Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.
Acute kidney injury
Contrast media
Contrast-associated nephropathy
Contrast-induced nephropathy
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
04
08
2022
accepted:
21
12
2022
pubmed:
31
1
2023
medline:
25
2
2023
entrez:
30
1
2023
Statut:
ppublish
Résumé
Evidence of an association between intravenous contrast media (CM) and persistent renal dysfunction is lacking for patients with pre-existing acute kidney injury (AKI). This study was designed to determine the association between intravenous CM administration and persistent AKI in patients with pre-existing AKI. A retrospective propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients ≥ 18 years old meeting Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI at time of arrival to one of three emergency departments between 7/1/2017 and 6/30/2021 who did or did not receive intravenous CM. Outcomes included persistent AKI at hospital discharge and initiation of dialysis within 180 days of index encounter. Our analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). CM was administered in 18.4% of all encounters. AKI resolved prior to hospital discharge for 69.1%. No association between intravenous CM administration and persistent AKI was observed after unadjusted multivariable logistic regression modeling (OR 1; 95% CI 0.89-1.11), propensity weighting (OR 0.93; 95% CI 0.83-1.05), and entropy balancing (OR 0.94; 95% CI 0.83-1.05). Sub-group analysis in those admitted to the ICU yielded similar results. Initiation of dialysis within 180 days was observed in 5.4% of the cohort. An association between CM administration and increased risk of dialysis within 180 days was not observed. Among patients with pre-existing AKI, contrast administration was not associated with either persistent AKI at hospital discharge or initiation of dialysis within 180 days. Current consensus recommendations for use of intravenous CM in patients with stable renal disease may also be applied to patients with pre-existing AKI.
Identifiants
pubmed: 36715705
doi: 10.1007/s00134-022-06966-w
pii: 10.1007/s00134-022-06966-w
doi:
Substances chimiques
Contrast Media
0
Types de publication
Journal Article
Comment
Langues
eng
Sous-ensembles de citation
IM
Pagination
205-215Subventions
Organisme : AHRQ HHS
ID : R01 HS027793
Pays : United States
Commentaires et corrections
Type : CommentOn
Informations de copyright
© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.
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