Does Exposure to Computed Tomography Contrast Media Increase Risk of End-Stage Renal Disease?

Abstract

Departmental sources Background:There are many studies on acute kidney injury (AKI) after exposure to contrast media in patients with chronic kidney disease (CKD). However, whether the risk of end-stage renal disease (ESRD) increases after exposure to contrast media in the long term, regardless of development of AKI after such exposure, has not been studied. Material/Methods:The electronic health records of patients diagnosed with CKD and followed up from 2014 to 2018 at a tertiary university hospital were retrospectively collected. Patients were divided into patients who progressed to ESRD (ESRD group) and those who did not (non-ESRD group). Patients in the non-ESRD group were matched 1: 1 to those in the ESRD group by using disease risk score generation and matching. Multivariate logistic regression analysis was performed to assess the effect of contrast media exposure on progression to ESRD. Results:In total, 179 patients were enrolled per group; 178 (99.4%) were in CKD stage 3 or above in both groups. Average serum creatinine was 4.31±3.02 mg/dl and 3.64±2.55 mg/dl in the ESRD and non-ESRD groups, respectively (p=0.242). Other baseline characteristics were not statistically significant, except for the number of times contrast-enhanced computed tomography (CECT) was performed (0.00 [Interquartile range (IQR) 0.00-2.00] in the ESRD group and 0.00 [IQR 0.00-1.00] in the non-ESRD group [p=0.006]); in multivariate logistic regression, this number (OR=1.24, 95% CI=1.08-1.47, p=0.006) was significantly related to progression to ESRD. Conclusions:The use of CECT increased the risk of ESRD 1.2-fold in advanced and stable CKD outpatients after 5-year follow-up.

Recent technologies in cardiac imaging

“…These imaging techniques use harsh iodine contrast, compared to the preferred gadolinium medium (which is metal-based), as CT contrast can damage the kidneys. One study found gadolinium is associated with a lower incidence of contrast nephropathy and early progression to end-stage renal disease in patients with pre-existing chronic kidney disease ( 75 ). However, other studies found that the real-life risk is insignificant by undergoing precautions ( 76 ).…”

Recent advances in medical image processing for the evaluation of chronic kidney disease

“…Although it ability to measure SK-GFR as well as the potential of CT angiography in renal function assessment in CKD patients, CT is still limited to ionizing radiation and contrast agent injection that can injure the kidney (Lerman et al, 1996;Maioli et al, 2012). Recently, Contrast-Enhanced CT was reported to increase the risk of End-Stage Renal Disease (ESRD) (Lim et al, 2020). However, identification of renal fibrosis or perfusion with non-contrast CT remains challenging (Zhu et al, 2018).…”

Association of Kidney-Related Safety Events with Incident Chronic Kidney Disease in Veterans

“…Like NSAIDs, AKI secondary to contrast use is now considered relatively rare in patients with higher eGFRs [26,28]. In those with existing CKD, contrast exposure has been associated with nephropathy and progression to ESKD in small studies [29,30]. Less is known about the association of contrast exposures with incident CKD.…”