Influence of Clinical Factors on Risk of Contrast-Induced Nephrotoxicity From IV Iodinated Low-Osmolality Contrast Material in Patients With a Low Estimated Glomerular Filtration Rate

James H Ellis, Shokoufeh Khalatbari, Matheos Yosef, Richard H Cohan, Matthew S Davenport
AJR. American Journal of Roentgenology 2019 July 3, : 1-6
OBJECTIVE. The objective of our study was to explore whether clinical factors historically associated with contrast material-causative kidney injury (contrast-induced nephrotoxicity [CIN]) increase risk after use of IV iodinated low-osmolality contrast material (LOCM) in patients with stage IIIb-V chronic kidney disease. MATERIALS AND METHODS. In this retrospective hypothesis-generating study, 1:1 propensity score matching was used to assess post-CT acute kidney injury (AKI) after unenhanced or contrast-enhanced CT in patients with stable estimated glomerular filtration rate (eGFR; 1112 patients with an eGFR = 30-44 mL/min/1.73 m2 and 86 patients with an eGFR < 30 mL/min/1.73 m2 and no dialysis). Historical risk factors including diabetes mellitus, age more than 60 years, hypertension, loop diuretic use, hydrochlorothiazide use, and cardiovascular disease were evaluated for modulation of CIN risk. Stepwise multivariable logistic regression was performed. RESULTS. Overall IV LOCM was an independent risk factor for post-CT AKI in patients with an eGFR of less than 30 mL/min/1.73 m2 (odds ratio, 3.96 [95% CI, 1.29-12.21]; p = 0.016) but not in those with an eGFR of 30-44 mL/min/1.73 m2 ( p = 0.24). In patients with an eGFR of less than 30 mL/min/1.73 m2 , the tested covariates did not significantly modify the risk of CIN ( p = 0.096-0.832). In patients with an eGFR of 30-44 mL/min/1.73 m2 , risk of CIN emerged in those with cardiovascular disease ( p = 0.015; number needed to harm from LOCM = 11 patients); the other tested cofactors had no significant effect ( p = 0.108-0.822). CONCLUSION. CIN was observed when eGFR was less than 30 mL/min/1.73 m2 . In those with an eGFR of 30-44 mL/min/1.73 m2 , CIN was not observed with LOCM alone but was observed in the presence of cardiovascular disease. Other cofactors historically thought to increase CIN risk (e.g., diabetes mellitus) did not increase risk of CIN. Further study is needed to determine whether these exploratory results are true associations.

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