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

Abstract

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.

Effects of renin–angiotensin inhibitors on renal function and the clinical course in patients with decompensated cirrhosis

“…Development of AKI is associated with longer hospital stays and prognosis worsens with increasing severity of AKI 15 , 16 . Recent studies have elucidated the importance of comedication on renal endpoints in the setting of decompensated liver cirrhosis, however the role of RAS-Inhibitors remains a matter of debate 17 . In this study we investigated for the first time, how the intake RAS-Inhibitor impacts the short- and long-term incidence of clinical endpoints.…”

Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting

“…Incidence of CIN is very low, 225 – 230 and therefore i.v. contrast studies should not be withheld due to concerns regarding AKI where the information obtained could potentially have important therapeutic implications…”