Post-contrast Acute Kidney Injury in the Super-elder Patients: a CT-scan Perspective

Overview

Journal Jpn J Radiol

Publisher Springer

Specialty Radiology

Date 2024 Sep 12

PMID 39264543

Authors

Yedidah Fraenkel

Naama R Bogot

Ruth Cytter Kuint

Efrat Ben-Shalom

Ofer Benjaminov

Alon Bnaya

Affiliations

Soon will be listed here.

Abstract

Introduction: The administration of intravenous (IV) contrast media during computed tomography (CT) examinations is essential to enhance diagnostic accuracy in various clinical scenarios. Traditionally, older age is considered a risk factor for the development of post-contrast Acute Kidney Injury (PC-AKI); however, there is limited information available for the super-elderly population (aged ≥ 85). This study aims to investigate the incidence and risk factors associated with PC-AKI in individuals aged 85 and older undergoing CT scans with IV contrast.

Methods: A retrospective cohort study, including all hospitalized patients aged 85 or older who underwent CT scans between the years 2005 and 2021. Patients were categorized into IV contrast and non-IV contrast groups. Baseline demographic and clinical data, along with kidney function parameters, were collected.

Results: The final cohort included 7,078 patients who underwent CT scans, with 40% receiving IV contrast. The overall AKI occurrence within 72 h post-CT was 5.72%, slightly elevated in the non-IV contrast group (6.25% vs. 4.94%, p = 0.02). However, multivariate analysis revealed no significant difference between the groups (OR 1, CI 0.8-1.2, p = 0.92), even after stratifying by kidney function. A secondary analysis, using a less strict AKI definition, supported these findings. Baseline creatinine levels emerged as prominent risk factor associated with PC- AKI.

Conclusion: The current study provides reassurance regarding the safety of contrast-enhanced CT scans in super-elderly patients, particularly those with baseline normal to mild kidney dysfunction. These findings may contribute to the ongoing discussion on the risk-benefit balance of contrast-enhanced CT scans in the super-elderly population.

References

Seidel J, Bissell M, Vatturi S, Hartery A . Retrospective Analysis of Emergency Computed Tomography Imaging Utilization at an Academic Centre: An Analysis of Clinical Indications and Outcomes. Can Assoc Radiol J. 2019; 70(1):13-22. DOI: 10.1016/j.carj.2018.10.004. View

Pandharipande P, Alabre C, Coy D, Zaheer A, Miller C, Herring M . Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings. Radiology. 2016; 281(3):835-846. DOI: 10.1148/radiol.2016152887. View

Parillo M, van der Molen A, Asbach P, Elsholtz F, Laghi A, Ronot M . The role of iodinated contrast media in computed tomography structured Reporting and Data Systems (RADS): a narrative review. Quant Imaging Med Surg. 2023; 13(11):7621-7631. PMC: 10644138. DOI: 10.21037/qims-23-603. View

Tsushima Y, Yamada S, Aoki J, Motojima T, Endo K . Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults. Clin Radiol. 2002; 57(6):507-13. DOI: 10.1053/crad.2001.0925. View

Bae K . Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010; 256(1):32-61. DOI: 10.1148/radiol.10090908. View

Hossain M, Costanzo E, Cosentino J, Patel C, Qaisar H, Singh V . Contrast-induced nephropathy: Pathophysiology, risk factors, and prevention. Saudi J Kidney Dis Transpl. 2018; 29(1):1-9. DOI: 10.4103/1319-2442.225199. View

Azzalini L, Spagnoli V, Ly H . Contrast-Induced Nephropathy: From Pathophysiology to Preventive Strategies. Can J Cardiol. 2015; 32(2):247-55. DOI: 10.1016/j.cjca.2015.05.013. View

McDonald J, McDonald R, Comin J, Williamson E, Katzberg R, Murad M . Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology. 2013; 267(1):119-28. DOI: 10.1148/radiol.12121460. View

McDonald R, McDonald J, Bida J, Carter R, Fleming C, Misra S . Intravenous contrast material-induced nephropathy: causal or coincident phenomenon?. Radiology. 2013; 267(1):106-18. PMC: 6940002. DOI: 10.1148/radiol.12121823. View

10.

Wilhelm-Leen E, Montez-Rath M, Chertow G . Estimating the Risk of Radiocontrast-Associated Nephropathy. J Am Soc Nephrol. 2016; 28(2):653-659. PMC: 5280012. DOI: 10.1681/ASN.2016010021. View

11.

Hinson J, Ehmann M, Fine D, Fishman E, Toerper M, Rothman R . Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Ann Emerg Med. 2017; 69(5):577-586.e4. DOI: 10.1016/j.annemergmed.2016.11.021. View

12.

Detrenis S, Meschi M, Bertolini L, Savazzi G . Contrast medium administration in the elderly patient: is advancing age an independent risk factor for contrast nephropathy after angiographic procedures?. J Vasc Interv Radiol. 2007; 18(2):177-85. DOI: 10.1016/j.jvir.2006.12.009. View

13.

Alsafi A, Alsafi Z, Lakhani A, Strickland N . Changes in renal function in elderly patients following intravenous iodinated contrast administration: a retrospective study. Radiol Res Pract. 2014; 2014:459583. PMC: 3981524. DOI: 10.1155/2014/459583. View

14.

Pan H, Wu X, Wan Q, Liu And B, Wu X . Analysis of the risk factors for contrast-induced nephropathy in over-aged patients receiving coronary intervention. Exp Biol Med (Maywood). 2018; 243(12):970-975. PMC: 6180409. DOI: 10.1177/1535370218799973. View

15.

Song W, Zhang T, Pu J, Shen L, He B . Incidence and risk of developing contrast-induced acute kidney injury following intravascular contrast administration in elderly patients. Clin Interv Aging. 2014; 9:85-93. PMC: 3883550. DOI: 10.2147/CIA.S55157. View

16.

Campbell K, OHare A . Kidney disease in the elderly: update on recent literature. Curr Opin Nephrol Hypertens. 2008; 17(3):298-303. DOI: 10.1097/MNH.0b013e3282f5dd90. View

17.

Roderick P, Atkins R, Smeeth L, Mylne A, Nitsch D, Hubbard R . CKD and mortality risk in older people: a community-based population study in the United Kingdom. Am J Kidney Dis. 2009; 53(6):950-60. DOI: 10.1053/j.ajkd.2008.12.036. View

18.

Rudnick M, Goldfarb S, Wexler L, Ludbrook P, Murphy M, Halpern E . Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int. 1995; 47(1):254-61. DOI: 10.1038/ki.1995.32. View

19.

Elicker B, Cypel Y, Weinreb J . IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. AJR Am J Roentgenol. 2006; 186(6):1651-8. DOI: 10.2214/AJR.05.0407. View

20.

Ostermann M, Bellomo R, Burdmann E, Doi K, Endre Z, Goldstein S . Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int. 2020; 98(2):294-309. PMC: 8481001. DOI: 10.1016/j.kint.2020.04.020. View