Association of contrast and acute kidney injury in the critically ill: A propensity matched study.
Chest. 2019 Oct 25;:
Authors: Williams LS, Walker GR, Loewenherz JW, Gidel LT
BACKGROUND: Despite evidence that low osmolar radiocontrast media is not associated with acute kidney injury, it is important to evaluate this association in critically ill patients with normal kidney function.
MATERIALS AND METHODS: This was a retrospective observational study of 7,333 adults with an ICU stay at a six-hospital health system in South Florida. Patients who received contrast were compared with unexposed controls before and after propensity score (PS) matching derived from baseline characteristics, admission diagnoses, comorbidities and severity of illness. AKI, defined as initial onset (stage 1) or increased severity, was determined from serum creatinine according to KDIGO guidelines.
RESULTS: Based on 2,306 PS-matched pairs obtained from 2,557 cases that received intravenous contrast and 4,776 unexposed controls, the increase in AKI attributable to contrast was 1.3% (19.3 vs. 18.0%, p=0.273) and no association was found between contrast and the pattern of onset and recovery. Hospital mortality increased by 14.3% subsequent to AKI (18.0 vs. 3.6, p<0.001) but the risk ratio in relation to patients with stable AKI did not vary when stratified by contrast. Multivariable regression identified sepsis, metabolic disorders, diabetes, history of renal disease, and severity of illness as factors more strongly associated with AKI.
CONCLUSIONS: In critically ill adults with normal kidney function, low osmolar radiocontrast media did not substantively increase AKI. Rather than limiting the use of contrast in ICU patients, efforts to prevent AKI should focus on the susceptibility of patients with sepsis, diabetes complications, high APACHE score, or a history of renal disease.
PMID: 31669231 [PubMed - as supplied by publisher]