Incidence of contrast-associated acute kidney injury: a prospective cohort / Incidência de lesão renal aguda associada ao contraste: uma coorte prospectiva

ABSTRACT Introduction: Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. Objective: To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. Methods: Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. Results: The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. Conclusion: The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.

RESUMO Introdução: Lesão renal aguda associada ao contraste (LRA-AC) é uma deterioração da função renal que ocorre após a administração de meio de contraste iodado (MCI). A maioria dos estudos que definiram esse fenômeno utilizaram MCI mais antigos, mais propensos a causar LRA-AC. Na última década, diversos artigos questionaram a verdadeira incidência de LRA-AC. Entretanto, ainda há escassez de dados sobre a segurança dos MCI mais novos. Objetivo: Avaliar a incidência de LRA-AC em pacientes hospitalizados expostos à tomografia computadorizada (TC) com e sem MCI. Métodos: Estudo de coorte prospectivo com 1.003 pacientes submetidos a TC em hospital terciário, de dezembro/2020 a março/2021. Todos os pacientes internados com idade ≥ 18 anos que realizaram TC nesse período foram selecionados. A LRA-AC foi definida como aumento relativo de creatinina sérica de ≥ 50% em relação ao valor basal ou aumento absoluto de ≥ 0,3 mg/dL dentro de 18 a 48 horas após a TC. Utilizamos o teste qui-quadrado, teste de Kruskal-Wallis e modelo de regressão linear com splines cúbicos restritos para análises estatísticas. Resultados: A incidência de LRA-AC foi 10,1% no grupo exposto ao MCI e 12,4% no grupo controle ao usar o critério de aumento absoluto. A variação da creatinina em relação ao valor basal não foi significativamente diferente entre os grupos. Após ajuste para fatores basais, o uso de contraste não se correlacionou com pior função renal. Conclusão: A taxa de LRA-AC é muito baixa, caso exista, com MCIs mais novos, e a cautela excessiva quanto ao uso de contraste provavelmente não se justifica.

Incidence of contrast-associated acute kidney injury: a prospective cohort.

INTRODUCTION: Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. OBJECTIVE: To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. METHODS: Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. RESULTS: The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. CONCLUSION: The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.

Risco de insuficiência renal aguda pós-contraste em tomografia computadorizada: estamos atentos à função renal? / Risk of post-contrast acute kidney injury in computed tomography: are we aware of renal function?

Introdução: Exames diagnósticos contrastados oferecem riscos para o desenvolvimento de Insuficiência Renal Aguda pós-contraste (IRA-PC), principalmente em pacientes com doença renal prévia. O objetivo deste estudo foi verificar se a função renal foi avaliada antes e após a realização de exame contrastado. Métodos: Coorte retrospectiva com 2778 pacientes que realizaram tomografia computadorizada (TC) contrastada em que foi verificada a creatinina sérica (CrS) pré e pós-exame, presença de fatores de risco, incidência de IRA-PC e óbito até 10 meses pós-TC. Resultados: Somente 263 (9,5%) apresentaram avaliação da função renal pré e pós-exame dentro dos prazos estabelecidos (7 dias para pacientes internados e 180 dias para ambulatoriais pré-exame, e 48 a 72 horas pós-exame), sendo que 91,6% eram de pacientes internados. IRA-PC foi observada em 38 (14,4%) pacientes e foi associada ao uso de medicamentos nefrotóxicos (Odds Ratio 1,645; IC95%: 1,138­2,390) e maior risco de óbito pós-exame (Razão de Incidência 1,84; IC95%:1,17-2,83). Conclusão: A grande maioria dos pacientes não apresentava adequada avaliação da função renal pré e pós-TC, principalmente em nível ambulatorial. Sugere-se o estabelecimento de medidas educativas para promover a aderência do corpo clínico à avaliação da função renal para pacientes de risco para IRA-PC. (AU)

Introduction: Contrast-enhanced diagnostic tests involve risks for the development of post-contrast acute kidney injury (PC-AKI), especially in patients with previous renal disease. The aim of this study was to investigate whether renal function was evaluated before and after the contrast-enhanced test. Methods: In this retrospective cohort of 2778 patients who underwent contrast-enhanced computed tomography (CT), pre- and post-CT serum creatinine (SCr), presence of risk factors, incidence of PC-AKI, and death within 10 months post-CT were investigated. Results: Only 263 (9.5%) patients had pre- and post-CT renal function evaluation performed within the established time frames (7 days for inpatients and 180 days for outpatients pre-CT and 48 to 72 hours post-CT), with 91.6% being inpatients. PC-AKI was observed in 38 (14.4%) patients and was associated with use of nephrotoxic drugs (odds ratio: 1.645, 95% CI: 1.138-2.390) and higher risk of death post-CT (incidence ratio: 1.84; 95% CI: 1.17-2.83). Conclusion: The vast majority of patients did not undergo an adequate pre- and post-CT renal function evaluation, especially at the outpatient level. Educational measures should be developed to promote adherence of clinical staff to renal function evaluation for patients at risk for PC-AKI. (AU)