Risk of intravenous contrast material-mediated acute kidney injury: A propensity score-matched study stratified by baseline-estimated glomerular filtration rate

Jennifer S. McDonald, Robert J. McDonald, Rickey E. Carter, Richard W Katzberg, David F. Kallmes, Eric E. Williamson

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Abstract

Purpose: To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT). Materials and Methods: This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m 2. Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of ≥0.5 mg/dL [≥44.2 μmol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test. Results: A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P < .0001). However, this incidence was not significantly different between contrast material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95% confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95% CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95% CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m2 (n = 1486), OR was 0.97 (95% CI: 0.72, 1.30), P = .89. Conclusion: Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in patients with eGFR of less than 30 mL/min/1.73 m2.

Original languageEnglish (US)
Pages (from-to)65-73
Number of pages9
JournalRadiology
Volume271
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Propensity Score
Glomerular Filtration Rate
Acute Kidney Injury
Contrast Media
Odds Ratio
Confidence Intervals
Tomography
Creatinine
Incidence
Health Insurance Portability and Accountability Act
Research Ethics Committees
Kidney Diseases
Serum
Chronic Renal Insufficiency
Inpatients
Research Design
Retrospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Risk of intravenous contrast material-mediated acute kidney injury : A propensity score-matched study stratified by baseline-estimated glomerular filtration rate. / McDonald, Jennifer S.; McDonald, Robert J.; Carter, Rickey E.; Katzberg, Richard W; Kallmes, David F.; Williamson, Eric E.

In: Radiology, Vol. 271, No. 1, 2014, p. 65-73.

Research output: Contribution to journalArticle

McDonald, Jennifer S. ; McDonald, Robert J. ; Carter, Rickey E. ; Katzberg, Richard W ; Kallmes, David F. ; Williamson, Eric E. / Risk of intravenous contrast material-mediated acute kidney injury : A propensity score-matched study stratified by baseline-estimated glomerular filtration rate. In: Radiology. 2014 ; Vol. 271, No. 1. pp. 65-73.
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abstract = "Purpose: To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT). Materials and Methods: This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m 2. Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of ≥0.5 mg/dL [≥44.2 μmol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test. Results: A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P < .0001). However, this incidence was not significantly different between contrast material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95{\%} confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95{\%} CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95{\%} CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m2 (n = 1486), OR was 0.97 (95{\%} CI: 0.72, 1.30), P = .89. Conclusion: Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in patients with eGFR of less than 30 mL/min/1.73 m2.",
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T1 - Risk of intravenous contrast material-mediated acute kidney injury

T2 - A propensity score-matched study stratified by baseline-estimated glomerular filtration rate

AU - McDonald, Jennifer S.

AU - McDonald, Robert J.

AU - Carter, Rickey E.

AU - Katzberg, Richard W

AU - Kallmes, David F.

AU - Williamson, Eric E.

PY - 2014

Y1 - 2014

N2 - Purpose: To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT). Materials and Methods: This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m 2. Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of ≥0.5 mg/dL [≥44.2 μmol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test. Results: A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P < .0001). However, this incidence was not significantly different between contrast material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95% confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95% CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95% CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m2 (n = 1486), OR was 0.97 (95% CI: 0.72, 1.30), P = .89. Conclusion: Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in patients with eGFR of less than 30 mL/min/1.73 m2.

AB - Purpose: To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT). Materials and Methods: This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m 2. Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of ≥0.5 mg/dL [≥44.2 μmol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test. Results: A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P < .0001). However, this incidence was not significantly different between contrast material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95% confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95% CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95% CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m2 (n = 1486), OR was 0.97 (95% CI: 0.72, 1.30), P = .89. Conclusion: Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in patients with eGFR of less than 30 mL/min/1.73 m2.

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