An evaluation of the relationship between traumatic injuries and the development of contrast-associated acute kidney injury

Abstract

Background: Intravenous contrast media-enhanced computed tomography is vitally important in the early identification of traumatic injuries. Contrast media, however, has the propensity to promote nephrotoxicity. Age, injury severity score, renal dysfunction, and hypotension upon presentation are factors associated with contrast-associated acute kidney injury in current trauma literature. This study endeavors to expand upon these findings and evaluate the relationship between traumatic injuries and contrast-associated acute kidney injury. Methods: This is a retrospective cohort study conducted at a Level 1 Trauma Center between January 2005 and August 2013. Patients identified by the institution's Trauma Registry were divided into two groups: contrast-associated acute kidney injury-positive and negative based on previously published definitions. Results: The analysis consisted of 831 intensive care patients; 161 contrast-associated acute kidney injury-positive and 670 contrast-associated acute kidney injury-negative. Logistic regression using significant findings from univariate comparisons between the study groups indicated that genitourinary (OR ¼ 2.859, 95% CI 1.587-5.152, p ¼ 0.000), arterial injuries (OR ¼ 2.464, 95% CI 1.294-4.690, p ¼ 0.006), and concomitant exposure to medications that are potentially nephrotoxic or alter renal hemodynamics (OR ¼ 1.483, 95% CI 1.018-2.158, p ¼ 0.040) were independent risk factors for contrast-associated acute kidney injury. Increasing revised trauma score (OR ¼ 0.874, 95% CI 0.790-0.966, p ¼ 0.009) and fluid administration prior to contrast (OR ¼ 0.445, 95% CI 0.301-0.656, p ¼ 0.000) were independently associated with decreased risk of contrast-associated acute kidney injury. Conclusion: The risk of contrast-associated acute kidney injury increases with escalating injury severity. Unless contraindicated, fluids should be administered prior to contrast, and concomitant exposure to agents that may increase the potential for contrast-associated acute kidney injury should be limited. These practices are increasingly important in patients presenting with arterial or genitourinary trauma.

Acute kidney injury development in polytrauma and the safety of early repeated contrast studies: A retrospective cohort study

“…This relationship would explain our findings that showed a higher incidence of blood product administration within those patients who developed AKI. There have been other risk factors that have been identified for AKI in trauma patients that our study did not control for including genitourinary trauma, arterial injuries, sepsis, ethnicity, and the use of nephrotoxic drugs 7,13,26 . The literature currently is equivocal regarding the risk posed by emergency angiography in trauma patients.…”

“…There have been other risk factors that have been identified for AKI in trauma patients that our study did not control for including genitourinary trauma, arterial injuries, sepsis, ethnicity, and the use of nephrotoxic drugs. 7 , 13 , 26 The literature currently is equivocal regarding the risk posed by emergency angiography in trauma patients. Our study found that emergency angiography in trauma patients did not increase the risk of AKI.…”

“…Within the other groups, those receiving one repeat contrast had 12 patients die (7.8%), and those not receiving repeat contrast had 22 (4.5%). Median ICU LOS was 8 (2-11) days in the two-repeat group, 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) days in the one-repeat group, and 3 (1-7) days in the no-repeat group. Hospital LOS showed a median of 22 (10-59) days in the two-repeat group, 21 (12-39) days in the one-repeat group, and 15 (8-30) days in the no-repeat group.…”

“…Trauma patients have a reported incidence of CI-AKI between 1.9% and 19.4%, which varies because of both the inconsistency of the definition of AKI and study population. 5,7 In general, higher injury severity is a well-established independent predictor of AKI in trauma patients. [8][9][10] The development of AKI in trauma patients has been shown to worsen outcomes, but it is unclear if contrast administration is an independent risk factor for worse outcomes.…”

“…[8][9][10] The development of AKI in trauma patients has been shown to worsen outcomes, but it is unclear if contrast administration is an independent risk factor for worse outcomes. 1,4,7,8 Multiple injury patients after the unavoidable initial i.v. contrast-enhanced diagnostic workup and resuscitation are admitted to the intensive care unit (ICU) from where frequently repeated contrast studies are performed as part of protocolled or individualized management.…”