Related Experiment Video
Updated: May 14, 2026
Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material
Matthew S Davenport1, Shokoufeh Khalatbari, Jonathan R Dillman
1Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48103, USA. matdaven@umich.edu
Insights
Intravenous low-osmolality iodinated contrast material increases the risk of post-computed tomography (CT) acute kidney injury (AKI) in patients with baseline serum creatinine (SCr) of 1.6 mg/dL or higher. Patients with stable SCr below 1.5 mg/dL are not at increased risk.
Area of Science:
- Nephrology
- Radiology
- Medical Imaging
Background:
- Acute kidney injury (AKI) is a significant concern in hospitalized patients.
- Contrast-induced nephrotoxicity (CIN) is a known complication of radiocontrast administration.
- Identifying risk factors for post-CT AKI is crucial for patient safety.
Purpose of the Study:
- To evaluate the association between intravenous low-osmolality iodinated contrast material and post-computed tomography (CT) acute kidney injury (AKI).
- To determine if baseline renal function influences the risk of contrast-associated AKI.
- To differentiate the impact of contrast material from other factors on post-CT AKI.
Main Methods:
- Retrospective cohort study of adult inpatients undergoing CT examinations over a 10-year period.
- One-to-one propensity score matching comparing unenhanced and contrast-enhanced CT cohorts (n=20,242).
- Primary outcome: post-CT AKI using Acute Kidney Injury Network criteria; Secondary outcome: AKI using traditional CIN criteria.
Main Results:
- Intravenous contrast material significantly increased post-CT AKI risk in patients with pre-CT SCr ≥1.6 mg/dL (OR, 1.45; P=.007).
- The risk of contrast-associated AKI escalated with increasing pre-CT SCr levels.
- Patients with stable SCr <1.5 mg/dL showed no increased risk of CIN (P=.25).
- Post-CT AKI prevalence increased with higher baseline SCr in both unenhanced and contrast-enhanced groups.
Conclusions:
- Intravenous low-osmolality iodinated contrast material is a nephrotoxic risk factor for patients with pre-existing renal impairment (SCr ≥1.6 mg/dL).
- Patients with stable serum creatinine levels below 1.5 mg/dL are not at increased risk for contrast-induced nephrotoxicity.
- Multiple factors beyond contrast administration contribute to the development of post-CT AKI.
Purpose:
To determine whether intravenous low-osmolality iodinated contrast material is associated with post-computed tomography (CT) acute kidney injury (AKI).
Materials And Methods:
Institutional review board approval was obtained and patient consent waived for this HIPAA-compliant retrospective study. CT examinations performed over a 10-year period in adult inpatients with sufficient serum creatinine (SCr) data were identified. A one-to-one propensity-matched matched cohort analysis with multivariate analysis of effects was performed with post-CT AKI as the primary outcome measure (10,121 unenhanced and 10,121 intravenous contrast-enhanced CT examinations in 20,242 patients). Propensity matching was performed with respect to likelihood of patient receiving intravenous contrast material (36 tested covariates). The primary endpoint was post-CT AKI by using Acute Kidney Injury Network SCr criteria; the secondary endpoint was post-CT AKI by using traditional SCr criteria for contrast material-induced nephrotoxicity (CIN; SCr increase ≥0.5 mg/dL [44.20 μmol/L] or ≥25%). Multivariate subgroup threshold analysis was performed (SCr <1.5 [<132.60 μmol/L]; ≥1.5 to ≥2.0 mg/dL [≥132.60 to ≥176.80 μmol/L]) and adjusted for assigned propensity scores.
Results:
Intravenous low-osmolality iodinated contrast material had a significant effect on the development of post-CT AKI for patients with pre-CT SCr levels of 1.6 mg/dL (141.44 μmol/L) or greater (odds ratio, 1.45; 95% confidence interval [CI]: 1.11, 1.89;P = .007). This effect strengthened as pre-CT SCr increased. Patients with stable SCr less than 1.5 mg/dL (132.60 μmol/L) were not at risk for developing CIN (P = .25, power > 95%). Both endpoints demonstrated similar results (eg, SCr ≥1.6 mg/dL [141.44 μmol/L] by using traditional CIN criteria: odds ratio, 1.64; 95% CI: 1.18, 2.28; P = .003). Post-CT AKI was prevalent in both the unenhanced and contrast-enhanced CT subgroups, and it increased with increases in pre-CT SCr. Many risk factors contributed to development of post-CT AKI, regardless of iodinated contrast material.
Conclusion:
Intravenous low-osmolality iodinated contrast material is a nephrotoxic risk factor, but not in patients with a stable SCr level less than 1.5 mg/dL. Many factors other than contrast material can affect post-CT AKI rates.
More Related Videos
Related Concept Videos
01:30Radiological Investigation I: X-ray and CT
01:27Imaging Studies III: Computed Tomography
01:19Imaging Studies VII: Vascular Imaging
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:28Imaging Studies for Cardiovascular System V: CT