Acute kidney injury in cirrhotic patients undergoing contrast-enhanced computed tomography

Filomia, Roberto; Maimone, S.; Saitta, Carlo; Visconti, Luca; Caloggero, Simona; Bottari, Andrea; Alibrandi, Angela; Cacciola, Irene; Caccamo, Gaia; Spinella, Sabrina; Vadalà, D.; Gambino, C.; Franzè, Maria Stella; Gambino, G; Raimondo, Giovanni; Squadrito, Giovanni

doi:10.1016/j.dld.2015.01.039

Cited by 2 publications

(12 citation statements)

References 17 publications

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“…Another recent study found that 8.8% of the LC patients developed CI-AKI. An older study concluded a frequency of 25% [ 1 - 3 ]. All of these were retrospective studies and the differing incidences may be because of different exclusion criteria and patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…Acute kidney injury (AKI) is a common occurrence in patients with LC. Approximately 20% of hospitalized LC patients have an AKI [ 1 - 2 ]. It is associated with increased morbidity and mortality in these patients and early recognition and treatment are important.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of AKI in LC varies greatly and various factors are implicated. Intravenous contrast (IC) administration is a known predisposing factor for AKI [ 1 , 3 ]. Patients with LC often undergo a variety of contrast imaging for diagnostic and therapeutic purposes.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with LC often undergo a variety of contrast imaging for diagnostic and therapeutic purposes. These are usually for the diagnosis or follow-up of hepatocellular carcinoma or for pre-transplant evaluation [ 1 ]. This has raised a concern in recent years regarding contrast-induced acute kidney injury (CI-AKI) in LC patients.…”

Section: Introductionmentioning

confidence: 99%

“…Liver cirrhosis may cause renal hypoperfusion because of hypovolemia, arterial hypotension, and the activation of different neurohormonal systems. This may theoretically place them at risk for developing CI-AKI [ 1 ]. The few studies done on this aspect have variable but interesting results.…”

Section: Introductionmentioning

confidence: 99%

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Contrast-induced Acute Kidney Injury in Patients with Liver Cirrhosis: A Retrospective Analysis

Abideen

Mahmud

Salih

et al. 2018

Cureus

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Contrast-induced acute kidney injury (CI-AKI) has been studied less extensively in patients with liver cirrhosis (LC). It is unclear whether the presence of severe liver disease is actually a predisposing factor for CI-AKI. Liver cirrhosis is extremely common in Pakistan and is attributed to the high prevalence of chronic viral hepatitis. Patients with LC often undergo contrast-enhanced computed tomograms (CECT) for various diagnostic and therapeutic purposes, and there have been concerns regarding them being at risk for CI-AKI. The available literature on this topic is scanty, and no study has been conducted in Pakistan. The purpose of this study, therefore, was to determine the frequency of CI-AKI in patients with LC undergoing CECT and to determine any significant predispositions. We retrospectively analyzed the records of 470 LC patients at our center. The frequency of CI-AKI in our study was 5.1%. A higher mean model for end-stage liver disease (MELD), MELD including sodium (MELD-Na), and Child-Pugh (CP) scores was significantly associated with developing CI-AKI (p<0.05). Patients with CI-AKI also had a significantly higher mean international normalized ratio (INR) and serum bilirubin levels, with lower mean venous bicarbonate and serum sodium levels (p<0.05). Our results show that patients with a more advanced liver disease and poorer synthetic function are increasingly susceptible to developing CI-AKI. Further studies can investigate the role of bicarbonate therapy in preventing CI-AKI in LC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Contrast-induced Acute Kidney Injury in Patients with Liver Cirrhosis: A Retrospective Analysis

Abideen

Mahmud

Salih

et al. 2018

Cureus

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Application of CT contrast medium is not associated with an increased risk for acute kidney injury in patients with decompensated cirrhosis

Tergast

Schulte

Griemsmann

et al. 2022

Aliment Pharmacol Ther

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Summary Background Acute kidney injury (AKI) is a frequent complication in patients with decompensated cirrhosis. Studies reported conflicting results regarding the nephrotoxic potential of iodinated contrast medium (CM) for computer tomography (CT). Aim To investigate the impact of diagnostic CM application on kidney function in patients with decompensated cirrhosis. Methods First, we evaluated the impact of diagnostic CM‐CT on AKI incidence in a cross‐sectional approach. Second, we analysed 28‐day AKI incidence post‐CM‐CT in patients with impaired kidney function (i.e., creatinine >133 μmoL/L). Third, we excluded all patients with relevant interventions besides CM‐CT. All remaining patients were matched via propensity score matching (PPSM) and further analysed. Last, we validated the results in an independent dataset of prospectively collected registry data of 118 patients with decompensated cirrhosis. Here, plasma samples were analysed regarding neutrophil‐gelatinase‐associated‐lipocalin (NGAL). Results Of the 611 included patients, 98 (16%) received CM‐CT. CM‐CT was not associated with AKI in the cross‐sectional approach (CM‐CT:8% vs. no CM‐CT:15%; p = 0.08). Furthermore, CM‐CT was not associated with higher 28‐day AKI incidence among patients with impaired kidney function (HR:0.79; 95% CI 0.45–1.38; p = 0.40). The PPSM cohort revealed no association between CM‐CT and AKI or severe AKI (HR:1.28, p = 0.45 and HR:1.62; p = 0.43). Moreover, CM‐CT did not result in worsening of kidney function after CM application. In the validation cohort, CM‐CT was also not linked to AKI (p = 0.85) and NGAL levels were not increased in those with CM‐CT (CM‐CT:309 ng/ml vs. No CM‐CT:266 ng/ml, p = 0.35). Conclusion Decompensated cirrhosis per se should not preclude diagnostic CM‐CT.

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Acute kidney injury in cirrhotic patients undergoing contrast-enhanced computed tomography

Cited by 2 publications

References 17 publications

Contrast-induced Acute Kidney Injury in Patients with Liver Cirrhosis: A Retrospective Analysis

Contrast-induced Acute Kidney Injury in Patients with Liver Cirrhosis: A Retrospective Analysis

Application of CT contrast medium is not associated with an increased risk for acute kidney injury in patients with decompensated cirrhosis

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