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 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. Contrast-enhanced (n = 142) and unenhanced (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≤ 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 during follow-up. Patients with renal replacement therapy were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine at 48 h and at 4–10 days after contrast-enhanced CT. Results Median P-creatinine at 24–48 h and days 4–10 post-CT in patients with eGFR> 60 and eGFR≥30–60 in contrast-enhanced and unenhanced groups did not differ from basal values. CI-AKI was observed at 48 h and at 4–10 days post contrast administration in 24 and 36% (n = 5/14) of patients with eGFR≥30–60. Corresponding figures in the eGFR> 60 contrast-enhanced CT group were 5 and 5% respectively, (p < 0.037 and p < 0.001, Pearson χ2 test). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that an eGFR≥30–60 and 30-day mortality were associated with CK-AKI both at 48 h and 4–10 days after contrast-enhanced CT. 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 contrast administration, which was associated with increased 30-day mortality. For patients with eGFR≥30–60, we recommend strict indications are practiced for contrast-enhanced CT. Contrast-enhanced CT had a modest effect in patients with eGFR> 60.

Did the COVID-19 Pandemic Affect Contrast Media-Induced Adverse Drug Reaction’s Reporting? A Pharmacovigilance Study in Southern Italy

“…Computed tomography (CT) has represented the reference standard for identifying lung involvement due to SARS-CoV-2 infection [ 12 ]. CT angiography is the key technique used for confirming pulmonary embolism [ 13 ]. In addition to respiratory complications, COVID-19 can also have implications on the cardiovascular system [ 14 ].…”

“…Newer contrast agents, characterized by lower ionic concentrations and lower osmolarity, are better tolerated [ 20 ]. However, CM, like all medicines, is not risk-free [ 21 ], with possible negative effects, for example, on kidney function, especially in previously nephropathic patients when exposed to iodine-based agents [ 13 ]. CM-induced nephropathy has been the object of several studies that aimed to identify possible risk factors or biomarkers and evaluate procedures to prevent it [ 21 ].…”

Biocompatible carbonized iodine-doped dots for contrast-enhanced CT imaging

“…In particular, in the case of CT contrast agents, administration can lead to nephropathy and adverse cardiac events in the clinical fields. For example, patients with iodine-based contrast agent injection showed an increased risk of worsened renal impairment and a significant effect on the development of post-CT acute kidney injury [ 11 – 13 ]. In addition, some CT contrast agents induce adverse cardiac events, such as cardiac death and heart failure, within one month after CT contrast agent administration [ 14 , 15 ].…”

Incidence of Contrast-Associated Acute Kidney Injury in Renal-Competent COVID-19 Patients Undergoing Computed Chest Angiography

“…17 This concern has been borne out in a small series of patients undergoing CTA and coronary catheterization, which demonstrate increased rates of AKI in this population. 18,19 Our investigation evaluated whether newly diagnosed COVID-positive patients without laboratory evidence of severe renal-impairment (eGFR >30) are at increased risk for CA-AKI. Although our study cohort was eligible to receive the contrast based on contemporary guidelines, 5 one could postulate that incipient COVID-related AKI may not manifest in measurable creatine increases at initial presentation, leading to an underestimation of CA-AKI risk.…”