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Prevention, Incidence, and Outcomes of Contrast-Induced Acute Kidney Injury
Steven D. Weisbord, MD, MSc;
Maria K. Mor, PhD;
Abby L. Resnick, MA;
Kathryn C. Hartwig, MA;
Ali F. Sonel, MD;
Michael J. Fine, MD, MSc;
Paul M. Palevsky, MD
Arch Intern Med. 2008;168(12):1325-1332.
Background Little is known about whether health care providers (physicians) implement preventive care for contrast-induced acute kidney injury (CIAKI). The objectives of our prospective cohort study were (1) to assess provider use of preventive strategies for CIAKI, (2) to determine the incidence of CIAKI, and (3) to examine the association of CIAKI with adverse outcomes at 30 days, including death, need for dialysis, and hospital admission.
Methods We prospectively identified patients with estimated glomerular filtration rates less than 60 mL/min/1.73 m2 undergoing procedures with intravascular radiocontrast agents and recorded the use of intravenous fluids and N-acetylcysteine and the discontinuation of nonsteroidal anti-inflammatory medications. We measured postprocedure serum creatinine levels to quantify the incidence of CIAKI and tracked 30-day mortality and need for dialysis or hospitalization to evaluate the association of CIAKI with these outcomes.
Results Preprocedure and postprocedure intravenous fluids were administered to 264 of 660 study patients (40.0%), more commonly with coronary angiography than with computed tomography (91.2% vs 16.6%, P < .001). N-acetylcysteine was administered to 39.2% of patients, while only 6.8% of patients using nonsteroidal anti-inflammatory drugs were instructed to discontinue the medication. In a propensity analysis, the use of intravenous fluids was associated with a reduced rate of CIAKI. The incidence of CIAKI was lowest following computed tomography (range, 0.0%-10.9%) and was highest following noncoronary angiography (range, 1.9%-34.0%). Eleven patients (1.7%) died, 1 patient (0.2%) required dialysis, and 83 patients (12.6%) were hospitalized; however, CIAKI was not independently associated with hospital admission or death.
Conclusions Strategies to prevent CIAKI are implemented nonuniformly. Although biochemical evidence of CIAKI is relatively common, clinically significant CIAKI is rare. These findings should help health care providers focus the use of preventive care on the highest-risk patients and have important implications for future clinical trials.
Author Affiliations: Center for Health Equity Research and Promotion (Drs Weisbord, Mor, Sonel, and Fine and Mss Resnick and Hartwig) and Renal Section, Medical Specialty Service Line (Drs Weisbord and Palevsky and Ms Hartwig), Veterans Affairs Pittsburgh Healthcare System; and Renal-Electrolyte Division (Drs Weisbord and Palevsky) and Division of General Internal Medicine (Dr Fine), Department of Medicine, School of Medicine, and Department of Biostatistics, Graduate School of Public Health (Dr Mor), University of Pittsburgh, Pittsburgh, Pennsylvania.
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