Abstract
ObjectivesPrevious 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.MethodsIn 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.ResultsMedian 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.ConclusionsIohexol 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.
Highlights
The real frequency and clinical importance of contrast induced acute kidney injury (CI-AKI) have been debated over the decades, with incidence data ranging from < 2 to 70% [1, 2]
Applying the updated European Society of Urogenital Radiology (ESUR) post-contrast AKI (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
We extended the post-coronary computed tomography (CT) angiography (CCTA) serum creatinine (Scr) blood sampling period to 48–96 h, while the old and updated ESUR criteria stipulate 48–72 h
Summary
The real frequency and clinical importance of contrast induced acute kidney injury (CI-AKI) have been debated over the decades, with incidence data ranging from < 2 to 70% [1, 2]. Recent controlled studies indicate that the risk of CI-AKI has been overestimated [3]. Confounding issues by variations in indication for computed tomography (CT) and possible selection bias of control groups in these retrospective studies make it difficult to observe true effects of contrast media (CM) on renal function [4,5,6,7]. Data about potential risk factors, apart from renal function, for developing PC-AKI, i.e., age (below or above 57 years), diabetes mellitus, cardiovascular disease (measured as coronary calcification score, CACS, or hypertension defined as systolic blood pressure > 140 or diastolic > 70 mmHg, or confirmed history of hypertension), current medication with nonsteroidal anti-inflammatory drugs (NSAID), and CM dose (including gram-iodine/eGFR ratio) [24], were provided from the SCAPIS databank. To study the representativeness of our study cohort, these background data were compared with background data from the remaining 5255 participants of the Gothenburg SCAPIS cohort
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