Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography

Abstract

Background and objectives: Most studies of contrast-induced acute kidney injury (CIAKI) have focused on patients undergoing angiographic procedures. The incidence and outcomes of CIAKI in patients undergoing nonemergent, contrastenhanced computed tomography in the inpatient and outpatient setting were assessed.Design, setting, participants, & measurements: Patients with estimated glomerular filtration rates (GFRs) <60 ml/min per 1.73 m 2 undergoing nonemergent computed tomography with intravenous iodinated radiocontrast at an academic VA Medical Center were prospectively identified. Serum creatinine was assessed 48 to 96 h postprocedure to quantify the incidence of CIAKI, and the need for postprocedure dialysis, hospital admission, and 30-d mortality was tracked to examine the associations of CIAKI with these medical outcomes.Results: A total of 421 patients with a median estimated GFR of 53 ml/min per 1.73 m 2 were enrolled. Overall, 6.5% of patients developed an increase in serum creatinine >25%, and 3.5% demonstrated a rise in serum creatinine >0.5 mg/dl. Although only 6% of outpatients received preprocedure and postprocedure intravenous fluid, <1% of outpatients with estimated GFRs >45 ml/min per 1.73 m 2 manifested an increase in serum creatinine >0.5 mg/dl. None of the study participants required postprocedure dialysis. Forty-six patients (10.9%) were hospitalized and 10 (2.4%) died by 30-d follow-up; however, CIAKI was not associated with these outcomes.Conclusions: Clinically significant CIAKI following nonemergent computed tomography is uncommon among outpatients with mild baseline kidney disease. These findings have important implications for providers ordering and performing computed tomography and for future clinical trials of CIAKI.

Contrast-Induced Acute Kidney Injury

“…Using a prospective design, routine repeat serum creatinine determinations 48 to 72 h after contrast, six definitions of contrast-induced AKI (CI-AKI), and the electronic medical record of the VA health care system, Weisbord et al (4) were able to determine the incidence of CIN and its long-term consequences in a group of patients who received intravenous contrast media for CT imaging. The minority of patients received any prophylaxis, in the form of intravenous saline before and/or after contrast exposure, use of N-acetylcysteine, or advice regarding discontinuation of nephrotoxins.…”

Accuracy of the smaller superior mesenteric vein sign for the detection of acute superior mesenteric artery occlusion

“…reported that administration of contrast agent beyond the maximum acceptable dose (contrast agent 5 mL/kg × body weight [kg]/serum creatinine) can increase the risk of nephropathy. A high incidence of contrast nephropathy has been reported at doses >100 mL 5. The onset of acute renal failure in ischemic bowel disease has been reported to increase the mortality rate 6.…”

“…Computed tomographic angiography has a high accuracy for the diagnosis of SMA occlusion (up to 95–100%). However, there might be issues with the use of contrast agents 5, 6. Magnetic resonance angiography requires a long time for imaging 1.…”

Comparison of Aortic Annulus Dimension After Aortic Valve Neocuspidization With Valve Replacement and Normal Valve

“…Several previous studies have identified a baseline eGFR <45 mL/ min per 1.73 m 2 to be associated with an increased risk of contrast-induced nephropathy. 10,11 We therefore excluded patients with an eGFR below baseline. No significant AR was observed with postoperative ultrasound cardiography (UCG) in the AVNeo group.…”