Assessing the risk of contrast induced-acute kidney injury (CI-AKI) after enhanced CT scan: Single-centre experience.
DOI:
https://doi.org/10.22317/jcms.v10i4.1510Keywords:
Acute kidney injury (AKI), Computed tomography scan (CT scan), Contrast-induced acute kidney injury (CI-AKI), Chronic kidney disease (CKD), Estimated glomerular filtration rate (eGFR)Abstract
Objective: This study was conducted to assess the risk of contrast-induced AKI (CI-AKI), among Saudi patients who underwent enhanced CT scans at a tertiary care hospital; to understand the incidence and the underlying associated factors of CI-AKI.
Methods: We conducted a retrospective review of patients who underwent CT scans with IV contrast from 2016 to 2021, at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All authors had no access to information that could identify individual participants during or after data collection. The occurrence of AKI was defined using the “Kidney Disease: Improving Global Outcomes” (KDIGO) consensus definition. The exclusion criteria comprised age <18 years and records with missing key clinical information. Statistical Package for the Social Sciences (SPSS) software, version 21 was used for statistical analysis. The prevalence is presented as a percentage with a 95% confidence level. A P-value <0.05 was considered statistically significant.
Results: We reviewed 2000 patient files, of which 1430 met the inclusion criteria. According to the KDIGO definition of AKI, the overall incidence CI-AKI in our study cohort was 8.7%. The incidence of CI-AKI varied across baseline CKD stages, with significantly higher occurrences observed in individuals with CKD Stage5 at 24.3% and Stage4 at 15.9%. Statistical analysis confirmed that the likelihood of CI-AKI is significantly influenced by the baseline eGFR levels. This retrospective analysis found that individuals with hypertension have significantly higher odds of CI-AKI (OR = 2.02, p=0.001) compared to those without hypertension. Moreover, individuals with hyperuricemia have significantly higher odds of CI-AKI (OR = 2.78, p<0.001), compared to those without. The association remains significant after adjusting for other variables (OR = 2.40, p<0.001). The presence of diabetes, malignancy, anaemia, and ischemic heart disease did not show a significant association with CI-AKI.
Conclusions: Based on the results of this retrospective study, the overall incidence of CI-AKI is around 8.7 %, among patients undergoing enhanced CT scan. The risk is low and highly influenced by patients’ baseline kidney function. Hypertension and Hyperuricemia are risk factors found to be associated with CI-AKI after enhanced CT scan. Diagnostic and clinically relevant enhanced CT scans should not be deferred based on the potential risk of CI-AKI. Furthermore, pre and peri-scan prevention protocols can significantly mitigate the risk of CI-AKI, even among high-risk patients.
References
Bell D AM, Sciacca F. Contrast Medium Radiopeadia.org14 June 2022 [Available from: https://radiopaedia.org/articles/69081.
Aycock RD, Westafer LM, Boxen JL, Majlesi N, Schoenfeld EM, Bannuru RR. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med. 2018;71(1):44-53.e4.
Kooiman J, Pasha SM, Zondag W, Sijpkens YW, van der Molen AJ, Huisman MV, et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012;81(10):2554-61.
McCullough PA, Sandberg KR. Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med. 2003;4 Suppl 5:S3-9.
Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World J Nephrol. 2017;6(3):86-99.
Rao QA, Newhouse JH. Risk of nephropathy after intravenous administration of contrast material: a critical literature analysis. Radiology. 2006;239(2):392-7.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84.
D'Amore C, Nuzzo S, Briguori C. Biomarkers of Contrast-Induced Nephropathy:: Which Ones are Clinically Important? Interv Cardiol Clin. 2020;9(3):335-44.
Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930-6.
Heyman SN, Clark BA, Kaiser N, Spokes K, Rosen S, Brezis M, et al. Radiocontrast agents induce endothelin release in vivo and in vitro. J Am Soc Nephrol. 1992;3(1):58-65.
Heyman SN, Rosen S, Brezis M. Radiocontrast nephropathy: a paradigm for the synergism between toxic and hypoxic insults in the kidney. Exp Nephrol. 1994;2(3):153-7.
Mitchell AM, Kline JA, Jones AE, Tumlin JA. Major Adverse Events One Year After Acute Kidney Injury After Contrast-Enhanced Computed Tomography. Ann Emerg Med. 2015;66(3):267-74 e4.
Davenport MS, Cohan RH, Ellis JH. Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction. AJR Am J Roentgenol. 2015;204(6):1174-81.
McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 2014;273(3):714-25.
McCullough PA, Choi JP, Feghali GA, Schussler JM, Stoler RM, Vallabahn RC, et al. Contrast-Induced Acute Kidney Injury. J Am Coll Cardiol. 2016;68(13):1465-73.
Alhassan AM, Aldayel A, Alharbi A, Farooqui M, Alhelal MH, Alhusain F, et al. Acute Kidney Injury in Patients With Suspected Pulmonary Embolism: A Retrospective Study of the Incidence, Risk Factors, and Outcomes in a Tertiary Care Hospital in Saudi Arabia. Cureus. 2022;14(1):e21198.
Fadel A, Almatham K, Almousa S, Abonab M, AlJaser A, Alqahtani A, et al. P0609 THE INCIDENCE AND RISK OF CONTRAST INDUCED ACUTE KIDNEY INJURY IN THE ELDERLY UNDERGOING PULMONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY. Nephrology Dialysis Transplantation. 2020;35(Supplement_3):gfaa142. P0609.
Radiology ACo. ACR Manual on Contrast Media. Version 10.3. . 2023.
Pistolesi V, Regolisti G, Morabito S, Gandolfini I, Corrado S, Piotti G, et al. Contrast medium induced acute kidney injury: a narrative review. J Nephrol. 2018;31(6):797-812.
Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med. 2019;380(22):2146-55.
Obed M, Gabriel MM, Dumann E, Vollmer Barbosa C, Weißenborn K, Schmidt BMW. Risk of acute kidney injury after contrast-enhanced computerized tomography: a systematic review and meta-analysis of 21 propensity score-matched cohort studies. Eur Radiol. 2022;32(12):8432-42.
Rudnick MR, Goldfarb S, Tumlin J. Contrast-induced nephropathy: is the picture any clearer? Clin J Am Soc Nephrol. 2008;3(1):261-2.
Lun Z, Mai Z, Liu L, Chen G, Li H, Ying M, et al. Hypertension as a Risk Factor for Contrast-Associated Acute Kidney Injury: A Meta-Analysis Including 2,830,338 Patients. Kidney and Blood Pressure Research. 2021;46(6):670-92.
Keaney JJ, Hannon CM, Murray PT. Contrast-induced acute kidney injury: how much contrast is safe? Nephrol Dial Transplant. 2013;28(6):1376-83.
Nguyen LS, Spagnoli V, Kerneis M, Hauguel-Moreau M, Barthélémy O, Collet JP, et al. Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as biomarkers of acute kidney injury after ST-segment elevation myocardial infarction treated by percutaneous coronary intervention. Arch Cardiovasc Dis. 2019;112(3):180-6.
Neyra JA, Shah S, Mooney R, Jacobsen G, Yee J, Novak JE. Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease. Nephrol Dial Transplant. 2013;28(6):1463-71.
Lee J, Cho JY, Lee HJ, Jeong YY, Kim CK, Park BK, et al. Contrast-induced nephropathy in patients undergoing intravenous contrast-enhanced computed tomography in Korea: a multi-institutional study in 101487 patients. Korean J Radiol. 2014;15(4):456-63.
Gao YM, Li D, Cheng H, Chen YP. Derivation and validation of a risk score for contrast-induced nephropathy after cardiac catheterization in Chinese patients. Clin Exp Nephrol. 2014;18(6):892-8.
Brown JR, MacKenzie TA, Maddox TM, Fly J, Tsai TT, Plomondon ME, et al. Acute Kidney Injury Risk Prediction in Patients Undergoing Coronary Angiography in a National Veterans Health Administration Cohort With External Validation. J Am Heart Assoc. 2015;4(12).
Tang H, Chen H, Li Z, Xu S, Yan G, Tang C, et al. Association between uric acid level and contrast-induced acute kidney injury in patients with type 2 diabetes mellitus after coronary angiography: a retrospective cohort study. BMC Nephrology. 2022;23(1):399.
Guo W, Song F, Chen S, Zhang L, Sun G, Liu J, et al. The relationship between hyperuricemia and contrast-induced acute kidney injury undergoing primary percutaneous coronary intervention: secondary analysis protocol for the ATTEMPT RESCIND-1 study. Trials. 2020;21(1):567.
Zuo T, Jiang L, Mao S, Liu X, Yin X, Guo L. Hyperuricemia and contrast-induced acute kidney injury: A systematic review and meta-analysis. Int J Cardiol. 2016;224:286-94.
Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart. 2013;99(11):759-66.
Borghi C, Rosei EA, Bardin T, Dawson J, Dominiczak A, Kielstein JT, et al. Serum uric acid and the risk of cardiovascular and renal disease. J Hypertens. 2015;33(9):1729-41; discussion 41.
Kang DH, Park SK, Lee IK, Johnson RJ. Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol. 2005;16(12):3553-62.
Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Physiol. 2007;293(2):C584-96.
Ejaz AA, Johnson RJ, Shimada M, Mohandas R, Alquadan KF, Beaver TM, et al. The Role of Uric Acid in Acute Kidney Injury. Nephron. 2019;142(4):275-83.
Erol T, Tekin A, Katırcıbaşı MT, Sezgin N, Bilgi M, Tekin G, et al. Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial. Int J Cardiol. 2013;167(4):1396-9.
Kumar A, Bhawani G, Kumari N, Murthy KS, Lalwani V, Raju Ch N. Comparative study of renal protective effects of allopurinol and N-acetyl-cysteine on contrast induced nephropathy in patients undergoing cardiac catheterization. J Clin Diagn Res. 2014;8(12):Hc03-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Journal of Contemporary Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
