Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study

Jennifer S McDonald, Robert McDonald, Eric E. Williamson, David F Kallmes, Kianoush Kashani

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38 Citations (Scopus)

Abstract

Purpose: To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination. Methods: All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR > 45 and eGFR ≤ 45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR ≥ 60, 30–59, and <30 subsets were also performed. Results: A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34%, OR .88 (95% CI .75–1.05), p = .15), dialysis (2.0 vs. 1.7%, OR 1.20 (.66–2.17), p = .55), and mortality (12 vs. 14%, OR .87 (.69–1.10), p = .23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR > 45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5%, OR 2.72 (1.14–6.46), p = .0240) were observed in the contrast versus noncontrast group in the matched eGFR ≤ 45 subset. Conclusions: Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR > 45. An increased risk of dialysis was observed in patients with pre-CT eGFR ≤ 45.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalIntensive Care Medicine
DOIs
StateAccepted/In press - Feb 17 2017

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Propensity Score
Acute Kidney Injury
Intensive Care Units
Dialysis
Contrast Media
Mortality
Cohort Studies
Research Design

Keywords

  • AKI
  • Iodinated contrast material
  • Post-contrast acute kidney injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Post-contrast acute kidney injury in intensive care unit patients : a propensity score-adjusted study. / McDonald, Jennifer S; McDonald, Robert; Williamson, Eric E.; Kallmes, David F; Kashani, Kianoush.

In: Intensive Care Medicine, 17.02.2017, p. 1-11.

Research output: Contribution to journalArticle

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abstract = "Purpose: To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination. Methods: All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR > 45 and eGFR ≤ 45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR ≥ 60, 30–59, and <30 subsets were also performed. Results: A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34{\%}, OR .88 (95{\%} CI .75–1.05), p = .15), dialysis (2.0 vs. 1.7{\%}, OR 1.20 (.66–2.17), p = .55), and mortality (12 vs. 14{\%}, OR .87 (.69–1.10), p = .23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR > 45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5{\%}, OR 2.72 (1.14–6.46), p = .0240) were observed in the contrast versus noncontrast group in the matched eGFR ≤ 45 subset. Conclusions: Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR > 45. An increased risk of dialysis was observed in patients with pre-CT eGFR ≤ 45.",
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AU - Kashani, Kianoush

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N2 - Purpose: To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination. Methods: All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR > 45 and eGFR ≤ 45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR ≥ 60, 30–59, and <30 subsets were also performed. Results: A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34%, OR .88 (95% CI .75–1.05), p = .15), dialysis (2.0 vs. 1.7%, OR 1.20 (.66–2.17), p = .55), and mortality (12 vs. 14%, OR .87 (.69–1.10), p = .23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR > 45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5%, OR 2.72 (1.14–6.46), p = .0240) were observed in the contrast versus noncontrast group in the matched eGFR ≤ 45 subset. Conclusions: Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR > 45. An increased risk of dialysis was observed in patients with pre-CT eGFR ≤ 45.

AB - Purpose: To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination. Methods: All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR > 45 and eGFR ≤ 45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR ≥ 60, 30–59, and <30 subsets were also performed. Results: A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34%, OR .88 (95% CI .75–1.05), p = .15), dialysis (2.0 vs. 1.7%, OR 1.20 (.66–2.17), p = .55), and mortality (12 vs. 14%, OR .87 (.69–1.10), p = .23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR > 45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5%, OR 2.72 (1.14–6.46), p = .0240) were observed in the contrast versus noncontrast group in the matched eGFR ≤ 45 subset. Conclusions: Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR > 45. An increased risk of dialysis was observed in patients with pre-CT eGFR ≤ 45.

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