Postcontrast Acute Kidney Injury in Pediatric Patients: A Cohort Study

Jennifer S McDonald, Robert McDonald, Cheryl L. Tran, Amy B. Kolbe, Eric E. Williamson, David F Kallmes

Research output: Contribution to journalArticle

Abstract

Rational & Objective: The risks of iodinated contrast material administered to pediatric patients are not well defined. The purpose of this study was to examine the rates of postcontrast acute kidney injury (AKI), dialysis therapy, and death following administration of intravenous contrast material to pediatric patients. Study Design: Retrospective cohort study. Setting & Participants: Pediatric (aged <18 years) patients who underwent either contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomography (CT) at our institution from December 2001 to January 2016. Exposure: Intravenous iodinated contrast material. Outcomes: Postcontrast AKI based on serum creatinine–defined KDIGO criteria, dialysis therapy, and death. Analytical Approach: Risks for AKI, dialysis therapy, and death were compared between contrast and noncontrast group patients using a propensity score analysis incorporating clinical covariates related to contrast exposure. Results: 2,201 pediatric patients (1,773 contrast and 428 noncontrast) were identified. Rates of AKI and dialysis therapy in the contrast group were 3.3% (59/1,773) and 0.1% (2/1,773), respectively. Following propensity score adjustment, no differences in risk for AKI (stage 1 AKI: OR, 0.75 [95% CI, 0.32-1.78], P = 0.5; stage 2: OR, 2.00 [95% CI, 0.18-21.9], P = 0.6; stage 3: OR, 0.50 [95% CI, 0.05-5.48], P = 0.6), dialysis therapy (OR, 1.00 [95% CI, 0.06-15.9], P = 0.9), or death (OR, 1.50 [95% CI, 0.53-4.22], P = 0.4) were observed between the contrast and noncontrast groups. All patients with post-CT stage 3 AKI diagnosed also had contrast-independent potential causes of AKI. Limitations: The study's small sample size and low rates of postcontrast AKI, dialysis therapy, and death limited the ability to detect an effect of contrast administration on these outcomes. Unmeasured residual confounders may limit the validity of our results. Few patients had decreased kidney function at the time of CT. Conclusions: Rates of postcontrast AKI, dialysis therapy, and death following contrast-enhanced CT were very low in this pediatric cohort. Although not detectably different, an effect of contrast on these outcomes could not be ruled out.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Acute Kidney Injury
Cohort Studies
Pediatrics
Dialysis
Tomography
Contrast Media
Propensity Score
Therapeutics
Reproducibility of Results
Intravenous Administration
Sample Size
Retrospective Studies
Kidney
Serum

Keywords

  • acute kidney injury (AKI)
  • children
  • computed tomography (CT)
  • contrast-induced AKI
  • contrast-induced nephropathy (CIN)
  • CT scan
  • death
  • dialysis
  • Iodinated contrast material
  • iohexol
  • nephrotoxicity
  • pediatric patients
  • renal function
  • serum creatinine (Scr)
  • teenagers

ASJC Scopus subject areas

  • Nephrology

Cite this

Postcontrast Acute Kidney Injury in Pediatric Patients : A Cohort Study. / McDonald, Jennifer S; McDonald, Robert; Tran, Cheryl L.; Kolbe, Amy B.; Williamson, Eric E.; Kallmes, David F.

In: American Journal of Kidney Diseases, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Rational & Objective: The risks of iodinated contrast material administered to pediatric patients are not well defined. The purpose of this study was to examine the rates of postcontrast acute kidney injury (AKI), dialysis therapy, and death following administration of intravenous contrast material to pediatric patients. Study Design: Retrospective cohort study. Setting & Participants: Pediatric (aged <18 years) patients who underwent either contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomography (CT) at our institution from December 2001 to January 2016. Exposure: Intravenous iodinated contrast material. Outcomes: Postcontrast AKI based on serum creatinine–defined KDIGO criteria, dialysis therapy, and death. Analytical Approach: Risks for AKI, dialysis therapy, and death were compared between contrast and noncontrast group patients using a propensity score analysis incorporating clinical covariates related to contrast exposure. Results: 2,201 pediatric patients (1,773 contrast and 428 noncontrast) were identified. Rates of AKI and dialysis therapy in the contrast group were 3.3{\%} (59/1,773) and 0.1{\%} (2/1,773), respectively. Following propensity score adjustment, no differences in risk for AKI (stage 1 AKI: OR, 0.75 [95{\%} CI, 0.32-1.78], P = 0.5; stage 2: OR, 2.00 [95{\%} CI, 0.18-21.9], P = 0.6; stage 3: OR, 0.50 [95{\%} CI, 0.05-5.48], P = 0.6), dialysis therapy (OR, 1.00 [95{\%} CI, 0.06-15.9], P = 0.9), or death (OR, 1.50 [95{\%} CI, 0.53-4.22], P = 0.4) were observed between the contrast and noncontrast groups. All patients with post-CT stage 3 AKI diagnosed also had contrast-independent potential causes of AKI. Limitations: The study's small sample size and low rates of postcontrast AKI, dialysis therapy, and death limited the ability to detect an effect of contrast administration on these outcomes. Unmeasured residual confounders may limit the validity of our results. Few patients had decreased kidney function at the time of CT. Conclusions: Rates of postcontrast AKI, dialysis therapy, and death following contrast-enhanced CT were very low in this pediatric cohort. Although not detectably different, an effect of contrast on these outcomes could not be ruled out.",
keywords = "acute kidney injury (AKI), children, computed tomography (CT), contrast-induced AKI, contrast-induced nephropathy (CIN), CT scan, death, dialysis, Iodinated contrast material, iohexol, nephrotoxicity, pediatric patients, renal function, serum creatinine (Scr), teenagers",
author = "McDonald, {Jennifer S} and Robert McDonald and Tran, {Cheryl L.} and Kolbe, {Amy B.} and Williamson, {Eric E.} and Kallmes, {David F}",
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T1 - Postcontrast Acute Kidney Injury in Pediatric Patients

T2 - A Cohort Study

AU - McDonald, Jennifer S

AU - McDonald, Robert

AU - Tran, Cheryl L.

AU - Kolbe, Amy B.

AU - Williamson, Eric E.

AU - Kallmes, David F

PY - 2018/1/1

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N2 - Rational & Objective: The risks of iodinated contrast material administered to pediatric patients are not well defined. The purpose of this study was to examine the rates of postcontrast acute kidney injury (AKI), dialysis therapy, and death following administration of intravenous contrast material to pediatric patients. Study Design: Retrospective cohort study. Setting & Participants: Pediatric (aged <18 years) patients who underwent either contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomography (CT) at our institution from December 2001 to January 2016. Exposure: Intravenous iodinated contrast material. Outcomes: Postcontrast AKI based on serum creatinine–defined KDIGO criteria, dialysis therapy, and death. Analytical Approach: Risks for AKI, dialysis therapy, and death were compared between contrast and noncontrast group patients using a propensity score analysis incorporating clinical covariates related to contrast exposure. Results: 2,201 pediatric patients (1,773 contrast and 428 noncontrast) were identified. Rates of AKI and dialysis therapy in the contrast group were 3.3% (59/1,773) and 0.1% (2/1,773), respectively. Following propensity score adjustment, no differences in risk for AKI (stage 1 AKI: OR, 0.75 [95% CI, 0.32-1.78], P = 0.5; stage 2: OR, 2.00 [95% CI, 0.18-21.9], P = 0.6; stage 3: OR, 0.50 [95% CI, 0.05-5.48], P = 0.6), dialysis therapy (OR, 1.00 [95% CI, 0.06-15.9], P = 0.9), or death (OR, 1.50 [95% CI, 0.53-4.22], P = 0.4) were observed between the contrast and noncontrast groups. All patients with post-CT stage 3 AKI diagnosed also had contrast-independent potential causes of AKI. Limitations: The study's small sample size and low rates of postcontrast AKI, dialysis therapy, and death limited the ability to detect an effect of contrast administration on these outcomes. Unmeasured residual confounders may limit the validity of our results. Few patients had decreased kidney function at the time of CT. Conclusions: Rates of postcontrast AKI, dialysis therapy, and death following contrast-enhanced CT were very low in this pediatric cohort. Although not detectably different, an effect of contrast on these outcomes could not be ruled out.

AB - Rational & Objective: The risks of iodinated contrast material administered to pediatric patients are not well defined. The purpose of this study was to examine the rates of postcontrast acute kidney injury (AKI), dialysis therapy, and death following administration of intravenous contrast material to pediatric patients. Study Design: Retrospective cohort study. Setting & Participants: Pediatric (aged <18 years) patients who underwent either contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomography (CT) at our institution from December 2001 to January 2016. Exposure: Intravenous iodinated contrast material. Outcomes: Postcontrast AKI based on serum creatinine–defined KDIGO criteria, dialysis therapy, and death. Analytical Approach: Risks for AKI, dialysis therapy, and death were compared between contrast and noncontrast group patients using a propensity score analysis incorporating clinical covariates related to contrast exposure. Results: 2,201 pediatric patients (1,773 contrast and 428 noncontrast) were identified. Rates of AKI and dialysis therapy in the contrast group were 3.3% (59/1,773) and 0.1% (2/1,773), respectively. Following propensity score adjustment, no differences in risk for AKI (stage 1 AKI: OR, 0.75 [95% CI, 0.32-1.78], P = 0.5; stage 2: OR, 2.00 [95% CI, 0.18-21.9], P = 0.6; stage 3: OR, 0.50 [95% CI, 0.05-5.48], P = 0.6), dialysis therapy (OR, 1.00 [95% CI, 0.06-15.9], P = 0.9), or death (OR, 1.50 [95% CI, 0.53-4.22], P = 0.4) were observed between the contrast and noncontrast groups. All patients with post-CT stage 3 AKI diagnosed also had contrast-independent potential causes of AKI. Limitations: The study's small sample size and low rates of postcontrast AKI, dialysis therapy, and death limited the ability to detect an effect of contrast administration on these outcomes. Unmeasured residual confounders may limit the validity of our results. Few patients had decreased kidney function at the time of CT. Conclusions: Rates of postcontrast AKI, dialysis therapy, and death following contrast-enhanced CT were very low in this pediatric cohort. Although not detectably different, an effect of contrast on these outcomes could not be ruled out.

KW - acute kidney injury (AKI)

KW - children

KW - computed tomography (CT)

KW - contrast-induced AKI

KW - contrast-induced nephropathy (CIN)

KW - CT scan

KW - death

KW - dialysis

KW - Iodinated contrast material

KW - iohexol

KW - nephrotoxicity

KW - pediatric patients

KW - renal function

KW - serum creatinine (Scr)

KW - teenagers

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