Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study.

Abstract

To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination. All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR>45 and eGFR≤45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR≥60, 30-59, and <30 subsets were also performed. A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34%, OR .88 (95%CI .75-1.05), p=.15), dialysis (2.0 vs. 1.7%, OR 1.20 (.66-2.17), p=.55), and mortality (12 vs. 14%, OR .87 (.69-1.10), p=.23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR>45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5%, OR 2.72 (1.14-6.46), p=.0240) were observed in the contrast versus noncontrast group in the matched eGFR≤45 subset. Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR>45. An increased risk of dialysis was observed in patients with pre-CT eGFR≤45.