CT Scan IV Contrast Not Linked With AKI or Emergent Dialysis, Even In Patients With Impaired Kidney Function

MedicalResearJennifer S. McDonald Ph.D Assistant Professor Department of Radiology Mayo Clinicch.com Interview with:
Jennifer S. McDonald Ph.D
Assistant Professor
Department of Radiology
Mayo Clinic

Medical Research: What is the background for this study? What are the main findings?

Dr. McDonald: Our research group is interested in studying contrast-induced nephropathy (CIN), which is the development of acute kidney injury following administration of iodinated contrast material. Iodinated contrast material is frequently administered during CT examinations. Recent publications, including those by our group, suggest that the incidence of contrast-induced nephropathy has been overestimated by prior, uncontrolled studies. The purpose of our study was to better evaluate the incidence and severity of CIN in patients with diminished renal function (eGFR < 60 ml/min/1.73m2). In the current article, we performed a controlled retrospective study comparing patients who received a contrast-enhanced CT scan at our institution to patients who received an unenhanced CT scan. We used propensity score analysis that incorporated numerous variables to match contrast recipients and control patients with similar clinical characteristics. After performing this analysis, we found that the rate of AKI, emergent dialysis, and short-term mortality was similar between contrast recipients and control patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. McDonald: Our study found that intravenous contrast material administration was not associated with an increased risk of acute kidney injury, emergent dialysis, and short-term mortality, even in patients with a pre-scan eGFR < 30 ml/min/1.73m2. These findings provide additional evidence that the risk of CIN is extremely low in the vast majority of patients who receive a CT scan. Our findings promote a more liberalized use of contrast material in patients where diagnostically indicated. This would mean better use of contrast material and faster, more accurate diagnoses for patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. McDonald: While our study was extensive, it was retrospective in nature. Prospective studies are needed to better evaluate the true incidence and severity of contrast-induced nephropathy. Ideally, randomized controlled trials should be performed where patients are randomized to contrast administration. We hope that the findings of our retrospective studies will help pave the way for these randomized trials.

Citation:

Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

McDonald JS1, McDonald RJ2, Lieske JC3, Carter RE4, Katzberg RW5, Williamson EE2, Kallmes DE

Mayo Clin Proc. 2015 Aug;90(8):1046-53. doi: 10.1016/j.mayocp.2015.05.016.

 

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Jennifer S. McDonald Ph.D (2015). CT Scan IV Contrast Not Linked With AKI or Emergent Dialysis, Even In Patients With Impaired Kidney Function

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