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Anna Kistner1,2, Chen Tamm3, Ann Mari Svensson4,3
1Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Solna, Stockholm, Sweden. anna.kistner@sll.se.
Insights
Contrast-enhanced CT in COVID-19 patients with reduced kidney function (eGFR ≥30-60) led to a high frequency of contrast-induced acute kidney injury (CI-AKI) and increased mortality. Strict indications for contrast-enhanced CT are recommended for these patients.
Area of Science:
- Nephrology
- Radiology
- Infectious Diseases
Background:
- Hospitalized COVID-19 patients with kidney disease face higher mortality risks.
- The impact of contrast enhancement on short-term renal function in these patients requires investigation.
Purpose of the Study:
- To evaluate the effect of contrast-enhanced computed tomography (CT) on short-term renal function in hospitalized COVID-19 patients.
- To identify risk factors associated with contrast-induced acute kidney injury (CI-AKI) in this population.
Main Methods:
- Plasma creatinine (P-creatinine) levels were monitored pre-CT and at 24h, 48h, and 4-10 days post-CT.
- Patients were categorized into contrast-enhanced (n=142) and unenhanced (n=24) groups, with subgroups based on estimated glomerular filtration rate (eGFR) >60 and ≤60 ml/min/1.73 m².
- CI-AKI was defined by a significant rise in P-creatinine or initiation of renal replacement therapy.
Main Results:
- In patients with eGFR ≥30-60, CI-AKI occurred in 24% at 48h and 36% at 4-10 days post-contrast, compared to 5% in both periods for eGFR >60 (p<0.037 and p<0.001).
- Four of five patients with eGFR ≥30-60 who developed CI-AKI died within 30 days.
- Lower eGFR (≥30-60) and 30-day mortality were significantly associated with CI-AKI at both 48h and 4-10 days post-contrast CT.
Conclusions:
- COVID-19 patients with eGFR ≥30-60 exhibit a high incidence of CI-AKI following contrast administration, linked to increased 30-day mortality.
- Conservative use of contrast-enhanced CT is advised for patients with eGFR ≥30-60.
- Contrast-enhanced CT had a minimal impact on renal function in patients with eGFR >60.
Background:
Kidney disease and renal failure are associated with hospital deaths in patients with COVID - 19. We aimed to test if contrast enhancement affects short-term renal function in hospitalized COVID - 19 patients.
Methods:
Plasma creatinine (P-creatinine) was measured on the day of computed tomography (CT) and 24 h, 48 h, and 4-10 days after CT. Contrast-enhanced (n = 142) and unenhanced (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≤ 60 ml/min/1.73 m2. Contrast-induced acute renal failure (CI-AKI) was defined as ≥27 μmol/L increase or a > 50% rise in P-creatinine from CT or initiation of renal replacement therapy during follow-up. Patients with renal replacement therapy were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine at 48 h and at 4-10 days after contrast-enhanced CT.
Results:
Median P-creatinine at 24-48 h and days 4-10 post-CT in patients with eGFR> 60 and eGFR≥30-60 in contrast-enhanced and unenhanced groups did not differ from basal values. CI-AKI was observed at 48 h and at 4-10 days post contrast administration in 24 and 36% (n = 5/14) of patients with eGFR≥30-60. Corresponding figures in the eGFR> 60 contrast-enhanced CT group were 5 and 5% respectively, (p < 0.037 and p < 0.001, Pearson χ2 test). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that an eGFR≥30-60 and 30-day mortality were associated with CK-AKI both at 48 h and 4-10 days after contrast-enhanced CT.
Conclusion:
Patients with COVID - 19 and eGFR≥30-60 had a high frequency of CK-AKI at 48 h and at 4-10 days after contrast administration, which was associated with increased 30-day mortality. For patients with eGFR≥30-60, we recommend strict indications are practiced for contrast-enhanced CT. Contrast-enhanced CT had a modest effect in patients with eGFR> 60.
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