The administration of contrast media: Is there a risk of acute kidney injury?

Puchol, M.D. Ferrer; García, P. Montesinos; Navarro, Margarita Suárez; Rodrigo, Elena; Blanco-Pérez, Esther; López, E. Taberner

doi:10.1016/j.rxeng.2019.04.001

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…Dos critérios de inclusão, nove artigos foram selecionados para estudo [16][17][18][19][20][21][22][23][24] . No total, foram analisados 53.169 pacientes alocados em grupo-controle e grupo de intervenção.…”

Section: Análise E Discussão Dos Resultadosunclassified

Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Moro

Strauch²,

Groto

et al. 2021

J. vasc. bras.

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Resumo A variação do valor encontrado nos exames de creatinina em pacientes submetidos à tomografia computadorizada (TC) contrastada tem sido utilizada como método prático para a avaliação de possíveis lesões renais causadas pelo uso do contraste. Entre os critérios, considera-se o aumento absoluto de creatinina sérica ≥ 0,5 mg/dL ou relativo em ≥ 25% para possíveis distúrbios renais, como a nefropatia induzida por contraste (NIC). Nosso objetivo foi analisar a incidência de NIC através de uma metanálise envolvendo nove artigos relacionados à incidência de lesão renal por contraste, sendo calculado o odds ratio (OR) e o intervalo de confiança (IC95%) por meio do programa RStudio. A incidência de NIC em pacientes submetidos a TC foi de 11,29%, sendo o OR de 1,38 (IC95% 0,88–2,16). Contrastes não iônicos apresentam maior segurança em seu uso que outros tipos de contraste, e o volume maior que 115 mL pode estar relacionado a NIC. A doença renal prévia apresentou significado estatístico em agravar a NIC.

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Section: Análise E Discussão Dos Resultadosunclassified

Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Moro

Strauch²,

Groto

et al. 2021

J. vasc. bras.

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Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score–matched cohort studies

et al. 2022

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Objectives Intravenous application of contrast media is part of a wide spectrum of diagnostic procedures for better imaging quality. Clinical avoidance of contrast-enhanced imaging is an ever-present quandary in patients with impaired kidney function. The objective of this study was to estimate the risk for acute kidney injury (AKI), dialysis and mortality among patients undergoing contrast-enhanced CT compared to propensity score–matched controls (i.e. contrast-unenhanced CT). Selected cohort studies featured high-risk patients with advanced kidney disease and critical illness. Methods This review was designed to conform to the Preferred Reporting Items in Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed was searched from August 2021 to November 2021 for all-language articles without date restriction. A random-effects model (DerSimonian and Laird method) was used for meta-analysis. Results Twenty-one articles were included, comprising data of 169,455 patients. The overall risk of AKI was similar in the contrast-enhanced and unenhanced groups (OR: 0.97 [95% CI: 0.85; 1.11], p = 0.64), regardless of baseline renal function and underlying disease. Substantial heterogeneity was detected (I2 = 90%, p ≤ 0.0001). Multivariable logistic regression identified hypertension (p = 0.03) and estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 (p = 0.0001) as factors associated with greater risk of post-contrast AKI. Conclusions Based on propensity score–matched pairs obtained from 21 cohort studies, we found no evidence for increased risk for AKI, dialysis or mortality after contrast-enhanced CT among patients with eGFR ≥ 45 mL/min/1.73 m2. In congruence with the emerging evidence in the literature, caution should be exercised in patients with hypertension and eGFR ≤ 30 mL/min/1.73 m2. Key Points • The application of contrast media for medical imaging is not associated with higher odds for AKI, induction of renal replacement therapy, or mortality. Many comorbidities traditionally associated with greater risk for acute kidney injury do not appear to predispose for renal decline after contrast media exposure. • Underlying hypertension and eGFR less than or equal to 30 mL/min/1.73 m2seem to predispose for post-contrast acute kidney injury. • Propensity score matching cannot account for unmeasured influences on AKI incidence, which needs to be addressed in the interpretation of results.

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Illuminating the Use of Trauma Whole-Body CT Scan During the Global Contrast Shortage

Ramsey

O’Neil

Ramdev

et al. 2023

Journal of the American College of Surgeons

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BACKGROUND: Use of whole-body CT scan (WBCT) is widespread in the evaluation of traumatically injured patients and may be associated with improved survival. WBCT protocols include the use of IV contrast unless there is a contraindication. This study tests the hypothesis that using plain WBCT scan during the global contrast shortage would result in greater need for repeat contrast-enhanced CT, but would not impact mortality, missed injuries, or rates of acute kidney injury (AKI). STUDY DESIGN: All trauma encounters at an academic level-I trauma center between March 1, 2022 and June 24, 2022, excluding burns and prehospital cardiac arrests, were reviewed. Imaging practices and outcomes before and during contrast shortage (beginning May 3, 2022) were compared. RESULTS: The study population included 1,109 consecutive patients (72% male), with 890 (80%) blunt and 219 (20%) penetrating traumas. Overall, 53% of patients underwent WBCT and contrast was administered to 73%. The overall rate of AKI was 6% and the rate of renal replacement therapy (RRT) was 1%. Contrast usage in WBCT was 99% before and 40% during the shortage (p < 0.001). There was no difference in the rate of repeat CT scans, missed injuries, AKI, RRT, or mortality. CONCLUSIONS: Trauma imaging practices at our center changed during the global contrast shortage; the use of contrast decreased despite the frequency of trauma WBCT scans remaining the same. The rates of AKI and RRT did not change, suggesting that WBCT with contrast is insufficient to cause AKI. The missed injury rate was equivalent. Our data suggest similar outcomes can be achieved with selective IV contrast use during WBCT.

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The administration of contrast media: Is there a risk of acute kidney injury?

Cited by 5 publications

References 20 publications

Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score–matched cohort studies

Illuminating the Use of Trauma Whole-Body CT Scan During the Global Contrast Shortage

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