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01-11-2019 | Computed Tomography | Original

Association between intravenous contrast media exposure and non-recovery from dialysis-requiring septic acute kidney injury: a nationwide observational study

Authors: Yoshihisa Miyamoto, Masao Iwagami, Shotaro Aso, Hideo Yasunaga, Hiroki Matsui, Kiyohide Fushimi, Yoshifumi Hamasaki, Masaomi Nangaku, Kent Doi

Published in: Intensive Care Medicine | Issue 11/2019

Abstract

Purpose

This study aimed to examine the association between the use of intravenous contrast and non-recovery from dialysis-requiring acute kidney injury (AKI-D) and in-hospital mortality among patients with sepsis.

Methods

This was a retrospective observational study using the Japanese Diagnosis Procedure Combination inpatient database between January 2011 and December 2016. We identified patients with septic AKI who began continuous renal replacement therapy (RRT) within 2-days of admission and underwent computed tomography. We compared patients with AKI-D with and without the use of intravenous contrast for computed tomography and performed propensity score matching to adjust for confounders for the association between exposure to intravenous contrast and outcomes, including a composite outcome of in-hospital mortality and RRT dependence at discharge and RRT duration.

Results

From 3782 and 6619 patients with septic AKI-D with and without intravenous contrast exposure, respectively, 3485 propensity score-matched pairs were generated. No significant differences were found in the outcomes between the propensity score-matched groups: a composite outcome of in-hospital mortality and RRT dependence, 49.6% vs. 50.2% (odds ratio (OR) 0.98; 95% CI (confidence interval) 0.88, 1.07); in-hospital mortality, 45.3% vs. 46.1% (OR 0.97; 95% CI 0.87, 1.06); RRT dependence, 4.4% vs 4.1% (OR 1.08; 95% CI 0.85, 1.31); and median (interquartile range) of RRT duration, 4 [2–11] days vs. 4 [2–11] days (P = 0.58).

Conclusions

This large observational study did not support an association between intravenous contrast media and adverse in-hospital outcomes in patients with septic AKI-D. Further studies are warranted to assess the generalizability.

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Iwagami M, Yasunaga H, Noiri E et al (2015) Current state of continuous renal replacement therapy for acute kidney injury in Japanese intensive care units in 2011: analysis of a national administrative database. Nephrol Dial Transplant 30:988–995. https://doi.org/10.1093/ndt/gfv069 CrossRefPubMed

Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818. https://doi.org/10.1001/jama.294.7.813 CrossRefPubMed

Uchino S, Bellomo R, Morimatsu H et al (2007) Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med 33:1563–1570. https://doi.org/10.1007/s00134-007-0754-4 CrossRefPubMed

Sood MM, Shafer LA, Ho J et al (2014) Early reversible acute kidney injury is associated with improved survival in septic shock. J Crit Care 29:711–717. https://doi.org/10.1016/j.jcrc.2014.04.003 CrossRefPubMed

Lee BJ, Hsu CY, Parikh RV et al (2018) Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study. BMC Nephrol 19:134. https://doi.org/10.1186/s12882-018-0924-3 CrossRefPubMedPubMedCentral

Chawla LS, Bellomo R, Bihorac A et al (2017) Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 13:241–257. https://doi.org/10.1038/nrneph.2017.2 CrossRefPubMed

Cecconi M, Evans L, Levy M, Rhodes A (2018) Sepsis and septic shock. Lancet 392:75–87. https://doi.org/10.1016/S0140-6736(18)30696-2 CrossRefPubMed

Bellomo R, Kellum JA, Ronco C et al (2017) Acute kidney injury in sepsis. Intensive Care Med 43:816–828. https://doi.org/10.1007/s00134-017-4755-7 CrossRefPubMed

Miyamoto Y, Iwagami M, Aso S et al (2019) Temporal change in characteristics and outcomes of acute kidney injury on renal replacement therapy in intensive care units: analysis of a nationwide administrative database in Japan, 2007–2016. Crit Care. https://doi.org/10.1186/s13054-019-2468-8 CrossRefPubMedPubMedCentral

10.

Stoker J, van Randen A, Laméris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253:31–46. https://doi.org/10.1148/radiol.2531090302 CrossRefPubMed

11.

Mehran R, Dangas GD, Weisbord SD (2019) Contrast-associated acute kidney injury. N Engl J Med 380:2146–2155. https://doi.org/10.1056/NEJMra1805256 CrossRef

12.

Azzalini L, Spagnoli V, Ly HQ (2016) Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol 32:247–255. https://doi.org/10.1016/j.cjca.2015.05.013 CrossRefPubMed

13.

McDonald JS, McDonald RJ, Williamson EE et al (2017) Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med 43:774–784. https://doi.org/10.1007/s00134-017-4699-y CrossRefPubMed

14.

Hinson JS, Ehmann MR, Fine DM et al (2017) Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med 69:577–586. https://doi.org/10.1016/j.annemergmed.2016.11.021 CrossRefPubMed

15.

McDonald JS, McDonald RJ, Lieske JC et al (2015) Risk of acute kidney injury, dialysis, and mortality in patients with chronic kidney disease after intravenous contrast material exposure. Mayo Clin Proc 90:1046–1053. https://doi.org/10.1016/j.mayocp.2015.05.016 CrossRefPubMedPubMedCentral

16.

Davenport A (2008) Practical guidance for dialyzing a hemodialysis patient following acute brain injury. Hemodial Int 12:307–312. https://doi.org/10.1111/j.1542-4758.2008.00271.x CrossRefPubMed

17.

McDonald RJ, McDonald JS, Carter RE et al (2014) Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology 273:714–725. https://doi.org/10.1148/radiol.14132418 CrossRefPubMed

18.

Wilhelm-Leen E, Montez-Rath ME, Chertow G (2017) Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol 28:653–659. https://doi.org/10.1681/ASN.2016010021 CrossRefPubMed

19.

Aycock RD, Westafer LM, Boxen JL et al (2018) Acute kidney injury after computed tomography: a meta-analysis. Ann Emerg Med 71:44–53. https://doi.org/10.1016/j.annemergmed.2017.06.041 CrossRefPubMed

20.

Ehrmann S, Quartin A, Hobbs BP et al (2017) Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med 43:785–794. https://doi.org/10.1007/s00134-017-4700-9 CrossRefPubMed

21.

Weisbord SD, du Cheryon D (2018) Contrast-associated acute kidney injury is a myth: no. Intensive Care Med 44:107–109. https://doi.org/10.1007/s00134-017-5015-6 CrossRefPubMed

22.

Kashani K, Levin A, Schetz M (2018) Contrast-associated acute kidney injury is a myth: we are not sure. Intensive Care Med 44:110–114. https://doi.org/10.1007/s00134-017-4970-2 CrossRefPubMed

23.

Ehrmann S, Aronson D, Hinson JS (2018) Contrast-associated acute kidney injury is a myth: yes. Intensive Care Med 44:104–106. https://doi.org/10.1007/s00134-017-4950-6 CrossRefPubMed

24.

Doi K, Nishida O, Shigematsu T et al (2018) The Japanese clinical practice guideline for acute kidney injury 2016. J Intensive Care 6:48. https://doi.org/10.1186/s40560-018-0308-6 CrossRefPubMedPubMedCentral

25.

Miyamoto Y, Iwagami M, Aso S et al (2019) SUN-164 association between intravenous contrast media and non-recovery from dialysis-requiring septic acute kidney injury in intensive care unit patients: a nationwide observational study. Kidney Int Rep 4:S226–S227. https://doi.org/10.1016/j.ekir.2019.05.566 CrossRef

26.

Yamana H, Moriwaki M, Horiguchi H et al (2017) Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol 27:476–482. https://doi.org/10.1016/j.je.2016.09.009 CrossRefPubMedPubMedCentral

27.

Su G, Xu H, Marrone G et al (2017) Chronic kidney disease is associated with poorer in-hospital outcomes in patients hospitalized with infections: electronic record analysis from China. Sci Rep 7:11530. https://doi.org/10.1038/s41598-017-11861-2 CrossRefPubMedPubMedCentral

28.

Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810. https://doi.org/10.1001/jama.2016.0287 CrossRefPubMedPubMedCentral

29.

Watanabe Y, Kawanishi H, Suzuki K et al (2015) Japanese society for dialysis therapy clinical guideline for “Maintenance hemodialysis: hemodialysis prescriptions”. Ther Apher Dial 19(Suppl 1):67–92. https://doi.org/10.1111/1744-9987.12294 CrossRefPubMed

30.

Quan H, Li B, Couris CM et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682. https://doi.org/10.1093/aje/kwq433 CrossRef

31.

Ono K, Wada K, Takahara T, Shirotani T (2007) Indications for computed tomography in patients with mild head injury. Neurol Med Chir 47:291–297 (discussion 297–8) CrossRef

32.

Rosenbaum PR, Rubin DB (1985) Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 39:33–38. https://doi.org/10.2307/2683903 CrossRef

33.

Brookhart MA, Schneeweiss S, Rothman KJ et al (2006) Variable selection for propensity score models. Am J Epidemiol 163:1149–1156. https://doi.org/10.1093/aje/kwj149 CrossRefPubMedPubMedCentral

34.

Tagami T, Matsui H, Horiguchi H et al (2015) Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J 45:463–472. https://doi.org/10.1183/09031936.00081514 CrossRefPubMed

35.

Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107. https://doi.org/10.1002/sim.3697 CrossRefPubMedPubMedCentral

36.

Franklin JM, Rassen JA, Ackermann D et al (2014) Metrics for covariate balance in cohort studies of causal effects. Stat Med 33:1685–1699. https://doi.org/10.1002/sim.6058 CrossRefPubMed

37.

Luo Z, Gardiner JC, Bradley CJ (2010) Applying propensity score methods in medical research: pitfalls and prospects. Med Care Res Rev 67:528–554. https://doi.org/10.1177/1077558710361486 CrossRefPubMedPubMedCentral

38.

KDIGO (2012) Clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2:1–138CrossRef

39.

Fleet JL, Dixon SN, Shariff SZ et al (2013) Detecting chronic kidney disease in population-based administrative databases using an algorithm of hospital encounter and physician claim codes. BMC Nephrol 14:81. https://doi.org/10.1186/1471-2369-14-81 CrossRefPubMedPubMedCentral

40.

Jolley RJ, Sawka KJ, Yergens DW et al (2015) Validity of administrative data in recording sepsis: a systematic review. Crit Care 19:139. https://doi.org/10.1186/s13054-015-0847-3 CrossRefPubMedPubMedCentral

Title: Association between intravenous contrast media exposure and non-recovery from dialysis-requiring septic acute kidney injury: a nationwide observational study
Authors: Yoshihisa Miyamoto
Masao Iwagami
Shotaro Aso
Hideo Yasunaga
Hiroki Matsui
Kiyohide Fushimi
Yoshifumi Hamasaki
Masaomi Nangaku
Kent Doi
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Acute Kidney Injury
Septicemia
Septicemia
Computed Tomography
Acute Kidney Injury
Published in: Intensive Care Medicine / Issue 11/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05755-2

At a glance: The STEP trials

Springer Medicine

Association between intravenous contrast media exposure and non-recovery from dialysis-requiring septic acute kidney injury: a nationwide observational study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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