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European Radiology

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Open Access 01-05-2021 | Acute Kidney Injury | Contrast Media

Minimal risk of contrast-induced kidney injury in a randomly selected cohort with mildly reduced GFR

Authors: Jeanette Carlqvist, Ulf Nyman, Gunnar Sterner, John Brandberg, Erika Fagman, Mikael Hellström

Published in: European Radiology | Issue 5/2021

Abstract

Objectives

Previous large studies of contrast-induced or post-contrast acute kidney injury (CI-AKI/PC-AKI) have been observational, and mostly retrospective, often with patients undergoing non-enhanced CT as controls. This carries risk of inclusion bias that makes the true incidence of PC-AKI hard to interpret. Our aim was to determine the incidence of PC-AKI in a large, randomly selected cohort, comparing the serum creatinine (Scr) changes after contrast medium exposure with the normal intraindividual fluctuation in Scr.

Methods

In this prospective study of 1009 participants (age 50–65 years, 48% females) in the Swedish CArdioPulmonary bioImage Study (SCAPIS), with estimated glomerular filtration rate (eGFR) ≥ 50 mL/min, all received standard dose intravenous iohexol at coronary CT angiography (CCTA). Two separate pre-CCTA Scr samples and a follow-up sample 2–4 days post-CCTA were obtained. Change in Scr was statistically analyzed and stratification was used in the search of possible risk factors.

Results

Median increase of Scr post-CCTA was 0–2 μmol/L. PC-AKI was observed in 12/1009 individuals (1.2%) according to the old ESUR criteria (> 25% or > 44 μmol/L Scr increase) and 2 individuals (0.2%) when using the updated ESUR criteria (≥ 50% or ≥ 27 μmol/L Scr increase). Possible risk factors (e.g., diabetes, age, eGFR, NSAID use) did not show increased risk of developing PC-AKI. The mean effect of contrast media on Scr did not exceed the intraindividual Scr fluctuation.

Conclusions

Iohexol administration to a randomly selected cohort with mildly reduced eGFR is safe, and PC-AKI is very rare, occurring in only 0.2% when applying the updated ESUR criteria.

Key Points

• Iohexol administration to a randomly selected cohort, 50–65 years old with mildly reduced eGFR, is safe and PC-AKI is very rare.

• Applying the updated ESUR PC-AKI criteria resulted in fewer cases, 0.2% compared to 1.2% using the old ESUR criteria in this cohort with predominantly mild reduction of renal function.

• The mean effect of CM on Scr did not exceed the intraindividual background fluctuation of Scr, regardless of potential risk factors, such as diabetes or NSAID use in our cohort of 1009 individuals.

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Title: Minimal risk of contrast-induced kidney injury in a randomly selected cohort with mildly reduced GFR
Authors: Jeanette Carlqvist
Ulf Nyman
Gunnar Sterner
John Brandberg
Erika Fagman
Mikael Hellström
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Acute Kidney Injury
CT Angiography
Acute Kidney Injury
Published in: European Radiology / Issue 5/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07429-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimal risk of contrast-induced kidney injury in a randomly selected cohort with mildly reduced GFR

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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