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Incidence, Risk Factors, the Role of Plasma NGAL and Outcome of Contrast-Induced Acute Kidney Injury in Critically
Yamini Agarwal1, Ramachandran Rameshkumar2, Sriram Krishnamurthy3
1Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
Insights
Contrast-induced acute kidney injury (CI-AKI) affects 35% of critically ill children, with younger age being a key risk factor. Plasma neutrophil gelatinase-associated lipocalin (NGAL) did not prove effective in predicting CI-AKI in this study.
Area of Science:
- Pediatric Nephrology
- Radiology
- Critical Care Medicine
Background:
- Contrast-induced acute kidney injury (CI-AKI) is a significant concern in pediatric patients undergoing contrast-enhanced computed tomography (CECT).
- Identifying risk factors and reliable biomarkers for CI-AKI is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To determine the incidence of CI-AKI in critically ill children.
- To evaluate independent risk factors associated with CI-AKI.
- To assess the diagnostic role of plasma neutrophil gelatinase-associated lipocalin (NGAL) in predicting CI-AKI.
- To analyze the outcomes of CI-AKI in this population.
Main Methods:
- A prospective cohort study included 100 children (1 month to 12 years) undergoing CECT.
- Exclusion criteria included pre-existing renal disease and certain clinical conditions.
- Serum creatinine and e-GFR were measured at multiple time points; plasma NGAL was measured before and 6 hours post-contrast.
- CI-AKI incidence was assessed using p-RIFLE criteria.
Main Results:
- The overall incidence of CI-AKI was 35%, with most cases classified as 'Risk' or 'Injury' by p-RIFLE criteria.
- Age younger than 2 years was identified as an independent risk factor for CI-AKI.
- Plasma NGAL levels before and after CECT did not show significant predictive value for CI-AKI (AUC < 0.5).
- The 30-day mortality rate was 7%; renal recovery was achieved in a high percentage of survivors.
Conclusions:
- CI-AKI is prevalent in critically ill children undergoing CECT, with younger age being a significant risk factor.
- Plasma NGAL is not a reliable biomarker for predicting CI-AKI in this pediatric cohort.
- While CI-AKI can occur, renal recovery rates are generally high among survivors.
Objectives:
To study the incidence of contrast-induced acute kidney injury (CI-AKI), evaluate its risk factors, study the role of plasma neutrophil gelatinase-associated lipocalin (NGAL) and evaluate the outcome of CI-AKI in critically ill children.
Methods:
In this prospective cohort study, children aged 1 mo to 12 y who underwent contrast computed tomography (CECT) for various medical indications were included. Patients without renal function test before contrast administration, children with chronic kidney disease, children admitted for less than 48 h, and those with serum bilirubin more than 5 mg per dL were excluded. Serum creatinine and estimated-Glomerular filtration rate (e-GFR) were measured at admission, immediately before, and at 6, 24, 48 h after contrast. Plasma neutrophil gelatinase-associated lipocalin (NGAL) was measured before and 6 h after contrast. The incidence of CI-AKI by p-RIFLE (Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease) criteria, its risk factors, the diagnostic role of NGAL in CI-AKI, and outcomes [30 d unfavorable outcome (death, readmission) and renal recovery] were studied.
Results:
One hundred children were enrolled. The indications for CECT were brain (58%) and respiratory pathology (20%). Incidence of CI-AKI was 35% (95% CI 26.4% to 44.8%); 71% in 'Risk,' and 29% in the 'Injury' stage. After multivariate logistic regression, age younger than 2 y was independently associated with CI-AKI. There was no significant difference in NGAL before (ROC-AUC 0.38, 95% CI 0.26 to 0.50) and 6 h after CECT scan (AUC 0.41, 95% CI 0.29 to 0.54) to predict CI-AKI. There were 7% deaths but no readmission at 30 d. Among 33 CI-AKI patients who survived, the operational definition of renal recovery was achieved in 51.5% (n = 17), complete renal recovery was achieved in 97% (n = 32), and partial renal recovery was achieved in 3% (n = 1) of patients at discharge, while none received renal supportive therapy.
Conclusions:
The incidence of contrast-induced acute kidney injury was 35% with age younger than two year being independently associated with CI-AKI. NGAL did not predict the CI-AKI.
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