Exposure to contrast media in the perioperative period confers no additional risk of acute kidney injury in surgical patients

Ian Zealley, Huan Wang, Peter T. Donnan, Samira Bell (Lead / Corresponding author)

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    Abstract

    Background: Iodinated contrast media used in angiography and computed tomography (CT) scans is an important cause of AKI in hospitalized patients undergoing surgery. Contrast induced nephropathy leads to AKI soon after contrast media administration. The aim of the study was to determine whether the timing of contrast media exposure related to diagnostic imaging during the immediate peri-operative period influences the risk of post-operative AKI.

    Methods: All patients aged 18 or over who underwent diagnostic imaging within 7 days of non-cardiac surgery between the1 st of January 2003 and 31st of December 2013 in the Tayside region of Scotland, UK were included in the analysis. The primary outcome of AKI was defined using the KDIGO creatinine based criteria. Multiple logistic regression was performed to identify predictors for AKI.

    Results: Of 9,300 patients, 6,224 were exposed to CM in the immediate peri-operative period and 3,076 were not. Post-operative AKI occurred in 678 (10.9%) of the 6,224 patients who were exposed to CM. On multiple logistic regression, independent predictors of post-operative AKI were increasing age, male gender, lower baseline renal function and treatment with ACE inhibitors or ARB. Timing of CM exposure did not affect risk of developing AKI, OR 0.972 (95% CI 0.935 - 1.010), p=0.146.

    Conclusions: For patients who have either just had or are soon to undergo general surgical procedures there appears to be no need to limit CT scan quality by avoiding the administration of contrast media. These patients may benefit from the increased diagnostic utility of contrastenhanced CT scans without increasing their risk of peri-operative AKI.
    Original languageEnglish
    Article numbergfx325
    Pages (from-to)1751-1756
    Number of pages6
    JournalNephrology Dialysis Transplantation
    Volume33
    Issue number10
    Early online date9 Dec 2017
    DOIs
    Publication statusPublished - 1 Oct 2018

    Fingerprint

    Perioperative Period
    Acute Kidney Injury
    Contrast Media
    Diagnostic Imaging
    Logistic Models
    Tomography
    Scotland
    Angiotensin-Converting Enzyme Inhibitors
    Creatinine
    Kidney

    Keywords

    • AKI
    • contrast media
    • contrast-induced nephropathy
    • epidemiology
    • perioperative

    Cite this

    @article{4b17746c7eb844898be4b55fffcbabb0,
    title = "Exposure to contrast media in the perioperative period confers no additional risk of acute kidney injury in surgical patients",
    abstract = "Background: Iodinated contrast media used in angiography and computed tomography (CT) scans is an important cause of AKI in hospitalized patients undergoing surgery. Contrast induced nephropathy leads to AKI soon after contrast media administration. The aim of the study was to determine whether the timing of contrast media exposure related to diagnostic imaging during the immediate peri-operative period influences the risk of post-operative AKI. Methods: All patients aged 18 or over who underwent diagnostic imaging within 7 days of non-cardiac surgery between the1 st of January 2003 and 31st of December 2013 in the Tayside region of Scotland, UK were included in the analysis. The primary outcome of AKI was defined using the KDIGO creatinine based criteria. Multiple logistic regression was performed to identify predictors for AKI. Results: Of 9,300 patients, 6,224 were exposed to CM in the immediate peri-operative period and 3,076 were not. Post-operative AKI occurred in 678 (10.9{\%}) of the 6,224 patients who were exposed to CM. On multiple logistic regression, independent predictors of post-operative AKI were increasing age, male gender, lower baseline renal function and treatment with ACE inhibitors or ARB. Timing of CM exposure did not affect risk of developing AKI, OR 0.972 (95{\%} CI 0.935 - 1.010), p=0.146. Conclusions: For patients who have either just had or are soon to undergo general surgical procedures there appears to be no need to limit CT scan quality by avoiding the administration of contrast media. These patients may benefit from the increased diagnostic utility of contrastenhanced CT scans without increasing their risk of peri-operative AKI.",
    keywords = "AKI, contrast media, contrast-induced nephropathy, epidemiology, perioperative",
    author = "Ian Zealley and Huan Wang and Donnan, {Peter T.} and Samira Bell",
    note = "This study was funded by Tenovus Tayside and Chief Scientist Office for Scotland.",
    year = "2018",
    month = "10",
    day = "1",
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    language = "English",
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    pages = "1751--1756",
    journal = "Nephrology Dialysis Transplantation",
    issn = "0931-0509",
    publisher = "Oxford University Press",
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    }

    TY - JOUR

    T1 - Exposure to contrast media in the perioperative period confers no additional risk of acute kidney injury in surgical patients

    AU - Zealley, Ian

    AU - Wang, Huan

    AU - Donnan, Peter T.

    AU - Bell, Samira

    N1 - This study was funded by Tenovus Tayside and Chief Scientist Office for Scotland.

    PY - 2018/10/1

    Y1 - 2018/10/1

    N2 - Background: Iodinated contrast media used in angiography and computed tomography (CT) scans is an important cause of AKI in hospitalized patients undergoing surgery. Contrast induced nephropathy leads to AKI soon after contrast media administration. The aim of the study was to determine whether the timing of contrast media exposure related to diagnostic imaging during the immediate peri-operative period influences the risk of post-operative AKI. Methods: All patients aged 18 or over who underwent diagnostic imaging within 7 days of non-cardiac surgery between the1 st of January 2003 and 31st of December 2013 in the Tayside region of Scotland, UK were included in the analysis. The primary outcome of AKI was defined using the KDIGO creatinine based criteria. Multiple logistic regression was performed to identify predictors for AKI. Results: Of 9,300 patients, 6,224 were exposed to CM in the immediate peri-operative period and 3,076 were not. Post-operative AKI occurred in 678 (10.9%) of the 6,224 patients who were exposed to CM. On multiple logistic regression, independent predictors of post-operative AKI were increasing age, male gender, lower baseline renal function and treatment with ACE inhibitors or ARB. Timing of CM exposure did not affect risk of developing AKI, OR 0.972 (95% CI 0.935 - 1.010), p=0.146. Conclusions: For patients who have either just had or are soon to undergo general surgical procedures there appears to be no need to limit CT scan quality by avoiding the administration of contrast media. These patients may benefit from the increased diagnostic utility of contrastenhanced CT scans without increasing their risk of peri-operative AKI.

    AB - Background: Iodinated contrast media used in angiography and computed tomography (CT) scans is an important cause of AKI in hospitalized patients undergoing surgery. Contrast induced nephropathy leads to AKI soon after contrast media administration. The aim of the study was to determine whether the timing of contrast media exposure related to diagnostic imaging during the immediate peri-operative period influences the risk of post-operative AKI. Methods: All patients aged 18 or over who underwent diagnostic imaging within 7 days of non-cardiac surgery between the1 st of January 2003 and 31st of December 2013 in the Tayside region of Scotland, UK were included in the analysis. The primary outcome of AKI was defined using the KDIGO creatinine based criteria. Multiple logistic regression was performed to identify predictors for AKI. Results: Of 9,300 patients, 6,224 were exposed to CM in the immediate peri-operative period and 3,076 were not. Post-operative AKI occurred in 678 (10.9%) of the 6,224 patients who were exposed to CM. On multiple logistic regression, independent predictors of post-operative AKI were increasing age, male gender, lower baseline renal function and treatment with ACE inhibitors or ARB. Timing of CM exposure did not affect risk of developing AKI, OR 0.972 (95% CI 0.935 - 1.010), p=0.146. Conclusions: For patients who have either just had or are soon to undergo general surgical procedures there appears to be no need to limit CT scan quality by avoiding the administration of contrast media. These patients may benefit from the increased diagnostic utility of contrastenhanced CT scans without increasing their risk of peri-operative AKI.

    KW - AKI

    KW - contrast media

    KW - contrast-induced nephropathy

    KW - epidemiology

    KW - perioperative

    U2 - 10.1093/ndt/gfx325

    DO - 10.1093/ndt/gfx325

    M3 - Article

    C2 - 29237046

    VL - 33

    SP - 1751

    EP - 1756

    JO - Nephrology Dialysis Transplantation

    JF - Nephrology Dialysis Transplantation

    SN - 0931-0509

    IS - 10

    M1 - gfx325

    ER -