Risk of acute kidney injury after contrast-enhanced computed tomography in emergency department

Abstract

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.