Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration: Risk comparison adjusted for patient characteristics by design

• Published in: The American heart journal Vol. 165; no. 5; pp. 793 - 799.e1
• Main Authors: Kooiman, Judith, MSc, Le Haen, Pum A., MD, Gezgin, Gülçin, BSc, de Vries, Jean-Paul P., MD, PhD, Boersma, Doeke, MD, Brulez, Harald F., MD, PhD, Sijpkens, Yvo W., MD, PhD, van der Molen, Aart J., MD, Cannegieter, Suzanne C., MD, PhD, Hamming, Jaap F., MD, Huisman, Menno V., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2013; Elsevier Limited
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - therapy; Cardiac arrhythmia; Cardiovascular; Cardiovascular disease; Comorbidity; Contrast agents; Contrast Media - administration & dosage; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary vessels; Diabetes; Disease prevention; Heart failure; Hospital Mortality - trends; Humans; Hypertension; Incidence; Injections, Intra-Arterial; Injections, Intravenous; Kidney diseases; Length of Stay; Medical imaging; Medical records; Mortality; Multivariate analysis; Netherlands - epidemiology; Older people; Renal Dialysis; Retrospective Studies; Risk Factors; Studies
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2013.02.013

Background Direct comparisons between risk of contrast induced acute kidney injury (CI-AKI) after intra-arterial versus intravenous contrast administration are scarce. We estimated and compared the risk of CI-AKI and its clinical course after both modes of contrast administration in patients who underwent both. Methods One hundred seventy patients who received both intra-arterial and intravenous contrast injections within one year between 2001 and 2010 were included. Primary outcome was occurrence of CI-AKI. Secondary outcomes were duration of hospital stay, the need for dialysis, recovery of renal function, and mortality. Results The risk of CI-AKI was 24/170 (14.0%, 95% CI 9.6-20.2) after intra-arterial contrast injection versus 20/170 (11.7%, 95% CI 7.7-17.5) after intravenous contrast administration, which led to a relative risk of 1.2 (95% CI 0.7-2.1). None of the patients had a need for dialysis. Median duration of hospital stay in CI-AKI patients was 15.0 days (2.5-97.5, percentile 1-92) after intra-arterial and 15.5 days (2.5-97.5, percentile 0-38) after intravenous contrast procedures. Renal function recovered after CI-AKI in 13/24 after intra-arterial and in 10/20 patients after intravenous contrast administration. Mortality risks in CI-AKI patients were slightly higher than in non-CI-AKI patients, hazard ratios 1.6 (95% CI 0.7-3.7) for intra-arterial and 1.7 (95% CI 0.7-4.4) for intravenous contrast administration, adjusted for confounders. Conclusion The risk of CI-AKI, and its clinical course was similar after intra-arterial and intravenous contrast media administration, after adjustment by design for patient-related risk factors.