Negative effects of iodine-based contrast agent on renal function in patients with moderate reduced renal function hospitalized for Covid-19

Abstract

Background Kidney disease and renal failure are associated with hospital deaths in patients with Covid-19. We aimed to test if contrast enhancement (CE) affects short-term renal function in hospitalized Covid-19 patients.Methods Plasma creatinine (P-creatinine) was measured on the day of computed tomography (CT) and 24 h, 48 h, and 4–10 days after CT. CE (n = 142) and non-CE (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≥ 30–60 ml/min/1.73 m2. Contrast-induced acute renal failure (CI-AKI) was defined as ≥ 27 µmol/L increase or a > 50% rise in P-creatinine from CT or initiation of renal replacement therapy (RRT) during follow-up. Patients with RRT were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine.Results Median P-creatinine at 24–48 h and days 4–10 post-CT in patients with eGFR > 60 and eGFR ≥ 30–60 in CE and non-CE groups did not differ from basal values. CI-AKI was observed at 48 h and at 4–10 days post-CE in 24% and 36% (n = 5/14) of patients with eGFR ≥ 30–60. Corresponding figures in the eGFR > 60 CE CT group were 5%, (p < 0.037 and p < 0.001, Pearson x2 test respectively). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that CI-AKI was associated with an eGFR ≤ 60 at CE and 30-day mortality both at 48 h and 4–10 days.Conclusion Patients with Covid-19 and eGFR ≥ 30–60 had a high frequency of CK-AKI at 48 h and at 4–10 days after CE, which was associated with increased 30-day mortality. For patients with eGFR ≥ 30–60, we recommend strict indications are practiced for CE CT. CE had a modest effect in patients with eGFR > 60.