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Title CT Contrast Administration during Acute Kidney Injury and Outcomes in Hospitalized Patients |
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Type Poster Presentation |
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Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
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Topic Acute Kidney Injury |
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Main Author Emmett Tsz Yeung Wong1 4 |
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Presenting Author Emmett Tsz Yeung Wong1 4 |
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Co-Author Hai-Dong He1 2 Tanusya Murali Murali4 Yee-Liang Thian 3 4 Horng-Ruey Chua1 4 |
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Department / Institution / Country Division of Nephrology, University Medicine Cluster / National University Hospital / Singapore1 Department of Nephrology / Shanghai Minhang District Central Hospital / China (中国)2 Department of Diagnostic Imaging / National University Hospital / Singapore3 Yong Loo Lin School of Medicine / National University of Singapore / Singapore4 |
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Abstract Content: Introduction, Method, Result, Conclusion Introduction Intravenous iodinated contrast for computed tomography (CT) imaging, when administered in patients with acute kidney injury (AKI), could potentially worsen renal outcomes. There is currently no evidence to support/refute this hypothesis.
Methods In this single-centre study of hospitalized patients with AKI fulfilling KDIGO criterion identified by electronic health records over one year, we examined patient outcomes associated with cumulative volume of iodinated CT contrast administered 72 hours before and after onset of AKI, adjusted for number of CT scans, patient demographics, comorbidities and acute illnesses. Outcomes evaluated include hospital mortality, renal replacement therapy (RRT), adjusted-RRT days (per 1000 patient-days in hospital), and maximum increase in serum creatinine from AKI onset (delta-sCr).
Results Of 3298 patients studied, 560 received CT contrast with median cumulative volume of 70(50–100) mL. Baseline eGFR were 94(76-108) and 87(60-105) mL/min/1.73m2 in contrast and non-contrasted patients respectively (p<0.0001). Among patients with contrast, more had solid-organ malignancy (23% versus 14%), critical illness (56% versus 35%), received prior RRT (10% versus 7%); fewer had eGFR <60mL/min/1.73m2(13% versus 25%), pneumonia (7% versus 10%), and acute cardiac diseases (11% versus 19%); all p<0.05. Hospital mortality in contrasted versus non-contrasted patients were 15% versus 11%; corresponding RRT incidences 8% and 4%, with adjusted-RRT days of 42(39-46) and 17(16-18); all p<0.01. On multivariate analyses, more CT scans performed peri-AKI, but not cumulative contrast volume, was independently associated with higher delta-sCr and RRT (p<0.05). CT scan-count or contrast volume was not associated with higher mortality or adjusted-RRT days; adverse outcomes were associated with co-variates including pneumonia, acute cardiac diseases, critical illness, lower baseline eGFR and malignancy.
Conclusions More CT scans performed peri-AKI was associated with worse renal outcomes, independent of contrast load. Intent for CT may be a marker of patient-illness acuity, in turn associated with adverse outcomes, regardless of contrast administration. |