Mayo Clinic Proceedings Home

Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure



      To examine the effect of intravenous iodinated contrast material administration on the subsequent development of acute kidney injury (AKI), emergent dialysis, and short-term mortality using a propensity score–adjusted analysis of computed tomographic scan recipients with chronic kidney disease (CKD).

      Patients and Methods

      In this institutional review board–approved retrospective study, all patients with CKD who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomographic scan from January 1, 2000, to August 1, 2013 were identified. Patients were subdivided into CKD stage III (baseline estimated glomerular filtration rate, 30-59 mL/min per 1.73 m2) and CKD stage IV-V (baseline estimated glomerular filtration rate, <30 mL/min per 1.73 m2) subgroups and separately underwent propensity score generation, stratification, and 1:1 matching. Rates of AKI, 30-day emergent dialysis, and mortality were compared between contrast and noncontrast groups. Sensitivity analyses examining only patients with stable prescan serum creatinine levels and incorporating intravenous fluid administration at the time of the CT scan into the model were also performed.


      A total of 6902 patients (4496 CKD stage III, matched: 1220 contrast and 1220 noncontrast; 2086 CKD stage IV-V, matched: 491 contrast and 491 noncontrast) were included in the study. After propensity score adjustment, rates of AKI, emergent dialysis, and mortality were not significantly higher in the contrast group than in the noncontrast group in either CKD subgroup (CKD stage III: OR, 0.65-1.00; P<.001-.99 and CKD stage IV-V: OR, 0.93-2.33; P=.22-.99). Both sensitivity analyses revealed similar results.


      Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function.

      Abbreviations and Acronyms:

      AKI (acute kidney injury), AKIN (Acute Kidney Injury Network), CIN (contrast-induced nephropathy), CKD (chronic kidney disease), CT (computed tomographic), eGFR (estimated glomerular filtration rate), EMR (electronic medical record), KDOQI (Kidney Disease Outcomes Quality Initiative), ICD-9 (International Classification of Diseases, Ninth Revision), SCr (serum creatinine)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. ACR manual on contrast media. Version 9. American College of Radiology website.∼/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast Manual/2013_Contrast_Media.pdf. Accessed June 29, 2015.

        • Stacul F.
        • van der Molen A.J.
        • Reimer P.
        • et al.
        • Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR)
        Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines.
        Eur Radiol. 2011; 21: 2527-2541
        • Katzberg R.W.
        • Lamba R.
        Contrast-induced nephropathy after intravenous administration: fact or fiction?.
        Radiol Clin North Am. 2009; 47 (v): 789-800
        • Katzberg R.W.
        • Newhouse J.H.
        Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe?.
        Radiology. 2010; 256: 21-28
        • McDonald J.S.
        • McDonald R.J.
        • Comin J.
        • et al.
        Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis.
        Radiology. 2013; 267: 119-128
        • Davenport M.S.
        • Khalatbari S.
        • Cohan R.H.
        • Dillman J.R.
        • Myles J.D.
        • Ellis J.H.
        Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate.
        Radiology. 2013; 268: 719-728
        • McDonald J.S.
        • McDonald R.J.
        • Carter R.E.
        • Katzberg R.W.
        • Kallmes D.F.
        • Williamson E.E.
        Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate.
        Radiology. 2014; 271: 65-73
        • Davenport M.S.
        • Cohan R.H.
        • Khalatbari S.
        • Ellis J.H.
        The challenges in assessing contrast-induced nephropathy: where are we now?.
        AJR Am J Roentgenol. 2014; 202: 784-789
        • Newhouse J.H.
        • RoyChoudhury A.
        Quantitating contrast medium-induced nephropathy: controlling the controls.
        Radiology. 2013; 267: 4-8
        • McDonald R.J.
        • McDonald J.S.
        • Bida J.P.
        • et al.
        Intravenous contrast material-induced nephropathy: causal or coincident phenomenon?.
        Radiology. 2013; 267: 106-118
        • McDonald R.J.
        • McDonald J.S.
        • Carter R.E.
        • et al.
        Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality.
        Radiology. 2014; 273: 714-725
        • Kern E.F.
        • Maney M.
        • Miller D.R.
        • et al.
        Failure of ICD-9-CM codes to identify patients with comorbid chronic kidney disease in diabetes.
        Health Serv Res. 2006; 41: 564-580
        • Newton K.M.
        • Wagner E.H.
        • Ramsey S.D.
        • et al.
        The use of automated data to identify complications and comorbidities of diabetes: a validation study.
        J Clin Epidemiol. 1999; 52: 199-207
        • Peabody J.W.
        • Luck J.
        • Jain S.
        • Bertenthal D.
        • Glassman P.
        Assessing the accuracy of administrative data in health information systems.
        Med Care. 2004; 42: 1066-1072
        • National Kidney Foundation
        K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S1-S266
        • Mehta R.L.
        • Kellum J.A.
        • Shah S.V.
        • et al.
        • Acute Kidney Injury Network
        Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.
        Crit Care. 2007; 11: R31
      2. Ridgeway G, McCaffrey DF, Morral AR, Burgette LF, Griffin BA. Toolkit for Weighting and Analysis of Nonequivalent Groups: a tutorial for the TWANG package. Accessed June 29, 2015.

      3. R: A Language and Environment for Statistical Computing.
        ([computer program]. Version 3.0.3) R Foundation for Statistical Computing, Vienna, Austria2012
        • Ehrmann S.
        • Badin J.
        • Savath L.
        • et al.
        Acute kidney injury in the critically ill: is iodinated contrast medium really harmful?.
        Crit Care Med. 2013; 41: 1017-1026
        • ACT Investigators
        Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT).
        Circulation. 2011; 124: 1250-1259
        • Sun Z.
        • Fu Q.
        • Cao L.
        • Jin W.
        • Cheng L.
        • Li Z.
        Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy: a meta-analysis of randomized, controlled trials.
        PloS One. 2013; 8: e55124
        • Zoungas S.
        • Ninomiya T.
        • Huxley R.
        • et al.
        Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy.
        Ann Intern Med. 2009; 151: 631-638

      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 90Issue 10
        • Preview
          In the Original Article entitled “Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure” published in the August 2015 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2015;90(8):1046-1053), the middle initial for one of the authors was published incorrectly; his name should read David F. Kallmes.
        • Full-Text
        • PDF