Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis

• Published in: Intensive care medicine 2023-02, Vol.49 (2), p.205-215
• Main Authors: Ehmann, Michael R., Mitchell, Jonathon, Levin, Scott, Smith, Aria, Menez, Steven, Hinson, Jeremiah S., Klein, Eili Y.
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury; Administration, Intravenous; Adolescent; Anesthesiology; Clinical outcomes; Contrast agents; Contrast media; Contrast Media - adverse effects; Creatinine; Critical Care Medicine; Dialysis; Emergency medical care; Emergency medical services; Emergency Medicine; Entropy; Hemodialysis; Hospital patients; Humans; Injury analysis; Intensive; Intensive care; Intravenous administration; Kidney diseases; Kidneys; Medicine; Medicine & Public Health; Original; Pain Medicine; Patient outcomes; Pediatrics; Physician and patient; Pneumology/Respiratory System; Renal Dialysis; Renal function; Retrospective Studies; Risk Factors
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-022-06966-w

Purpose Evidence of an association between intravenous contrast media (CM) and persistent renal dysfunction is lacking for patients with pre-existing acute kidney injury (AKI). This study was designed to determine the association between intravenous CM administration and persistent AKI in patients with pre-existing AKI. Methods A retrospective propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients ≥ 18 years old meeting Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI at time of arrival to one of three emergency departments between 7/1/2017 and 6/30/2021 who did or did not receive intravenous CM. Outcomes included persistent AKI at hospital discharge and initiation of dialysis within 180 days of index encounter. Results Our analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). CM was administered in 18.4% of all encounters. AKI resolved prior to hospital discharge for 69.1%. No association between intravenous CM administration and persistent AKI was observed after unadjusted multivariable logistic regression modeling (OR 1; 95% CI 0.89–1.11), propensity weighting (OR 0.93; 95% CI 0.83–1.05), and entropy balancing (OR 0.94; 95% CI 0.83–1.05). Sub-group analysis in those admitted to the ICU yielded similar results. Initiation of dialysis within 180 days was observed in 5.4% of the cohort. An association between CM administration and increased risk of dialysis within 180 days was not observed. Conclusion Among patients with pre-existing AKI, contrast administration was not associated with either persistent AKI at hospital discharge or initiation of dialysis within 180 days. Current consensus recommendations for use of intravenous CM in patients with stable renal disease may also be applied to patients with pre-existing AKI.