Risk of Acute Kidney Injury After Intravenous Contrast Media Administration

Hinson, Jeremiah S.; Ehmann, Michael R.; Fine, Derek M.; Fishman, Elliot K.; Toerper, Matthew; Rothman, Richard E.; Klein, Eili Y.

doi:10.1016/j.annemergmed.2016.11.021

Cited by 217 publications

(190 citation statements)

References 25 publications

Supporting

Mentioning

157

Contrasting

Unclassified

Order By: Relevance

“…These rates of AKI in this high-risk population are higher than the rates reported in the literature [3,7,8]. This is likely explained by 2 factors.…”

Section: Discussioncontrasting

confidence: 54%

“…The rate of CIN AKI in patients who received IA contrast (16.5%) is similar to the rates described in CKD populations [9]. On the other hand, the rate of CIN AKI after IV contrast (12.5%) was higher than previously reported rates of 2-4% [11,12] in the general population and closer to those reported in CKD populations, ranging from 2.5 to 11% [2,7,13]. This slightly higher incidence can be explained by the higher risk population analyzed in this study (inpatient CKD) along with the more conservative definition of AKI used for our analysis (0.3 mg/dL rather than 0.5 mg/dL).…”

Section: Discussioncontrasting

confidence: 40%

See 1 more Smart Citation

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

Chaudhury

Armanyous

Harb

et al. 2018

Nephron

View full text Add to dashboard Cite

Background/Aims: contrast-induced nephropathy (CIN) is well described following an administration of intraarterial contrast, but its occurrence after intravenous (IV) contrast is being questioned. We evaluated the incidence of acute kidney injury (AKI), post-contrast AKI (PC-AKI), CIN, dialysis and mortality in patients with chronic kidney disease (CKD) undergoing non-contrast computed tomography (NCCT) or contrast CT (CCT) or coronary angiography (CoA). Methods: We identified individuals who had CoA or CCT or NCCT between 2010 and 2015 in the Cleveland Clinic CKD registry. We used propensity scores to match patients in the 3 groups. We evaluated the proportion of patients that developed AKI and CIN across the groups with chi-square tests. We generated Kaplan-Meier plots comparing mortality and ESRD among patients who developed AKI (in the NCCT group), PC (multifactorial AKI, CIN) AKI and no AKI. Results: Out of 251 eligible patients, 200 who had CoA were matched to each of the other CT scan groups. The incidence of AKI was 27% in CoA, 24% in CCT and 24% in NCCT (p = 0.72). The incidence of CIN AKI was 16.5% in CoA and 12.5% in CCT (p = 0.26). The Kaplan-Meier survival at 2 years was 74.8 (95% CI 63.8–87.7) for those with CIN and 53.2 (95% CI 39.7–71.4) for those with multifactorial AKI and 56.5 (95% CI 43.4–73.6) for those with AKI-NCCT and 71.4 (95% CI 67.2–76.0) for those without AKI. The Kaplan-Meier ESRD-free estimates at 2 years were 89.9 (95% CI 80.8–100) for those with CIN and 89.4 (95% CI 78.7–100) for those with multifactorial AKI and 77.4 (95% CI 63.6–94.3) for those with AKI-NCCT and 94.4 (95% CI 91.9–97.1) for those without AKI. Conclusion: The administration of both IV and intra-arterial contrast is associated with a risk of AKI. Multifactorial AKI was associated with worse outcomes, while CIN was associated with better outcomes.

show abstract

“…These rates of AKI in this high-risk population are higher than the rates reported in the literature [3,7,8]. This is likely explained by 2 factors.…”

Section: Discussioncontrasting

confidence: 54%

Section: Discussioncontrasting

confidence: 40%

Intra-Arterial versus Intravenous Contrast and Renal Injury in Chronic Kidney Disease: A Propensity-Matched Analysis

Chaudhury

Armanyous

Harb

et al. 2018

Nephron

View full text Add to dashboard Cite

show abstract

“…The concept of CI-AKI arose from observation and assumed causality, and despite a lack of rigorous hypothesis testing, has driven clinical practice for more than five decades. While a randomized controlled trial has not been conducted, there is now substantial evidence suggesting that CM contributes minimally, if at all, to the development of AKI [6,7,9,11,13,[15][16][17]. Despite the existence of such evidence, a pervasive preoccupation with what should be referred to as contrast-associated AKI (CA-AKI) persists in clinical practice, medical texts, and even among clinical researchers.…”

Section: Resultsmentioning

confidence: 99%

“…Several subsequent studies have utilized propensity matching analysis to minimize this bias. None of these studies identified an independent association between intravenous CM administration and risk for AKI, dialysis, or death in the general population [11][12][13]. While one group did report increased risk of AKI associated with CM administration in the less than 5% of patients with an estimated glomerular filtration rate below 30 mL/ min/1.73 m 2 , two others did not [11][12][13].…”

Section: Intravenous Contrast Media and Acute Kidney Injury In The Gementioning

confidence: 91%

Contrast-associated acute kidney injury is a myth: Yes

2017

Self Cite

View full text Add to dashboard Cite

“…Finally, it is now becoming evident that initial concerns regarding intravenous contrast and resultant acute kidney injury, termed contrast induced nephropathy (CIN), were overestimated [43]. The largest and most recent study to date was unable to established between IV contrast and CIN [44].…”

Section: Limitations Of Ctmentioning

confidence: 99%