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Postcontrast Acute Kidney Injury in Pediatric Patients: A Cohort Study
Jennifer S McDonald1, Robert J McDonald1, Cheryl L Tran2
1Department of Radiology, Mayo Clinic, Rochester, MN.
Insights
This study found very low rates of acute kidney injury (AKI), dialysis, and death in pediatric patients receiving iodinated contrast material for CT scans. The risks were not detectably different from those not receiving contrast, though an effect cannot be ruled out.
Area of Science:
- Pediatric Nephrology
- Radiology
- Clinical Outcomes Research
Background:
- The safety of iodinated contrast material in pediatric patients undergoing computed tomography (CT) scans is not well-established.
- Assessing risks such as acute kidney injury (AKI), dialysis, and mortality is crucial for informed clinical decision-making.
Purpose of the Study:
- To investigate the incidence of postcontrast AKI, dialysis therapy, and death in pediatric patients receiving intravenous iodinated contrast material.
- To compare these outcomes between contrast-enhanced and unenhanced CT scans in a pediatric cohort.
Main Methods:
- A retrospective cohort study was conducted on pediatric patients (<18 years) undergoing contrast-enhanced or unenhanced CT scans.
- Propensity score analysis was used to compare risks of AKI, dialysis, and death between the two groups, adjusting for relevant covariates.
- AKI was defined using KDIGO criteria based on serum creatinine.
Main Results:
- The study identified 2,201 pediatric patients (1,773 contrast, 428 noncontrast).
- Rates of AKI and dialysis in the contrast group were 3.3% and 0.1%, respectively.
- After propensity score adjustment, no significant differences in the risk of AKI, dialysis, or death were observed between contrast and noncontrast groups. All severe AKI cases had alternative causes.
Conclusions:
- Postcontrast AKI, dialysis therapy, and death occurred at very low rates in this pediatric cohort undergoing contrast-enhanced CT.
- While not detectably different from the noncontrast group, the study's limitations (small sample size, low event rates) preclude ruling out a potential effect of contrast material.
- Further research with larger cohorts may be needed to definitively assess contrast-related risks in pediatric patients.
Rational & Objective:
The risks of iodinated contrast material administered to pediatric patients are not well defined. The purpose of this study was to examine the rates of postcontrast acute kidney injury (AKI), dialysis therapy, and death following administration of intravenous contrast material to pediatric patients.
Study Design:
Retrospective cohort study.
Setting & Participants:
Pediatric (aged <18 years) patients who underwent either contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomography (CT) at our institution from December 2001 to January 2016.
Exposure:
Intravenous iodinated contrast material.
Outcomes:
Postcontrast AKI based on serum creatinine-defined KDIGO criteria, dialysis therapy, and death.
Analytical Approach:
Risks for AKI, dialysis therapy, and death were compared between contrast and noncontrast group patients using a propensity score analysis incorporating clinical covariates related to contrast exposure.
Results:
2,201 pediatric patients (1,773 contrast and 428 noncontrast) were identified. Rates of AKI and dialysis therapy in the contrast group were 3.3% (59/1,773) and 0.1% (2/1,773), respectively. Following propensity score adjustment, no differences in risk for AKI (stage 1 AKI: OR, 0.75 [95% CI, 0.32-1.78], P=0.5; stage 2: OR, 2.00 [95% CI, 0.18-21.9], P=0.6; stage 3: OR, 0.50 [95% CI, 0.05-5.48], P=0.6), dialysis therapy (OR, 1.00 [95% CI, 0.06-15.9], P=0.9), or death (OR, 1.50 [95% CI, 0.53-4.22], P=0.4) were observed between the contrast and noncontrast groups. All patients with post-CT stage 3 AKI diagnosed also had contrast-independent potential causes of AKI.
Limitations:
The study's small sample size and low rates of postcontrast AKI, dialysis therapy, and death limited the ability to detect an effect of contrast administration on these outcomes. Unmeasured residual confounders may limit the validity of our results. Few patients had decreased kidney function at the time of CT.
Conclusions:
Rates of postcontrast AKI, dialysis therapy, and death following contrast-enhanced CT were very low in this pediatric cohort. Although not detectably different, an effect of contrast on these outcomes could not be ruled out.
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