title: Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study.
abstract: OBJECTIVE
  To examine the association of intravenous iodinated contrast material administration with the subsequent development of post-contrast AKI (PC-AKI), emergent dialysis, and short-term mortality using a propensity score-adjusted analysis of a cohort of intensive care unit (ICU) patients who underwent CT examination.
  
  
  METHODS
  All ICU patients at our institution who received a contrast-enhanced (contrast group) or unenhanced (noncontrast group) CT scan from January 2006 to December 2014 were identified. Patients were subdivided into pre-CT eGFR > 45 and eGFR ≤ 45 subsets and separately underwent propensity score analysis. Rates of KDIGO-defined AKI, dialysis, and mortality were compared between contrast and noncontrast groups. Separate analyses of eGFR ≥ 60, 30-59, and <30 subsets were also performed.
  
  
  RESULTS
  A total of 6877 ICU patients (4351 contrast, 2526 noncontrast) were included in the study. Following propensity score adjustment, the rates of AKI (31 vs. 34%, OR .88 (95% CI .75-1.05), p = .15), dialysis (2.0 vs. 1.7%, OR 1.20 (.66-2.17), p = .55), and mortality (12 vs. 14%, OR .87 (.69-1.10), p = .23) were not significantly higher in the contrast versus noncontrast group in the matched eGFR > 45 subset. Significantly higher rates of dialysis (6.7 vs. 2.5%, OR 2.72 (1.14-6.46), p = .0240) were observed in the contrast versus noncontrast group in the matched eGFR ≤ 45 subset.
  
  
  CONCLUSIONS
  Intravenous contrast material administration was not associated with an increased risk of AKI, emergent dialysis, and short-term mortality in ICU patients with pre-CT eGFR > 45. An increased risk of dialysis was observed in patients with pre-CT eGFR ≤ 45.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. mcdonald.jennifer@mayo.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McDonald
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Williamson
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kianoush
authors.initials: K
authors.lastname: Kashani
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy*; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007455:Iodine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media; D007455:Iodine
keywords: AKI; Iodinated contrast material; Post-contrast acute kidney injury