scholarly journals Hypotension at Hospital Presentation and Post-contrast Acute Kidney Injury Following Computed Tomography with Contrast Media

2021 ◽  
Author(s):  
Jo Yoshizawa ◽  
Ryo Yamamoto ◽  
Koichiro Homma ◽  
Hanae Kamikura ◽  
Kazuhiko Sekine ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Kidney Injury ◽  
Contrast Media ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Complication ◽  
Chronic Haemodialysis ◽  
Background Characteristics ◽  
Post Contrast ◽  
Media Usage

Abstract Background: Post-contrast acute kidney injury (PC-AKI) is a major complication of contrast media usage, and risks for PC-AKI are generally evaluated before performing computed tomography (CT) with contrast at the emergency department (ED). Although persistent hypotension (systolic blood pressure [sBP] <80 mmHg for 1 h) is associated with increased PC-AKI incidence, it remains unclear whether tentative hypotension that is hemodynamically stabilised before CT is a risk for PC-AKI. We hypothesised that hypotension on ED arrival would be associated with higher PC-AKI incidence; even if CT with contrast was performed after patients are appropriately resuscitated. Methods: This multicenter retrospective observational study was conducted at three tertiary care centres during 2013–2014. We identified 280 patients who underwent CT with contrast at ED and whose kidney function was subsequently evaluated. Patients were divided into two groups based on sBP on arrival (<80 vs ≥80 mmHg); hypotension was considered as tentative because CT with contrast has always been performed after patients were stabilised at participating hospitals. PC-AKI incidence was compared between the groups, and inverse probability weighting (IPW) was conducted to adjust background characteristics, including age, sex, comorbidities, anaemia, and acute physiology and chronic health evaluation II score. Results: Eighteen patients were excluded due to chronic haemodialysis, cardiac arrest on arrival, or died within 72 h, and 262 were eligible for this study. PC-AKI incidence was higher in the tentative hypotension group than in the normotension group (7/27 [28.6%] vs 24/235 [10.2%], odds ratio [OR] 3.08 [95% confidence interval (CI) 1.18–8.03], p = 0.026), which was confirmed by IPW (OR 3.25 [95% CI 1.99–5.29], p < 0.001). Similar results were obtained in subgroups with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. Conclusion: Tentative hypotension at ED was associated with PC-AKI development.

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 Oral Hydration as a Safe Prophylactic Measure To Prevent Post-Contrast Acute Kidney Injury in Oncologic Patients with Chronic Kidney Disease (IIIb) Referred for Contrast-Enhanced Computed Tomography: Subanalysis of The Oncological Group of The NICIR Study.

2021 ◽  
Author(s):  
Carmen Sebastia ◽  
Alfredo Páez-Carpio ◽  
Elena Guillen ◽  
Blanca Paño ◽  
JoanAlbert Arnaiz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Oral Hydration ◽  
Post Contrast ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract Background The objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). Material and Methods We performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water two hours before and 2000 mL during the 24 hours after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L)3 mL/kg/h starting one hour before and 1 mL/kg/h during the first hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the first 48 to 72 hours after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis in each group. Results Of 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no significant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. Conclusion In oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not significantly differ from that of patients receiving i.v. hydration.

MO419THE ROLE OF SHORT-TERM, HIGH-DOSE ATORVASTATIN FOR PREVENTION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDERGOING COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST ADMINISTRATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Andrey Vasin ◽  
Olga Mironova ◽  
Viktor Fomin
Keyword(s):  
Computed Tomography ◽  
Acute Kidney Injury ◽  
Cardiovascular Diseases ◽  
Contrast Media ◽  
Kidney Injury ◽  
Ct Scans ◽  
Intravenous Contrast ◽  
Dosing Regimens ◽  
Intravenous Contrast Media ◽  
Contrast Media Administration

Abstract Background and Aims Computed tomography with intravenous contrast media is widely used in hospitals. The incidence of CI-AKI due to intravenous contrast media administration in high-risk patients remains not studied as well as CI-AKI after intraarterial contrast media administration is. According to other researchers, the use of statins in the prevention of AKI after intra-arterial administration of a contrast agent is currently considered an efficient preventive measure. The aim of our study is to assess the incidence of contrast-induced acute kidney injury in patients with cardiovascular diseases during CT scan with intravenous contrast media and analyze the efficacy and safety of various statin dosing regimens for prevention of CI-AKI. Method A randomized controlled open prospective study is planned. Statin naive patients with cardiovascular diseases will be divided into 3 groups. Patients in the first group will receive atorvastatin 80mg 24 hours and 40mg 2 hours before CT scans and 40 mg after. The second group – 40 mg 2 hours before CT scans and 40 mg after. A third group is a control group. Exclusion criteria were current or previous statin treatment, contraindications to statins, severe renal failure, acute coronary syndrome, administration of nephrotoxic drugs. The primary endpoint will the development of CI-AKI, defined as an increase in serum Cr concentration 0.5 mg/dl (44.2 mmol/l) or 25% above baseline at 72 h after exposure to the contrast media. Results We assume a higher incidence of contrast-induced acute kidney injury in the group of patients not receiving statin therapy (about 5-10%). At the same time, it is unlikely to get a significant difference between statin dosing regimens. Risk factors such as age over 75 years, the presence of chronic kidney disease, diabetes mellitus, and chronic heart failure increase the risk of contrast-induced acute kidney injury. Conclusion Despite the significantly lower incidence of CI-AKI with intravenous contrast compared to intra-arterial, patients with CVD have a greater risk of this complication even with intravenous contrast. Therefore, the development of prevention methods and scales for assessing the likelihood of CI-AKI is an important problem. As a result of the study, we expect to conclude the benefits of statins in CI-AKI prevention and the optimal dosage regimen. This information will help us to reduce the burden of CI-AKI after CT scanning in statin naive patients with cardiovascular diseases in everyday clinical practice. ClinicalTrials.gov ID: NCT04666389

scholarly journals Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Toxins ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 395
Author(s):  
Inga Chomicka ◽  
Marlena Kwiatkowska ◽  
Alicja Lesniak ◽  
Jolanta Malyszko
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Creatinine Concentration ◽  
Post Contrast ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Enhanced Ct

Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14–28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.

Serum neutrophil-gelatinase associated lipocalin as a predictor of post-contrast acute kidney injury in children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alyaa A Kotby ◽  
Marwa W Nasef ◽  
Walaa A Kabiel ◽  
Yasser H Mohammad ◽  
Rana M Elmaghrabi
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Significant Rise ◽  
Contrast Injection ◽  
Post Contrast ◽  
Contrast Media Administration

Abstract Background Diagnosis of post-contrast acute kidney injury (PC-AKI) by serum creatinine can be delayed because of various factors. A new biomarker neutrophilgelatinase associated lipocalin (NGAL) is postulated to be more sensitive for recognizing patients prone to PC-AKI. Objective To assess serum NGAL changes as an early biomarker of PC-AKI in children with congenital heart disease undergoing cardiac catheterization. Methods This observational study included 30 children with congenital heart disease who underwent cardiac catheterization at the Pediatric Cardiac Catheterization Unit, New Children’s Hospital, Ain Shams University. They had a median age of 30 months and 63% were females. Serum NGAL was measured just before the catheterization, 6hrs and 24hrs after contrast media administration while serum creatinine was measured before and after 24hrs of contrast media administration. Results Significant rise of serum NGAL was noted within 24hrs after contrast administration (p &lt; 0.05) while serum creatinine showed a non-significant rise (p &gt; 0.05). Serum NGAL was positively correlated with age, weight, height, body surface area and rate of contrast injection (p &lt; 0.01). Higher levels of serum NGAL were found among patients who underwent diagnostic cardiac catheterization and those who received Midazolam for initial sedation during induction of anesthesia (p &lt; 0.05). Conclusions Serum NGAL was elevated as early as 6 hours post contrast injection, however its serum level is affected by many factors. It’s important to be aware of other possible risk factors of PC-AKI rather than contrast media as type of cardiac catheterization and the anaesthetic Midazolam.

scholarly journals Protective effect of glycyrrhizin, a direct HMGB1 inhibitor, on post-contrast acute kidney injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyewon Oh ◽  
Arom Choi ◽  
Nieun Seo ◽  
Joon Seok Lim ◽  
Je Sung You ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Acute Kidney Injury ◽  
Contrast Media ◽  
Protective Effect ◽  
Inflammatory Cytokines ◽  
Kidney Tissue ◽  
Kidney Injury ◽  
Enzyme Linked Immunosorbent Assay ◽  
Post Contrast ◽  
Pro Inflammatory Cytokines

AbstractPost contrast-acute kidney injury (PC-AKI) is defined as the deterioration of renal function after administration of iodinated contrast media. HMGB1 is known to play an important role in the development of acute kidney injury. The purpose of this study was to investigate the association between HMGB1 and PC-AKI and the protective effect of glycyrrhizin, a direct inhibitor of HMGB1, in rats. Rats were divided into three groups: control, PC-AKI and PC-AKI with glycyrrhizin. Oxidative stress was measured with MDA levels and H2DCFDA fluorescence intensity. The mRNA expressions of pro-inflammatory cytokines (IL-1α, IL-1β, IL-6 and TNF-α) and kidney injury markers (KIM-1, NGAL and IL-18) were assessed using RT-PCR and ELISA in kidney tissue. In addition, the serum and intracellular protein levels of HMGB1were analyzed with the enzyme-linked immunosorbent assay (ELISA) and western blotting. Histologic changes were assessed with H&E staining using the transmission electron microscope (TEM). Moreover, serum creatinine (SCr), blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) levels were assessed. Oxidative stress, pro-inflammatory cytokines, kidney injury markers and LDH were significantly higher in PC-AKI compared to the controls, but were lower in PC-AKI with glycyrrhizin. Intracellular and serum HMGB1 levels significantly increased after contrast media exposure, whereas they markedly decreased after glycyrrhizin pretreatment. SCr and BUN also decreased in PC-AKI with glycyrrhizin compared to PC-AKI. In PC-AKI, we could frequently observe tubular dilatation with H&E staining and cytoplasmic vacuoles on TEM, whereas these findings were attenuated in PC-AKI with glycyrrhizin. Our findings indicate that HMGB1 plays an important role in the development of PC-AKI and that glycyrrhizin has a protective effect against renal injury and dysfunction by inhibiting HMGB1 and reducing oxidative stress.

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