Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department–based Study

Radiology ◽  
2021 ◽  
Author(s):  
Tse-Hsuan Su ◽  
Chih-Huang Hsieh ◽  
Yi-Ling Chan ◽  
Yon-Cheong Wong ◽  
Chang-Fu Kuo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Contrast Media ◽  
Kidney Injury ◽  
Ct Contrast

scholarly journals Risk of acute kidney injury after contrast-enhanced computed tomography in emergency department

2020 ◽  
pp. 102490792091339
Author(s):  
Seda Dağar ◽  
Emine Emektar ◽  
Hüseyin Uzunosmanoğlu ◽  
Şeref Kerem Çorbacıoğlu ◽  
Özge Öztekin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Contrast Media ◽  
Kidney Injury ◽  
Intravenous Contrast ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

scholarly journals Trends in contrast-induced acute kidney injury rate after percutaneous coronary interventions in coronary artery disease

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
O Mironova ◽  
OA Sivakova ◽  
VV Fomin
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Media ◽  
Preventive Measures ◽  
Clinical Importance ◽  
Injury Rate ◽  
Kidney Injury ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background. Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated. Purpose. The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively. Methods. 1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury.  Results. The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p < 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs). Conclusion. The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.

scholarly journals 113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C McCann ◽  
A Hall ◽  
J Min Leow ◽  
A Harris ◽  
N Hafiz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Ward Round ◽  
Fluid Administration ◽  
Ward Staff ◽  
Intravenous Fluid Therapy ◽  
Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

scholarly journals Risk factors, mortality and acute kidney injury outcomes in cirrhotic patients in the emergency department

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Paulo Ricardo Gessolo Lins ◽  
Wallace Stwart Carvalho Padilha ◽  
Carolina Frade Magalhaes Giradin Pimentel ◽  
Marcelo Costa Batista ◽  
Aécio Flávio Teixeira de Gois
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Cirrhotic Patients ◽  
Injury Outcomes

scholarly journals Urinary Nitrate Might Be an Early Biomarker for Pediatric Acute Kidney Injury in the Emergency Department

2011 ◽  
Vol 70 (2) ◽  
pp. 203-207 ◽  
Author(s):  
Asad I Mian ◽  
Yue Du ◽  
Harsha K Garg ◽  
A Chantal Caviness ◽  
Stuart L Goldstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Pediatric Acute Kidney Injury ◽  
Early Biomarker

Fractional excretion of sodium or urea as prognostic indicators for acute kidney injury in the emergency department

2021 ◽  
Vol 29 (1) ◽  
pp. 82-84
Author(s):  
Gregor Lindner ◽  
Adrian Wolfensberger ◽  
Aristomenis K. Exadaktylos ◽  
Christoph Schwarz ◽  
Georg-Christian Funk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Prognostic Indicators ◽  
Fractional Excretion Of Sodium

scholarly journals Rhabdomyolysis and acute kidney injury in severe COVID-19 infection

2020 ◽  
Vol 13 (9) ◽  
pp. e237616 ◽  
Author(s):  
Knut Taxbro ◽  
Hannes Kahlow ◽  
Hannes Wulcan ◽  
Anna Fornarve
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Abdominal Pain ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Forced Diuresis

We report the case of a 38-year-old man who presented to the emergency department with fever, myalgia, nausea, vomiting, dry cough, breathlessness and abdominal pain. He was admitted due to hypoxaemia and was diagnosed with SARS-CoV-2 and was subsequently referred to the intensive care unit for intubation and mechanical ventilation. Severe rhabdomyolysis and acute kidney injury developed 4 days later and were suspected after noticing discolouration of the urine and a marked increase in plasma myoglobin levels. Treatment included hydration, forced diuresis and continuous renal replacement therapy. In addition to the coronavirus disease acute respiratory distress syndrome, he was diagnosed with possible SARS-CoV-2-induced myositis with severe rhabdomyolysis and kidney failure. The patient survived and was discharged from intensive care after 12 days, returning home 23 days after hospitalisation, fully mobilised with a partially restored kidney function.

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