Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy

The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619,pvalue = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26,pvalue = 0.031).

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Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽

10.1186/s13054-019-2706-0 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

François Dépret ◽

Clément Hoffmann ◽

Laura Daoud ◽

Camille Thieffry ◽

Laure Monplaisir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Smoke Inhalation ◽

Logistic Regression Models ◽

Increased Risk ◽

The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

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SUN-165 ACUTE KIDNEY INJURY (AKI) FOLLOWING COMPUTED TOMOGRAPHY (CT) SCAN WITH VERSUS WITHOUT INTRAVENOUS CONTRAST MEDIA: A META-ANALYSIS

Kidney International Reports ◽

10.1016/j.ekir.2019.05.567 ◽

2019 ◽

Vol 4 (7) ◽

pp. S227

Author(s):

R. MONTEPIO ◽

A.P. Estabillo ◽

M. Pile-Coronel

Keyword(s):

Computed Tomography ◽

Acute Kidney Injury ◽

Contrast Media ◽

Ct Scan ◽

Meta Analysis ◽

Kidney Injury ◽

Intravenous Contrast ◽

Intravenous Contrast Media

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Fluctuations in Serum Chloride and Acute Kidney Injury among Critically Ill Patients: A Retrospective Association Study

Journal of Clinical Medicine ◽

10.3390/jcm8040447 ◽

2019 ◽

Vol 8 (4) ◽

pp. 447 ◽

Cited By ~ 3

Author(s):

Tak Kyu Oh ◽

In-Ae Song ◽

Young-Tae Jeon ◽

You Hwan Jo

Keyword(s):

Acute Kidney Injury ◽

Confidence Interval ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Kidney Injury ◽

Icu Admission ◽

Serum Chloride ◽

Increased Risk ◽

The Difference

Exposure to dyschloremia among critically ill patients is associated with an increased risk of acute kidney injury (AKI). We aimed to investigate how fluctuations in serum chloride (Cl−) are associated with the development of AKI in critically ill patients. We retrospectively analyzed medical records of adult patients admitted to the intensive care unit (ICU) between January 2012 and December 2017. Positive and negative fluctuations in Cl− were defined as the difference between the baseline Cl- and maximum Cl- levels and the difference between the baseline Cl− and minimum Cl− levels measured within 72 h after ICU admission, respectively. In total, 19,707 patients were included. The odds of developing AKI increased 1.06-fold for every 1 mmol L−1 increase in the positive fluctuations in Cl− (odds ratio: 1.06; 95% confidence interval: 1.04 to 1.08; p < 0.001) and 1.04-fold for every 1 mmol L−1 increase in the negative fluctuations in Cl− (odds ratio: 1.04; 95% confidence interval: 1.02 to 1.06; p < 0.001). Increases in both the positive and negative fluctuations in Cl- after ICU admission were associated with an increased risk of AKI. Furthermore, these associations differed based on the functional status of the kidneys at ICU admission or postoperative ICU admission.

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Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients

The American Surgeon ◽

10.1177/000313481908500101 ◽

2019 ◽

Vol 85 (1) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Paul K. McGaha ◽

Jeremy Johnson ◽

Tabitha Garwe ◽

Zoona Sarwar ◽

Prasenjeet Motghare ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ct Scan ◽

Injury Severity ◽

Pediatric Trauma ◽

Kidney Injury ◽

Trauma Patients ◽

Severely Injured ◽

Intravenous Contrast ◽

Trauma Population ◽

Significant Difference

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post–CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

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Coadministration of Liposomal Amphotericin B and Contrast Medium Does Not Increase Risk of Kidney Injury

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00323-17 ◽

2017 ◽

Vol 61 (8) ◽

Cited By ~ 2

Author(s):

John C. O'Horo ◽

Douglas R. Osmon ◽

Omar M. Abu Saleh ◽

Jasmine R. Marcelin ◽

Kamel A. Gharaibeh ◽

...

Keyword(s):

Contrast Medium ◽

Amphotericin B ◽

Liposomal Amphotericin ◽

Fungal Infections ◽

Kidney Injury ◽

Liposomal Amphotericin B ◽

Intravenous Contrast ◽

Intravenous Contrast Medium ◽

Increased Risk ◽

Propensity Score Adjustment

ABSTRACT Intravenous radiographic contrast medium and amphotericin B are commonly required in the care of patients with fungal infections. Both interventions have proposed nephrotoxicity through similar mechanisms. We systematically examined patients who received coadministration of liposomal amphotericin B (AmBisome; GE Healthcare) and intravenous contrast medium within a 24-h period and compared the results for those patients with the results for patients who underwent non-contrast medium studies. We found 114 cases and 85 controls during our study period. Overall, no increased risk of renal injury was seen with coadministration of these 2 agents. Adjustment for age, baseline kidney function, and other clinical factors through propensity score adjustment did not change this result. Our observations suggest that, when clinically indicated, coadministration of contrast medium and liposomal amphotericin B does not present excess risk compared with that from the administration of liposomal amphotericin B alone.

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Risk of Acute Kidney Injury after Intravenous Contrast Media Administration in Patients with Suspected Pulmonary Embolism: A Propensity-Matched Study

Thrombosis and Haemostasis ◽

10.1055/s-0040-1721387 ◽

2020 ◽

Author(s):

Adi Elias ◽

Doron Aronson

Keyword(s):

Acute Kidney Injury ◽

Pulmonary Embolism ◽

Propensity Score ◽

Contrast Media ◽

Contrast Material ◽

Kidney Injury ◽

Suspected Pulmonary Embolism ◽

Intravenous Contrast ◽

Increased Risk ◽

Lung Scan

Abstract Background Although computed tomography pulmonary angiography (CTPA) is the preferred diagnostic procedure in patients with suspected pulmonary embolism (PE), some patients undergo ventilation/perfusion (V/Q) lung scan due to concern of contrast-associated acute kidney injury (AKI). Methods The study used a cohort of 4,565 patients with suspected PE. Patients who received contrast during CTPA were compared with propensity score-matched unexposed control patients who underwent V/Q lung scanning. AKI was defined as ≥50% increase in serum creatinine during the first 72 hours after either CTPA or V/Q lung scan. Results Classification and regression tree analysis demonstrated that baseline creatinine was the strongest determinant of the decision to use CTPA. Propensity-score matching yielded 969 patient pairs. There were 44 AKI events (4.5%) in patients exposed to contrast media (CM) and 33 events (3.4%) in patients not exposed to CM (risk difference: 1.1%, 95% confidence interval [CI]: −0.6 to 2.9%; odds ratio [OR]: 1.39, 95% CI: 0.86–2.26; p = 0.18). Using different definitions for AKI and extending the time window for AKI diagnosis gave similar results. In a sensitivity analysis with the inverse probability weighting method, the OR for AKI in the CTPA versus V/Q scan was 1.14 (95% CI: 0.72–1.78; p = 0.58). Conclusion Intravenous contrast material administration was not associated with an increased risk of AKI in patients with suspected PE. Given the diagnostic superiority of CTPA, these results are reassuring with regard to the use of CTPE in patients with suspected PE perceived to be at risk for AKI.

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Frequency of Acute Kidney Injury Following Intravenous Contrast Medium Administration: A Systematic Review and Meta-Analysis

Radiology ◽

10.1148/radiol.12121460 ◽

2013 ◽

Vol 267 (1) ◽

pp. 119-128 ◽

Cited By ~ 204

Author(s):

Jennifer S. McDonald ◽

Robert J. McDonald ◽

Jules Comin ◽

Eric E. Williamson ◽

Richard W. Katzberg ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Contrast Medium ◽

Meta Analysis ◽

Kidney Injury ◽

Intravenous Contrast ◽

Contrast Medium Administration ◽

Intravenous Contrast Medium

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MO345LIFESAVING BIOMARKERS IN CONTRAST-INDUCED ACUTE KIDNEY INJURY IN ADULT CRITICAL ICU PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab084.0018 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ravi Mishra ◽

HARSHIT SINGH ◽

Saurabh Chaturvedi ◽

Durga P Mishra ◽

Vikas Agarwal ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ct Scan ◽

Cystatin C ◽

Kidney Injury ◽

P Value ◽

Roc Curve Analysis ◽

Intravenous Contrast ◽

Post Contrast ◽

Icu Patients ◽

Contrast Exposure

Abstract Background : - Intravenous administration of radiocontrast media is referred to as contrast-induced kidney injury (CI-AKI).CI-AKI is described as the third most common cause of new AKI in hospitalized patients. The occurrence of CI-AKI is reported up to 55% in these high-risk patients.: NGAL (Neutrophil gelatinase-associated Lipocalin)and Cystatin C have been found an early and sensitive marker of acute kidney injury (AKI). Aims To evaluate biomarkers in plasma (P) and urine (U) after intravenous contrast in adult ICU patients. Method Total of 36 patients recruited as per inclusion criteria. ICU patients who were >18 years with radiographic contrast for diagnostic or interventional computed tomography (CT scan), were included. After ethical approval, samples of 5 ml blood and 5 ml urine were collected before contrast exposure and at 4 h, 24 h, and 48 h after contrast exposure. NGAL and Cystatin C assay was done by ELISA, and urinary levels were normalized as per urine creatinine (UCr) values for each sample. In the present study, CI-AKI is defined as a rise in SCr of ≥0.3 mg/dl within 48 hrs. Data presented in a mean or median analysis performed. Results In this study, 30 CT scan episodes requiring intravenous contrast in 25 ICU patients were included. Median age was 36 yrs and 13 (43%) were male. On day of inclusion, median SOFA score was 3; 16% In patients having CI-AKI, mean values changes from pre-contrast to at 4 h, 24 h and 48 h after contrast are presented..Kinetics of plasma (P) and urine (U) NGAL and Cystatin C levels (Mean±SD) with p value among patients having CI-AKI P NGAL (ng/ml), Before Contrast(BC)( 708.5±201.76) , 04hrC(851.5±332.05, p=0.07), 24hrC(1093.25±225.03, p=0.02), 48hrC(788±323.4, p=0.21), UNGAL (ng/mg of U Cr)BC(67.63±48.09) , 04hrC(39.69±19.79, p=0.07) , 24hrC(101.97±90, p=0.12) , 48hrC(59.87±56.85, p=0.73) , P Cystatin C (ng/ml) BC(4698.85±574.71), 04hrC(4704.57±1144.87) , p=0.02) , 24hrC(4428.85±1135.73, p=0.03), 48hrC(4288.85±435.8, p=0.17), U Cystatin C (ng/mg of UCr) BC(3 46.06±224.7), 04hrC(219.66±72.18, p=0.91), 24hrC (470.21±536.28, p=0.99), 48hrC(633.61±811.77, p=0.23). Conclusion ROC curve analysis during pre-contrast exposure: NGAL, and Cystatin C), both plasma and urine level AUC was significantly higher in patients who develop CI-AKI and Post-contrast exposure Plasma levels AUC significantly higher than Urine levels.

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