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Published on: February 2, 2021
Incidence of Acute Kidney Injury After Exposure to Intravenous Contrast in Emergency Department Patients Presenting
Imran Faruqi1, Terrell Caffery1, Maddie Colter1
1Louisiana State University Health Sciences Center School of Medicine - New Orleans, Baton Rouge Branch Campus, Baton Rouge, Louisiana.
Insights
Patients with chronic kidney disease (CKD) undergoing CT scans face varying risks of acute kidney injury (AKI). CKD stage III patients have similar AKI risk to those with normal kidney function, while CKD stage IV risk is lower than expected.
Area of Science:
- Nephrology
- Radiology
- Critical Care Medicine
Background:
- Chronic kidney disease (CKD) is a known risk factor for contrast-induced acute kidney injury (AKI) after computed tomography (CT).
- Existing data on the incidence of post-CT AKI in CKD patients are limited.
Purpose of the Study:
- To investigate the incidence of AKI following intravenous contrast administration in patients with and without CKD.
- To compare AKI risk across different stages of chronic kidney disease.
Main Methods:
- A retrospective study of 794 patients who underwent CT angiography as part of a stroke protocol.
- Patients were categorized into "normal to mild" (GFR > 60), CKD III (GFR 30-60), and CKD IV (GFR < 30) groups.
- Exclusion criteria included patients already on dialysis.
Main Results:
- The overall incidence of AKI was 2.5%.
- Patients with normal GFR had a 2.4% AKI incidence, CKD III had 1.4%, and CKD IV had 8.1%.
- CKD IV patients had a significantly higher odds ratio for AKI (OR=3.52) compared to normal GFR, but AKI was transient and did not require renal replacement therapy.
Conclusions:
- Patients with CKD stage III do not appear to have an increased risk of post-CT AKI compared to those with normal renal function.
- The risk of post-CT AKI in CKD stage IV patients may be lower than previously estimated and is often transient.
- No CKD IV patients who developed AKI required renal replacement therapy.
Background:
Chronic kidney disease (CKD) is to be considered an independent risk factor for developing post-computed tomography (CT) acute kidney injury (AKI); however, current data are limited.
Objectives:
Examine the incidence of AKI after intravenous contrast exposure among patients with and without CKD.
Methods:
A single-center retrospective study examined patients that presented to the Emergency Department and activated the stroke protocol, which involved an immediate CT angiogram. Patients were subdivided into "normal to mild" (glomerular filtration rate [GFR] > 60 mL/min/1.73 m2), CKD III (GFR 30-60 mL/min/1.73 m2), and CKD IV (GFR < 30 mL/min/1.73 m2) groups. The primary outcome was the development of AKI. Patients already on dialysis were excluded.
Results:
Among the 794 patients identified, 452 (56.9%) were classified as "normal to mild," 280 (35.3%) were classified as CKD III, and 62 (7.8%) were classified as CKD IV. Patients with normal GFR had a 2.4% incidence of developing AKI, those with CKD III had a 1.4% incidence, and patients with CKD IV had an 8.1% incidence of developing AKI. Overall, 2.5% of patients developed AKI. For CKD III vs. "normal" groups, odds ratio (OR) = 0.58 (95% confidence interval [CI] 0.16-1.72). For CKD IV vs. "normal," OR = 3.52 (95% CI 1.07-10.05). Of those patients with CKD IV who had AKI, all saw improvement in their creatinine prior to discharge and none required renal replacement therapy.
Conclusion:
This study builds on the evidence demonstrating that patients with CKD III are likely at the same risk of developing post-CT AKI as those with normal renal function. Furthermore, the risk of developing post-CT AKI in CKD IV patients may be far lower than previously thought, was transient, and did not result in renal replacement therapy.
