title: The risk of acute kidney injury with transjugular intrahepatic portosystemic shunts.
abstract: Transjugular intrahepatic portosystemic shunts (TIPS) have been used for almost 40 years as a safe and effective alternative to surgical shunts, mostly in the setting of portal hypertension. Well described procedural complications include hepatic encephalopathy, hemorrhage, liver infarction and failure. The risk of post procedural acute kidney injury (AKI) associated with intraprocedural intravenous contrast administration has not been evaluated. Using a retrospective chart review of all consecutive patients undergoing a TIPS procedure as part of routine clinical care between 2001 and 2011, we examined whether the volume of administered intravenous contrast was associated with AKI. Of 163 patients who had a TIPS procedure, 16% developed AKI as defined by a 0.3 mg/dl increase in serum creatinine within 48 h of the procedure. In adjusted analysis, a 50 ml increase of intravenous contrast was associated with a 1.27 (95% CI 1.01-1.60), p = 0.04 increased risk of AKI. Baseline serum creatinine was also associated with post procedural AKI; a 0.1 mg/dl increase in creatinine was associated with a 1.17 (1.04-1.31), p = 0.008 risk. In patients with underlying kidney dysfunction, a 50 ml increase of intravenous contrast was associated with a 1.63 (1.20-2.31), p = 0.003 adjusted risk of AKI. In conclusion, intravenous contrast administered during a TIPS procedure is associated with an increased risk of AKI, particularly in patients with impaired renal function at baseline.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Farr 8, Boston, MA, 02215, USA. jdanzige@bidmc.harvard.edu.
authors.forename: John
authors.initials: J
authors.lastname: Danziger
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
authors.forename: Laxmi
authors.initials: L
authors.lastname: Thummalakunta
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Farr 8, Boston, MA, 02215, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nelson
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
authors.forename: Salomao
authors.initials: S
authors.lastname: Faintuch
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced*; D061605:Administration, Intravenous; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine; C044834:iodixanol; C054871:ioversol
keywords: Acute kidney injury; Ascites; Cirrhosis; Contrast nephropathy; Portal hypertension; TIPS