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

      Abstract

      Objective

      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.

      Results

      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.

      Conclusion

      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)
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      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 90Issue 10
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          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.
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