Abstract: FR-PO126

Dialysis-Requiring AKI in CKD Patients Receiving Radiocontrast

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Pan, Di, Mount Sinai St. Lukes and Mount Sinai West Hospitals, New York, New York, United States
  • Mariuma, David, Mount Sinai St. Lukes and Mount Sinai West Hospitals, New York, New York, United States
  • Wen, Yumeng, Mount Sinai St. Lukes and Mount Sinai West Hospitals, New York, New York, United States
  • Gramuglia, Michael, Montefiore Health System, New York, New York, United States
  • Meisels, Ira S., Mount Sinai St. Luke's and West Hospitals, New York, New York, United States
Background

Contrast-induced nephropathy has been a widely recognized and long-accepted complication of radiocontrast administration. However, there have been recent studies that call into question whether a link between acute kidney injury (AKI) and radiocontrast truly exists in the setting of iso-osmolar or low-osmolar contrast use in imaging and vascular procedures. The goal of this study is to evaluate the relationship between dialysis-requiring AKI and contrast administration in patients with different stages of chronic kidney disease (CKD).

Methods

This is a retrospective analysis utilizing the 2014 Nationwide Inpatient Sample, the largest publically available inpatient database in the United States. A total of 3,367,411 patients over age 18 with CKD were included. End-stage renal disease patients on chronic dialysis were excluded.
Multivariate logistic regression was performed to test for indepedent associations between dialysis-requiring AKI and exposure to either intravenous contrast (IV; n=8170), arteriography/angiogram (AG; n=160,110), or arterial catheterization with intervention (ACI; n=86,715), specifically coronary, peripheral vascular, or neurovascular interventions. Further subgroup analysis was performed for CKD stages 3 to 5. Procedures and diagnoses were identified using ICD-9-CM codes. Analysis was performed using Stata 14.2.

Results

All CKD patients regardless of stage, who received either IV (OR 2.4, p<0.0001), AG (OR 1.28, p<0.0001), or ACI (OR 1.24, p=0.005), had increased associations with dialysis-requiring AKI. Similar results were observed in the subgroup analyses. CKD 5 subgroup: IV (OR 3.15, p=0.007), AG (OR 2.34, p<0.0001), ACI (OR 1.24, p=0.005). CKD 4 subgroup: IV (OR 5.0, p<0.0001), AG (OR 2.13, p<0.0001), ACI (OR 1.66, p=0.022). CKD 3 subgroup: IV (OR 1.98, p=0.045), AG (OR 1.28, p=0.013), ACI (OR 1.81, p<0.0001).

Conclusion

Our results demonstrate that there are strong associations between dialysis-requiring AKI and radiocontrast exposure among patients with CKD. Despite conflicting data that challenge this relationship, clinicians should continue to exercise caution when administering radiocontrast in this patient population. Further prospective cohort and randomized controlled studies should be performed before definitive conclusions can be made.