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Does IV Contrast Cause AKI in Critically Ill Patients?

December 13, 2019

Written by Clay Smith

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Use of low osmolar IV contrast in critically ill patients did not appear to increase risk of acute kidney injury (AKI).

Why does the matter?
We have written a lot on this topic in past JF posts. Here is a sampler.

Once again, IV contrast and AKI seem uncoupled
This was a retrospective study with propensity score analysis in critically ill patients with normal baseline renal function in 6 Florida hospitals. They made two matched groups, each with 2,306 patients; the main difference was exposure to low osmolar IV contrast or not, and the primary outcome was AKI. They found the attributable risk of developing AKI was 1.3%; 19.3% with vs 18.0% without contrast; P = .273; risk ratio for IV contrast was 1.07 (95%CI 0.95 to 1.21) after matching. Using multiple logistic regression, they found that, “sepsis, metabolic disorders, diabetes, history of renal disease, and severity of illness” were all more strongly associated with AKI than IV contrast. Once again, administration of IV contrast does not seem to meaningfully increase the risk of AKI. We should not be deterred from giving IV contrast to critically ill patients when needed to optimize imaging quality and diagnostic accuracy.

Association of Contrast and Acute Kidney Injury in the Critically Ill: A Propensity-Matched Study. Chest. 2019 Oct 25. pii: S0012-3692(19)34101-7. doi: 10.1016/j.chest.2019.10.005. [Epub ahead of print]

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What are your thoughts?