Bilateral Sustained Nephrograms After Parenteral Administration of Iodinated Contrast Material: A Potential Biomarker for Acute Kidney Injury, Dialysis, and Mortality

Jennifer S McDonald, Erik M. Steckler, Robert McDonald, Richard W. Katzberg, Eric E. Williamson, Joseph G. Cernigliaro, Abdurrahman M. Hamadah, Kamel Gharaibeh, David F Kallmes, Nelson Leung

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality. Patients and Methods: All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded. Nephrograms were identified by radiologist review and CT attenuation measurements. Univariate and multivariate analyses were performed to determine nephrogram risk factors. Acute kidney injury (defined as a creatinine level of ≥0.5 mg/dL or Kidney Disease: Improving Global Outcomes stages 1-3), dialysis, and mortality proportions were compared between patients with and without bilateral global nephrograms using the Fisher's exact test. Results: A total of 123 patients met all inclusion criteria. The proportion of patients with a nephrogram was 37.4% (n=46), with a higher proportion following interventional (67% [18 of 30]) vs diagnostic (27.3% [9 of 33]) catheterization or contrast-enhanced computed tomography (31.7% [19 of 60]). Age (P=.002), chronic kidney disease (P=.05), and acute hypotension or shock (P=.02) were significant risk factors for nephrogram development. Patients with nephrogram had significantly higher rates of AKI (37.0% [17 of 46] vs 5.2% [4 of 77]; odds ratio [OR], 10.7 [95% CI, 3.31-34.5]; P<.001), dialysis (17.4% [8 of 46] vs 1.3% [1 of 77]; OR, 16.0 [95% CI, 1.93-133]; P=.001), and mortality (15.2% [7 of 46] vs 1.3% [1 of 77]; OR, 13.6 [1.62-115]; P=.003) than patients without nephrogram. Conclusion: The presence of persistent bilateral global nephrograms suggests an increased risk of AKI, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - Jan 1 2018

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Acute Kidney Injury
Contrast Media
Dialysis
Biomarkers
Mortality
Tomography
Odds Ratio
Creatinine
Iohexol
Kidney Diseases
Cardiac Catheterization
Chronic Renal Insufficiency
Catheterization
Hypotension
Shock
Multivariate Analysis
Kidney

ASJC Scopus subject areas

  • Medicine(all)

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Bilateral Sustained Nephrograms After Parenteral Administration of Iodinated Contrast Material : A Potential Biomarker for Acute Kidney Injury, Dialysis, and Mortality. / McDonald, Jennifer S; Steckler, Erik M.; McDonald, Robert; Katzberg, Richard W.; Williamson, Eric E.; Cernigliaro, Joseph G.; Hamadah, Abdurrahman M.; Gharaibeh, Kamel; Kallmes, David F; Leung, Nelson.

In: Mayo Clinic Proceedings, 01.01.2018.

Research output: Contribution to journalArticle

McDonald, Jennifer S ; Steckler, Erik M. ; McDonald, Robert ; Katzberg, Richard W. ; Williamson, Eric E. ; Cernigliaro, Joseph G. ; Hamadah, Abdurrahman M. ; Gharaibeh, Kamel ; Kallmes, David F ; Leung, Nelson. / Bilateral Sustained Nephrograms After Parenteral Administration of Iodinated Contrast Material : A Potential Biomarker for Acute Kidney Injury, Dialysis, and Mortality. In: Mayo Clinic Proceedings. 2018.
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title = "Bilateral Sustained Nephrograms After Parenteral Administration of Iodinated Contrast Material: A Potential Biomarker for Acute Kidney Injury, Dialysis, and Mortality",
abstract = "Objective: To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality. Patients and Methods: All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded. Nephrograms were identified by radiologist review and CT attenuation measurements. Univariate and multivariate analyses were performed to determine nephrogram risk factors. Acute kidney injury (defined as a creatinine level of ≥0.5 mg/dL or Kidney Disease: Improving Global Outcomes stages 1-3), dialysis, and mortality proportions were compared between patients with and without bilateral global nephrograms using the Fisher's exact test. Results: A total of 123 patients met all inclusion criteria. The proportion of patients with a nephrogram was 37.4{\%} (n=46), with a higher proportion following interventional (67{\%} [18 of 30]) vs diagnostic (27.3{\%} [9 of 33]) catheterization or contrast-enhanced computed tomography (31.7{\%} [19 of 60]). Age (P=.002), chronic kidney disease (P=.05), and acute hypotension or shock (P=.02) were significant risk factors for nephrogram development. Patients with nephrogram had significantly higher rates of AKI (37.0{\%} [17 of 46] vs 5.2{\%} [4 of 77]; odds ratio [OR], 10.7 [95{\%} CI, 3.31-34.5]; P<.001), dialysis (17.4{\%} [8 of 46] vs 1.3{\%} [1 of 77]; OR, 16.0 [95{\%} CI, 1.93-133]; P=.001), and mortality (15.2{\%} [7 of 46] vs 1.3{\%} [1 of 77]; OR, 13.6 [1.62-115]; P=.003) than patients without nephrogram. Conclusion: The presence of persistent bilateral global nephrograms suggests an increased risk of AKI, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.",
author = "McDonald, {Jennifer S} and Steckler, {Erik M.} and Robert McDonald and Katzberg, {Richard W.} and Williamson, {Eric E.} and Cernigliaro, {Joseph G.} and Hamadah, {Abdurrahman M.} and Kamel Gharaibeh and Kallmes, {David F} and Nelson Leung",
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T2 - A Potential Biomarker for Acute Kidney Injury, Dialysis, and Mortality

AU - McDonald, Jennifer S

AU - Steckler, Erik M.

AU - McDonald, Robert

AU - Katzberg, Richard W.

AU - Williamson, Eric E.

AU - Cernigliaro, Joseph G.

AU - Hamadah, Abdurrahman M.

AU - Gharaibeh, Kamel

AU - Kallmes, David F

AU - Leung, Nelson

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality. Patients and Methods: All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded. Nephrograms were identified by radiologist review and CT attenuation measurements. Univariate and multivariate analyses were performed to determine nephrogram risk factors. Acute kidney injury (defined as a creatinine level of ≥0.5 mg/dL or Kidney Disease: Improving Global Outcomes stages 1-3), dialysis, and mortality proportions were compared between patients with and without bilateral global nephrograms using the Fisher's exact test. Results: A total of 123 patients met all inclusion criteria. The proportion of patients with a nephrogram was 37.4% (n=46), with a higher proportion following interventional (67% [18 of 30]) vs diagnostic (27.3% [9 of 33]) catheterization or contrast-enhanced computed tomography (31.7% [19 of 60]). Age (P=.002), chronic kidney disease (P=.05), and acute hypotension or shock (P=.02) were significant risk factors for nephrogram development. Patients with nephrogram had significantly higher rates of AKI (37.0% [17 of 46] vs 5.2% [4 of 77]; odds ratio [OR], 10.7 [95% CI, 3.31-34.5]; P<.001), dialysis (17.4% [8 of 46] vs 1.3% [1 of 77]; OR, 16.0 [95% CI, 1.93-133]; P=.001), and mortality (15.2% [7 of 46] vs 1.3% [1 of 77]; OR, 13.6 [1.62-115]; P=.003) than patients without nephrogram. Conclusion: The presence of persistent bilateral global nephrograms suggests an increased risk of AKI, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.

AB - Objective: To determine whether persistent bilateral global nephrograms are associated with acute kidney injury (AKI), dialysis, and mortality. Patients and Methods: All patients who underwent (1) contrast-enhanced computed tomography (CT) or cardiac catheterization with iohexol between January 1, 2000, and December 31, 2014, and (2) noncontrast abdominal CT in the subsequent 24±6 hours were identified. Patients without preprocedure and postprocedure creatinine measurements or who received additional contrast material were excluded. Nephrograms were identified by radiologist review and CT attenuation measurements. Univariate and multivariate analyses were performed to determine nephrogram risk factors. Acute kidney injury (defined as a creatinine level of ≥0.5 mg/dL or Kidney Disease: Improving Global Outcomes stages 1-3), dialysis, and mortality proportions were compared between patients with and without bilateral global nephrograms using the Fisher's exact test. Results: A total of 123 patients met all inclusion criteria. The proportion of patients with a nephrogram was 37.4% (n=46), with a higher proportion following interventional (67% [18 of 30]) vs diagnostic (27.3% [9 of 33]) catheterization or contrast-enhanced computed tomography (31.7% [19 of 60]). Age (P=.002), chronic kidney disease (P=.05), and acute hypotension or shock (P=.02) were significant risk factors for nephrogram development. Patients with nephrogram had significantly higher rates of AKI (37.0% [17 of 46] vs 5.2% [4 of 77]; odds ratio [OR], 10.7 [95% CI, 3.31-34.5]; P<.001), dialysis (17.4% [8 of 46] vs 1.3% [1 of 77]; OR, 16.0 [95% CI, 1.93-133]; P=.001), and mortality (15.2% [7 of 46] vs 1.3% [1 of 77]; OR, 13.6 [1.62-115]; P=.003) than patients without nephrogram. Conclusion: The presence of persistent bilateral global nephrograms suggests an increased risk of AKI, dialysis, and mortality when compared with patients whose kidneys fully eliminated the contrast material.

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