Abstract: FR-PO0065
Increasing Use of IV Contrast in Advanced CKD in Two Emergency Departments, 2015-2024
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Cho, Elizabeth, Brown University Health, Providence, Rhode Island, United States
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Hu, Susie L., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- O'Bell, John W., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
Background
Acute kidney injury (AKI) in the setting of intravenous (IV) contrast is a controversial topic across various subspecialities. Previous studies report wide variations in the incidence of contrast associated AKI (3.3-14.5%) with mechanistic studies demonstrating nephrotoxicity via direct tubulotoxicity and intrarenal vasoconstriction leading to ischemia. Patients with advanced CKD (aCKD) have not been well represented in these studies.
Methods
We conducted a retrospective cohort study of ED visits for patients with aCKD (stages 4-5) across 2 urban academic hospitals from 2015-2024. We extracted demographic data, baseline eGFR and creatinine, and IV contrast administration from EHR records. Our primary outcome was trend in contrast administration rates. We used the Cochrane-Armitage test to evaluate temporal trends.
Results
We identified 59,334 ED visits with aCKD (57.1% CKD4, mean eGFR 23.17±4.0; 42.9% CKD5, mean eGFR 9.10±3.5). Persons with CKD5 were more likely male 52.9%, Black (20.1% vs 10.9%), and Hispanic (19.1% vs 10.8%). Over the 10 years, IV contrast use rates increased from 12.7% to 40.5% overall (p <.001). Both CKD stages showed upward trends, CKD4 rising from 12.8% to 44.0% (p <.001) and CKD5 from 12.4% to 35.9% (p <.001).
Conclusion
Our findings demonstrate a large rise in contrast usage in patients with advanced CKD. NKF-ACR guidelines suggest the risk of IV contrast has been overstated, but prior studies are underpowered to estimate risk in CKD patients. Further research on the impact of contrast on aCKD patients is needed.
Table 1
| CKD Stage 4 | CKD Stage 5 | |
| ED visits | 33,907 (57.15%) | 25,427 (42.85%) |
| Sex Male Female | 46.84% 53.16% | 52.92% 47.08% |
| Race White Black Asian Other | 74.98% 10.92% 1.13% 12.98% | 56.19% 20.1% 2.17% 21.53% |
| Hispanic Non Hispanic Hispanic/Latino Missing | 88.56% 10.81% 0.63% | 85.15% 14.37% 0.49% |
| eGFR | 23.16 (SD 4.024) | 9.095 (SD 3.537) |
| Serum Creatinine | 2.46 (SD 0.542) | 6.63 (SD 3.36) |