Contrast CT Scans in the Emergency Department Do Not Increase Risk of Adverse Renal Outcomes

Heller, Michael; Krieger, Paul; Finefrock, Douglas; Nguyen, Thomas; Akhtar, Saadia

doi:10.5811/westjem.2016.4.28994

Cited by 21 publications

(21 citation statements)

References 20 publications

(15 reference statements)

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“…The few remaining controlled studies demonstrated similar risks of dialysis and death between contrast material and control groups; however, these studies were small and did not control for selection bias (11)(12)(13)(14)(15)(16). Our current study corroborates the findings of these studies and offers several advances.…”

Section: Discussionsupporting

confidence: 92%

“…Because these intraarterial studies inherently lacked a control population of patients who did not receive contrast material, the incidence of adverse outcomes attributable to contrast material cannot be extricated from contrast materialindependent causes. Second, a recent systematic review of controlled studies of intravenous contrast material exposure demonstrated that adverse outcomes directly attributable to intravenous contrast material administration are extremely rare (11)(12)(13)(14)(15)(16). Specifically, clinically important outcomes, particularly dialysis and death, have not been clearly linked to intravenous contrast material exposure.…”

Section: Advances In Knowledgementioning

confidence: 97%

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Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality

et al. 2014

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Section: Discussionsupporting

confidence: 92%

Section: Advances In Knowledgementioning

confidence: 97%

Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality

et al. 2014

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“…Previous studies in emergency medical settings have shown wide variation in the incidence of postcontrast AKI (3.2%-12%); this may be partially explained by the variety of diseases encountered in the ED, as well as differences in the definitions of AKI adopted in each study. 6,7,[19][20][21][22][23][24]31 Nearly half of the patients (49%) in the present study experienced septic shock; thus, the increased incidence of postcontrast AKI in our patients (12.4%), compared with that observed in prior studies, may be attributed to the impaired physical status of our patients. This may also explain the considerably higher rates of emergent dialysis and short-term mortality, as well as the increased median length of hospital stay for survivors among our patients, compared to those parameters measured in other studies that did not focus on patients with sepsis.…”

Section: Discussionsupporting

confidence: 44%

“…This may also explain the considerably higher rates of emergent dialysis and short-term mortality, as well as the increased median length of hospital stay for survivors among our patients, compared to those parameters measured in other studies that did not focus on patients with sepsis. 21,34 Thus far, the pathophysiology of CA-AKI remains poorly characterised. Based on the results of some animal studies, proposed mechanisms include acute tubular necrosis caused by medullary hypoxia from vasoconstriction, as well as direct cytotoxic effects of the contrast agent on renal tubular cells.…”

Section: Discussionmentioning

confidence: 99%

“…18 Previous studies on CA-AKI in an emergency setting have been inconclusive. 6,7,[19][20][21][22][23][24] Although those studies investigated the benefits and risks of contrast administration in many clinical settings, including acute stroke, pulmonary embolism, and trauma, very few of them evaluated the impact of contrast administration on patients with sepsis. Notably, sepsis remains a leading cause of mortality in critically ill patients 2 and CT imaging studies play important roles in both identifying the source of infection and facilitating infection control in patients with sepsis.…”

Section: Implications For Clinical Practice or Policymentioning

confidence: 99%

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Risk of post-contrast acute kidney injury in emergency department patients with sepsis

Hsu

Sun

et al. 2019

Hong Kong Med J

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Campaign, a care bundle of sepsis treatmentincluding fluid resuscitation, antimicrobial therapy, and source control-is recommended as life-saving treatment for patients with sepsis. 2 Computed tomography (CT) scanning is a popular method for ORIGINAL ARTICLE (20 vs 19 days, P=0.742). Conclusions: Intravenous contrast administration during CT scanning was not associated with prolonged length of hospital stay in patients with sepsis in an emergency setting. Moreover, the use of contrast-enhanced CT was not associated with increased risks of acute kidney injury, emergent dialysis, or short-term mortality.

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Association of Intravenous Radiocontrast With Kidney Function

et al. 2021

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IMPORTANCERadiocontrast has long been thought of as nephrotoxic; however, a number of recent observational studies found no evidence of an association between intravenous contrast and kidney injury. Because these studies are at high risk of confounding and selection bias, alternative study designs are required to enable more robust evaluation of this association.OBJECTIVE To determine whether intravenous radiocontrast exposure is associated with clinically significant long-term kidney impairment, using a study design that permits stronger causal interpretation than existing observational research. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included all emergency department patients aged 18 years or older undergoing D-dimer testing between 2013 and 2018 in the Canadian province of Alberta. A fuzzy regression discontinuity design was used, exploiting the fact that individuals just either side of the eligibility cutoff for computed tomographic pulmonary angiogram (CTPA)-typically 500 ng/mL-have markedly different probabilities of contrast exposure, but should otherwise be similar with respect to potential confounders.EXPOSURES Intravenous contrast in the form of a CTPA. MAIN OUTCOMES AND MEASURESEstimated glomerular filtration rate (eGFR) up to 6 months following the index emergency department visit.RESULTS During the study period 156 028 individuals received a D-dimer test. The mean age was 53 years, 68 206 (44%) were men and 87 822 (56%) were women, and the mean baseline eGFR level was 86 mL/min/1.73 m 2 . Patients just above and below the CTPA eligibility cutoff were similar in terms of measured confounders. There was no evidence for an association of contrast with eGFR up to 6 months later, with a mean change in eGFR of −0.4 mL/min/1.73 m 2 (95% CI, −4.9 to 4.0) associated with CTPA exposure. There was similarly no evidence for an association with need for kidney replacement therapy (risk difference [RD], 0.07%; 95% CI, −0.47% to 0.61%), mortality (RD, 0.3%; 95% CI, −2.9% to 3.2%), and acute kidney injury (RD, 4.3%; 95% CI, −2.7% to 12.9%), though the latter analysis was limited by missing data. Subgroup analyses were potentially consistent with harm among patients with diabetes (mean eGFR change −6.4 mL/min/1.73 m 2 ; 95% CI, −15.4 to 0.2), but not among those with other reported risk factors for contrast-induced nephropathy; these analyses, however, were relatively underpowered.CONCLUSIONS AND RELEVANCE Using a cohort study design and analysis that permits stronger causal interpretation than existing observational research, we found no evidence for a harmful effect on kidney function of intravenous contrast administered for CTPA in an emergency setting.

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Contrast CT Scans in the Emergency Department Do Not Increase Risk of Adverse Renal Outcomes

Cited by 21 publications

References 20 publications

Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality

Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality

Risk of post-contrast acute kidney injury in emergency department patients with sepsis

Association of Intravenous Radiocontrast With Kidney Function

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