Risk of Acute Kidney Injury After Contrast-enhanced MRI Examinations in a Pediatric Population

Objectives: To investigate the associations between gadolinium-based contrast agent (GBCA) administration and the occurrence of acute kidney injury (AKI) in pediatric patients, and to determine the risks associated with AKI.

Materials And Methods: This retrospective study was conducted on pediatric patients who underwent contrast-enhanced or unenhanced MRI between January 1st, 2015, and June 30th, 2021. Examinations were included if they had data on height and serum creatinine levels within 3 months before and 2 days after the examinations. AKI was defined according to the AKI Network criteria. Multivariable generalized estimating equations, propensity score analyses, and inverse probability of treatment weighting analysis were used to evaluate associations between GBCA and AKI. Subgroup analyses were conducted to evaluate the interaction effects of GBCA and each subgroup variable (age, sex, examination type, admission type, chronic kidney disease stage, diabetes mellitus, cardiovascular disease, or surgery or contrast-enhanced CT performed 7 days before and 2 days after MRI).

Results: A total of 2508 examinations were included (1996 with contrast-enhanced, 512 with unenhanced MRI). AKI occurred in 1.5% of the contrast group and 1.2% of the noncontrast group. Multivariable analysis showed no significant difference in AKI incidence between the groups (adjusted OR, 1.29 [95% CI: 0.53, 3.11]; p = 0.58). Propensity score matching and inverse probability of treatment weighting analysis also showed no significant association (p = 0.22 and p = 0.21, respectively). Subgroup analysis showed no significant interaction between GBCA and any of the subgroup variables.

Conclusion: The study found no significant association between gadolinium-based contrast agent administration and the occurrence of acute kidney injury in pediatric patients.

Key Points: Question There is limited data on the development of acute kidney injury following exposure to gadolinium-based contrast agent in pediatric patients. Findings There was no significant association between the administration of gadolinium-based contrast agent and occurrence of acute kidney injury in pediatric patients. Clinical relevance The administration of gadolinium-based contrast agents does not increase the risk of acute kidney injury in pediatric patients following MRI.