Risk factors for post-contrast acute kidney injury in patients sequentially administered iodine- and gadolinium-based contrast media on the same visit to the emergency department: a retrospective study

Abstract

Background: This study compares the incidence of post-contrast acute kidney injury (PC-AKI) in patients who received a single administration of iodine-based contrast medium (ICM) with that in patients who received a sequential administration of ICM and gadolinium-based contrast agents (GBCA) in a single visit to an emergency department (ED) to determine the risk factors for PC-AKI. Methods: Patients who received one or more contrast media in the ED from 2016 to 2021 were included in this retrospective study. They were divided into the ICM alone and ICM + GBCA groups, and the incidence of PC-AKI was compared between the groups. The risk factors were assessed using a multivariable analysis after propensity score matching (PSM). Results: Overall, 6,318 patients were analyzed, of whom 139 were in the ICM + GBCA group. The incidence of PC-AKI was significantly higher in the ICM + GBCA group than in the ICM alone group (10.9% vs. 27.3%, p < 0.001). In the multivariable analysis, sequential administration was a risk factor for PC-AKI, and single administration was not (adjusted odds ratio [95% confidence interval] in the 1:1, 2:1, and 3:1 PSM cohorts: 2.38 [1.25-4.55], 2.13 [1.26-3.60], and 2.28 [1.39-3.72], respectively). In subgroup analyses of the ICM + GBCA group, osmolality (1. 05 [1.01-1.10]) and estimated glomerular filtration rate (eGFR,) were associated with PC-AKI. Conclusion: Compared with a single administration of ICM alone, sequential administration of ICM and GBCA during a single ED visit might be a risk factor for PC-AKI. Osmolality and eGFR might be associated with PC-AKI after sequential administration.

Risk of acute kidney injury following contrast-enhanced CT or MRI in a cohort of 3061 hospitalized children in China

“…Although initially believed to be without major adverse effects, gadolinium-based contrast agents was demonstrated to cause nephrogenic systemic fibrosis in patients with abnormal renal function [ 5 ]; moreover, a recent study indicated that exposure to Gadolinium was related to both necrosis and apoptosis of proximal tubular epithelium which led to kidney injury after Gadolinium exposure [ 6 , 7 ]. A retrospective study found that sequential exposure to iodine- and gadolinium-based contrast media on the same admission was a risk factors for post-contrast acute kidney injury (AKI) [ 1 ].…”

“…Contrast-associated acute kidney injury (CA-AKI) is characterized by a decrease in kidney function that occurs within several days after the intravascular administration of contrast material during imaging examination [ 1 , 2 ], which is similar with post-contrast acute kidney injury [ 1 , 8 ] and includes contrast-induced AKI (CI-AKI) [ 9 ]. The diagnosis of CI-AKI requires a causal temporality between contrast media and AKI as well as excluding other possible causes [ 10 ].…”

“…Contrast media are essential for enhanced imaging examinations, such as iodine-based contrast mediums used in computed tomography (CT) and gadolinium-based contrast agents used in magnetic resonance imaging (MRI), which helps physicians to obtain indispensable information [1]. However, the impacts of intravenous iodinebased contrast on renal function, including renal tubular epithelial cells damage and hemodynamic perturbations induced by contrast media, are still a research hotspot [2][3][4].…”