Contrast Media and Acute Kidney Injury in the ICU.

Area of Science:

• Nephrology
• Critical Care Medicine
• Radiology

Background:

• Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients, significantly impacting prognosis.
• Contrast-associated AKI (CA-AKI) is a specific type of AKI linked to contrast media exposure.
• Understanding the temporal and dose-response relationships of CA-AKI is crucial for patient management.

Purpose of the Study:

• To investigate the incidence and temporal development of CA-AKI in ICU patients.
• To examine the relationship between contrast media dose and CA-AKI development.
• To assess the impact of CA-AKI on ICU length of stay (LOS) and mortality.

Main Methods:

• Adult ICU patients admitted between 2010-2015 with ≥54 hours stay were analyzed.
• AKI was scored hourly; CA-AKI was defined as KDIGO AKI stage increase within 48 hours of contrast administration.
• Matched analysis compared contrast-exposed to unexposed patients based on stay duration and renal function.

Main Results:

• CA-AKI developed in 16% of 277 contrast-exposed patients; AKI preceded contrast in 76.2% of cases.
• AKI reversal occurred in 65 cases post-contrast; no significant dose-response relationship for CA-AKI was observed.
• Contrast-exposed patients had longer ICU LOS (10.9 vs. 5.5 days) and higher ICU mortality (OR 1.67), with similar renal replacement therapy use.

Conclusions:

• CA-AKI is associated with increased mortality and ICU LOS, but AKI frequently precedes contrast exposure.
• AKI reversal is more common than AKI following contrast, and no clear dose-response was found.
• The observational design limits definitive conclusions on contrast media as a cause of AKI in this ICU cohort.