Acute Renal Failure

Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography

Steven D. Weisbord, Maria K. Mor, Abby L. Resnick, Kathryn C. Hartwig, Paul M. Palevsky and Michael J. Fine
CJASN September 2008, 3 (5) 1274-1281; DOI: https://doi.org/10.2215/CJN.01260308

Article Figures & Data

Tables

  • Table 1.

    Patient demographic and clinical characteristics

    DemographicsOverall (n = 421)Inpatient (n = 127)Outpatient (n = 294)P
        age (yr)69 ± 1070 ± 1069 ± 100.5
        male403 (96)121 (95)282 (96)0.8
        white385 (91)114 (90)271 (92)0.5
        black31 (7)11 (9)20 (7)0.5
    Comorbid illnesses
        diabetes mellitus172 (41)60 (47)112 (38)0.09
        liver disease59 (14)20 (16)39 (13)0.5
        congestive heart failure68 (16)30 (24)38 (13)0.01
        peripheral vascular disease54 (13)19 (15)35 (12)0.4
        cerebrovascular disease45 (11)23 (18)22 (7)<0.01
    Baseline renal function
        serum creatinine (mg/dl)1.4 (1.3, 1.5)1.4 (1.3, 1.5)1.4 (1.3, 1.5)1.0
        eGFR (ml/min per 1.73 m2)53 (48, 57)52 (49, 56)53 (48, 57)0.7
        eGFR 30–59 ml/min per 1.73 m2421 (100)127 (100)294 (100)1.0
        eGFR 15–29 ml/min per 1.73 m20 (0)0 (0)0 (0)NC
        eGFR <15 ml/min per 1.73 m20 (0)0 (0)0 (0)NC
    Preexisting medication use
        nonsteroidal anti-inflammatories40 (10)11 (9)29 (10)0.9
        loop diuretics101 (24)36 (28)65 (22)0.2
        angiotensin converting enzyme inhibitors161 (38)42 (33)119 (40)0.2
        theophylline2 (0.5)1 (1.0)1 (0.3)0.5

    • eGFR, estimated glomerular filtration rate; NC, not calculable. Data are n (%), mean ± SD, or median (interquartile range).

  • Table 2.

    Use of preventive care

    Overall (n = 421)Inpatient (n = 127)Outpatient (n = 294)P
    Intravenous fluid use
    Preprocedure84 (20)62 (49)22 (7)<0.01
    Postprocedure91 (22)70 (55)21 (7)<0.01
    Preprocedure and postprocedure70 (17)53 (42)17 (6)<0.01
    N-acetylcysteine use73 (17)48 (38)25 (9)<0.01
    Discontinuation of non-steroidal anti-inflammatoriesa0 (0)0 (0)(0) 0—
    Instructed to increase oral fluids74 (18)33 (26)41 (14)<0.01
    Complied with increase in oral fluidsb59 (80)28 (82)31 (76)0.4

    • Data are n (%).

    • ↵a n (%) of the 40 study patients taking nonsteroidal anti-inflammatories.

    • ↵b n (%) of patients who were instructed to increase oral fluids.

  • Table 3.

    Incidence of contrast-induced acute kidney injury

    CIAKI definitionOverall (n = 367)Inpatient (n = 119)Outpatient (n = 248)Pb
    All patients
        ≥ 25%24 (6.5)15 (12.6)9 (3.6)0.001
        ≥ 50%a2 (0.5)1 (0.8)1 (0.4)0.6
        ≥ 100%(0) 00 (0)0 (0)—
        ≥ 0.25 mg/dl40 (10.9)21 (17.6)19 (7.7)0.004
        ≥ 0.5 mg/dl13 (3.5)8 (6.7)5 (2.0)0.2
        ≥ 1.0 mg/dl1 (0.3)0 (0)1 (0.4)0.5
    eGFR ≤ 45 ml/min per 1.73 m2n = 51n = 15n = 36
        ≥ 25%6 (11.8)2 (13.3)4 (11.1)0.8
        ≥ 50%a1 (2.0)0 (0)1 (2.8)0.5
        ≥ 100%0 (0)0 (0)0 (0)—
        ≥ 0.25 mg/dl7 (13.7)2 (13.3)5 (13.9)0.9
        ≥ 0.5 mg/dl5 (9.8)2 (13.3)3 (8.3)0.6
        ≥ 1.0 mg/dl1 (2.0)0 (0)1 (2.8)0.5
    eGFR > 45 ml/min per 1.73 m2n = 316n = 104n = 212
        ≥ 25%18 (5.7)13 (12.5)5 (2.4)<0.001
        ≥ 50%a1 (0.3)1 (1)0 (0)0.2
        ≥ 100%0 (0)0 (0)0 (0)—
        ≥ 0.25 mg/dl33 (10.4)19 (18.3)14 (6.6)0.001
        ≥ 0.5 mg/dl8 (2.5)6 (5.7)2 (0.9)0.01
        ≥ 1.0 mg/dl0 (0)0 (0)0 (0)—

    • eGFR, estimated glomerular filtration rate; —, not applicable. Data are n (%).

    • ↵a The 2 patients meeting this definition of CIAKI also met criteria for RISK category of acute kidney injury as defined by RIFLE criteria.

    • ↵b Comparison of CIAKI between inpatients and outpatients.

  • Table 4.

    Associations of patient and procedural factors with the development of CIAKI

    Patient factorOdds of CIAKI (↑ Scr ≥ 25%)Odds of CIAKI (↑ Scr ≥0.5 mg/dl)
    Age >65 yr1.0 (0.4, 2.4)1.1 (0.3, 3.7)
    Diabetes mellitus1.4 (0.6, 3.1)1.2 (0.4, 3.5)
    Congestive heart failure2.4 (1.0, 5.9)4.1 (1.3, 12.7)
    Peripheral vascular disease2.4 (0.9, 6.4)2.1 (0.5, 7.8)
    Cerebrovascular disease1.3 (0.4, 4.4)0.7 (0.1, 5.6)
    Scr > 1.5 mg/dl2.5 (1.1, 5.9)5.7 (1.8, 17.8)
    eGFR ≤ 45 ml/min per 1.73 m22.1 (0.8, 5.6)4.0 (1.3, 12.7)
    Hematocrit < 35%1.8 (0.8, 4.3)2.6 (0.8, 7.9)
    Inpatient status3.8 (1.6, 9.0)3.5 (1.1, 10.9)
    Procedure factors
    Contrast (iso-osmolal)0.5 (0.2, 1.3)0.9 (0.2, 4.4)
    Dose contrast > 100 ml3.3 (1.0, 11.5)2.5 (0.6, 11.7)
    Preprocedure and postprocedure IV fluid1.6 (0.6, 4.1)0.8 (0.2, 3.8)
    N-acetylcysteine use2.4 (1.9, 5.8)2.0 (0.6, 6.7)

    • Data presented as odds ratios and 95% confidence limits.

  • Table 5.

    Association of contrast-induced acute kidney injury with mortality

    Definition of CIAKI based on Δ ScrUnadjusted OR for deatha95% CIAdjusted OR for deathb95% CI
    ≥ 25%3.80.4–20.62.20.2–14.6
    ≥ 50%NC———
    ≥ 100%NC———
    ≥ 0.25 mg/dl2.10.2–11.01.70.1–10.9
    ≥ 0.5 mg/dl7.70.7–45.94.80.4–39.5
    ≥ 1.0 mg/dlNC———

    • OR, odds ratio; CI, confidence interval; NC, not calculable (because of absence of deaths); —, not applicable.

    • ↵a ORs are based on comparisons of patients who did and did not develop CIAKI.

    • ↵b Adjusted for status at time of procedure and cerebrovascular disease.

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Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography
Steven D. Weisbord, Maria K. Mor, Abby L. Resnick, Kathryn C. Hartwig, Paul M. Palevsky, Michael J. Fine
CJASN Sep 2008, 3 (5) 1274-1281; DOI: 10.2215/CJN.01260308
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