Diastolic dysfunction is associated with an increased risk of postcontrast acute kidney injury

Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction.

This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT.

We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ± 7.66 mL·min·1.73 m and 11.56 ± 5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51-25.23, P = .015) was a significant risk factor for PC-AKI.

This study demonstrated that, among the echocardiographic variables, E/E was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.