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Acute Kidney Injury After Intravenous Versus Intra-Arterial Contrast Material Administration in a Paired Cohort
Jennifer S McDonald1, Caleb B Leake, Robert J McDonald
1From the *Department of Radiology, †Mayo Medical School, ‡Division of Cardiovascular Diseases, and §Department of Neurosurgery, Mayo Clinic, Rochester, MN; and ∥Department of Radiology, Medical University of South Carolina, Charleston, SC.
Investigative Radiology
|June 15, 2016
Summary
Intra-arterial contrast during cardiac catheterization has a similar risk of acute kidney injury (AKI) as intravenous contrast during CT scans. This suggests baseline patient risk factors, not contrast route, explain prior AKI rate differences.
Area of Science:
- Nephrology
- Radiology
- Cardiology
Background:
- Acute kidney injury (AKI) is a concern following contrast-enhanced procedures.
- Previous studies suggested higher AKI rates with intra-arterial contrast (cardiac catheterization) versus intravenous (IV) contrast (CT scans).
Purpose of the Study:
- To compare the risk of AKI between intra-arterial and IV contrast administration within the same patient cohort.
- To investigate if contrast route or baseline patient factors influence AKI rates.
Main Methods:
- Retrospective cohort study of 1969 patients who underwent both CT scans and cardiac catheterization (2000-2014).
- AKI defined as serum creatinine ≥0.3 mg/dL or 50% above baseline.
- McNemar test used for comparison of AKI rates.
Main Results:
- Overall AKI rates were similar: 9.9% after CT (IV contrast) and 11% after cardiac catheterization (intra-arterial contrast) (P=0.12).
- AKI rates remained similar across different procedure orders, catheterization types, and baseline kidney function.
Conclusions:
- Intra-arterial contrast administration during cardiac catheterization poses a similar AKI risk compared to IV contrast during CT scans in patients undergoing both.
- Observed differences in AKI rates in prior studies likely stem from dissimilar baseline clinical risk factors between patient groups.
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