Contrast-induced nephropathy following CT scan for trauma is not rare and is associated with increased mortality in South African trauma patients

Abstract

Acute trauma patients are at risk for the development of acute kidney injury (AKI). One potential nephrotoxic agent, which a trauma patient may be exposed to, is iodinated contrast media (ICM). We aim to review the incidence and outcome of contrast-induced nephropathy (CIN) in trauma patients in a busy trauma service, and to identify potentially modifiable risk factors. During the period from December 2012 to April 2017, all patients who underwent a contrast-enhanced CT scan for trauma were included. Data were examined and outcome data were reviewed. A total of 1566 patients required a CT scan following blunt trauma at our institution. Of this total 755 patients underwent a contrast-enhanced CT scan. There were 173 females (22.9%) and 582 males (77.1%). All these patients received intravenous contrast. A total of 143 (18.9%) were admitted to ICU, and 58 (7.7%) of patients died. Detailed electrolyte studies pre- and post-procedure were available for 312 patients. Of these 312 patients, 46 developed CIN (14.7%).There was no difference in the incidence of pre-CT AKI or deranged electrolytes between the patients who developed CIN and those who did not. The development of CIN was associated with an increased risk of death as well as increased need for renal replacement therapy as well as increased need for ICU. Contrast-induced nephropathy is a real risk in trauma patients undergoing contrast-enhanced CT scan for blunt trauma in our environment. Further work is needed to define and delineate risk factors.