Use of contrast media in ICU patients does not increase acute kidney injury risk

Florida: The use of intravenous (IV) contrast is not associated with acute kidney injury (AKI) in critically ill patients, a recent study published in the CHEST journal has found. AKI was however significantly associated with clinical factors such as metabolic disorders, the severity of illness, and sepsis.

According to the study in ICU patients with normal kidney function, the use of low osmolar radiocontrast media did not substantively increase AKI risk compared with similar patients who did not receive it.

Despite evidence that low osmolar radiocontrast media is not associated with acute kidney injury, it is important to evaluate this association in critically ill patients with normal kidney function, note the authors.

This retrospective observational study by Lisa-Mae S. Williams, Baptist Health South Florida, Coral Gables, Florida, and colleagues included 7,333 adults with an ICU stay at a six-hospital health system in South Florida. Patients who had received low osmolar radiocontrast media were propensity-matched (on baseline characteristics, admission diagnoses, comorbidities, and severity of illness) to unexposed controls to create 2,306 patient pairs.

The primary outcome was acute kidney injury, defined as initial onset (stage I) or increased severity, was determined from serum creatinine levels according to Kidney Disease: Improving Global Outcomes guidelines.

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Key findings of the study include:

• Patients who received contrast had an AKI risk of 19.3% compared to 18.0% in those who didn't, an insignificant difference.


• No association was found between contrast use and the pattern of AKI onset and recovery.


• Patients who developed AKI did have a significantly increased risk of hospital mortality (18.0% vs. 3.6%), but the risk ratio did not vary when stratified by contrast use.


• Multivariable regression analysis found factors other than the receipt of contrast were associated with AKI, including sepsis, metabolic disorders, diabetes, history of renal disease, and severity of illness.

"The results, add to the growing body of evidence that the risk of AKI in relation to administration of contrast media has been overstated leading to unnecessary guidelines limiting its use and diverting the focus of preventive measures away from more significant susceptibilities," wrote the authors.

"In critically ill adults with normal kidney function, low osmolar radiocontrast media did not substantively increase AKI. Rather than limiting the use of contrast in ICU patients, efforts to prevent AKI should focus on the susceptibility of patients with sepsis, diabetes complications, high Acute Physiology and Chronic Health Evaluation scores, and history of renal disease," they concluded.

The article, "Association of Contrast and Acute Kidney Injury in the Critically Ill," is published in the CHEST journal.

DOI: https://doi.org/10.1016/j.chest.2019.10.005

Journal Information: CHEST