prescribe contrast to patients with decreased renal function and more likely to prescribe intravenous fluids if contrast was administered.

CONCLUSION:

In the largest well-controlled study of acute kidney injury following contrast administration in the ED to date, intravenous contrast was not associated with an increased frequency of acute kidney injury.

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

PMID: 28131489 [PubMed - as supplied by publisher]