ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

ASN / Education & Meetings / Kidney Week /

Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: TH-PO118

Intravenous Contrast on Continuous Renal Replacement Therapy: Does It Matter?

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Mehdi, Ali, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Marinescu, Mark A., Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Arrigain, Susana, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Coppa, Christopher, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Mclennan, Gordon, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Demirjian, Sevag, Cleveland Clinic Foundation, Cleveland, Ohio, United States
Background

Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is commonly encountered in the intensive care unit (ICU). Clinicians caring for ICU patients are often forced to weight the risks of aggravating the AKI before using intravenous (IV) contrast agents when obtaining diagnostic imaging studies for patients on CRRT. We hereby describe the risk of dialysis dependency (DD) or persistent severe kidney dysfunction (SKD), defined as creatinine >4 mg/dL at discharge, among ICU patients receiving IV contrast while on CRRT for AKI.

Methods

All ICU patients at our institution who underwent a CT scan while on CRRT between 2013-2017 were identified. ESRD patients, those with baseline eGFR <15 mL/min per 1.73 m2, and those without overnight ICU stay were excluded. Cases were grouped according to IV contrast exposure as contrast-enhanced (CECT) or unenhanced (UCT) groups. We compared baseline characteristics, mortality, and DD/SKD at discharge between the groups using Wilcoxon Rank-sum and Chi-square tests. We fitted a competing risk regression model for DD/SKD at discharge with death as a competing risk adjusted for demographics and known comorbidities.

Results

A total of 189 CECT and 644 UCT patients were included in the final analysis. Baseline characteristics were similar between groups including baseline creatinine and CKD stage as defined by the Kidney Disease Outcomes Quality Initiative cutoffs. The CECT group had significantly higher ICU length of stay (median 24 vs 17 days; p<0.001) and required more days on CRRT (median 10 vs 6; p<0.001). 58.7% of CECT and 51.6% of UCT died during hospitalization (p=0.08), while 27.5% and 27% had DD/SKD at discharge respectively (p = 0.89). Similarly, no significant difference was found in competing risk model for DD/SKD (SHR for CECT vs UCT: 0.81; 95% CI: 0.60-1.10; p=0.18)

Conclusion

Despite the apparently sicker CECT group, IV contrast administration while on CRRT for AKI was not associated with an increased risk of DD/SKD at discharge. This study suggests that contrast enhanced imaging need not be withheld from AKI patients on CRRT, particularly when valuable information can be gained from the contrast study with potential therapeutic implications.