Postcontrast Acute Kidney Injury in Pediatric Patients: A Cohort Study

Abstract

The risks of iodinated contrast material administered to pediatric patients are not well defined. The purpose of this study was to examine the rates of postcontrast acute kidney injury (AKI), dialysis therapy, and death following administration of intravenous contrast material to pediatric patients. Retrospective cohort study. Pediatric (aged<18 years) patients who underwent either contrast-enhanced (contrast group) or unenhanced (noncontrast group) computed tomography (CT) at our institution from December 2001 to January2016. Intravenous iodinated contrast material. Postcontrast AKI based on serum creatinine-defined KDIGO criteria, dialysis therapy, and death. Risks for AKI, dialysis therapy, and death were compared between contrast and noncontrast group patients using a propensity score analysis incorporating clinical covariates related to contrast exposure. 2,201 pediatric patients (1,773 contrast and 428 noncontrast) were identified. Rates of AKI and dialysis therapy in the contrast group were 3.3% (59/1,773) and 0.1% (2/1,773), respectively. Following propensity score adjustment, no differences in risk for AKI (stage 1 AKI: OR, 0.75 [95% CI, 0.32-1.78], P=0.5; stage 2: OR, 2.00 [95% CI, 0.18-21.9], P=0.6; stage 3: OR, 0.50 [95% CI, 0.05-5.48], P=0.6), dialysis therapy (OR, 1.00 [95% CI, 0.06-15.9], P=0.9), or death (OR, 1.50 [95% CI, 0.53-4.22], P=0.4) were observed between the contrast and noncontrast groups. All patients with post-CT stage 3 AKI diagnosed also had contrast-independent potential causes of AKI. The study's small sample size andlow rates of postcontrast AKI, dialysis therapy, and death limited the ability to detect an effect of contrast administration on these outcomes. Unmeasured residual confounders maylimit the validity of our results. Few patients had decreased kidney function at the time ofCT. Rates of postcontrast AKI, dialysis therapy, and death following contrast-enhanced CT were very low in this pediatric cohort. Although not detectably different, an effect of contrast on these outcomes could not be ruled out.