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. 2021 Feb 26;5(1):46-54.
doi: 10.1016/j.mayocpiqo.2020.08.012. eCollection 2021 Feb.

Acute Kidney Injury After Repeated Exposure to Contrast Material for Coronary Angiography

Aisha Betoko  1 , Matthew B Matheson  1 , Mohammad R Ostovaneh  2 , Julie M Miller  2 , Jeffrey Brinker  2 , Christopher Cox  1 , João A C Lima  2 , Armin Arbab-Zadeh  2
Affiliations

Acute Kidney Injury After Repeated Exposure to Contrast Material for Coronary Angiography

Aisha Betoko et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To assess the incidence of contrast-associated acute kidney injury (CAAKI) after repeated exposure to contrast material for computed tomography (CT) and conventional coronary angiography within short intervals.

Methods: We studied 651 patients enrolled in the CorE-64 (November 5, 2005-January 30, 2007) and CORE320 (October 21, 2009-August 17, 2011) multicenter studies. Participants with suspected obstructive coronary heart disease were referred for diagnostic cardiac catheterization and underwent coronary CT angiography for research before invasive angiography. Nonionic, low-osmolality iodinated contrast material was used for all imaging.

Results: The median age of the patients was 62 years, and 190 (29%) were women. Major risk factors for acute kidney injury were present in 277 of 651 (43%) patients. The median interval between CT imaging and invasive angiography was 3.1 days (interquartile range, 0.9-8.0 days). The median volume of contrast material was 100 mL for each test. In 16 (2.5%) of 651 patients, CAAKI developed. Of these cases, 1 occurred after the CT scan, whereas 6 were documented after invasive angiography (compared with post-CT creatinine concentration assessment). In 9 patients, CAAKI was found in comparing creatinine concentration after completion of both tests with baseline values (but not compared with post-CT imaging).

Conclusion: Acute kidney injury after repeated exposure to iodinated contrast media within a few days is uncommon even in a population of patients with highly prevalent risk factors. Withholding of clinically indicated contrast-enhanced imaging may therefore not be justified in this setting.

Keywords: CAAKI, contrast-associated acute kidney injury; CTA, computed tomography angiography; ICA, invasive coronary angiography; IQR, interquartile range; PCI, percutaneous coronary intervention; SE, standard error.

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Figures

Figure 1
Figure 1
Bland-Altman plot of serum creatinine (SCr) changes after computed tomography (CT) angiography. A Bland-Altman graph is provided for the difference of SCr after CT scan and baseline SCr against the average of both values. The difference was computed as post-CT SCr minus baseline SCr. Correlation coefficient is 0.89 (95% CI, 0.86 to 0.92), the mean difference is 0.03 mg/dL (95% CI, −0.03 to 0.09), and the standard deviation ratio is 0.96 (95% CI, 0.90 to 1.03). The plot demonstrates that very little change occurred in SCr levels before and after exposure to contrast media during CT scan.
Figure 2
Figure 2
Bland-Altman plot of serum creatinine (SCr) changes after computed tomography (CT) angiography and invasive coronary angiography (ICA). A Bland-Altman graph is shown for the mean difference of SCr after ICA and after CT against the average of both values. The difference was computed as post-ICA SCr minus post-CT SCr. Correlation coefficient is 0.83 (95% CI, 0.77 to 0.87), the mean difference is −0.03 mg/dL (95% CI, −0.11 to 0.05), and the standard deviation ratio is 1.04 (95% CI, 0.94 to 1.15). Very little change is observed in SCr level before and after exposure to contrast media during ICA.
Figure 3
Figure 3
Bland-Altman plot of serum creatinine (SCr) changes after invasive coronary angiography (ICA) vs baseline. A Bland-Altman graph is provided for the mean difference of SCr after ICA and baseline SCr against the average of both values. The difference was computed as post-ICA SCr minus baseline SCr. Correlation coefficient is 0.75 (95% CI, 0.67- to 0.81), the mean difference is −0.07 mg/dL (95% CI, −0.18 to 0.04), and the standard deviation ratio is 1.07 (95% CI, 0.95 to 1.20). Very little change is observed in SCr level before and after exposure to contrast media during CT and ICA.
Figure 4
Figure 4
Bland-Altman plot of serum creatinine (SCr) changes at discharge vs baseline. A Bland-Altman graph is shown for the mean difference of SCr at discharge and baseline SCr against the average of both values. The difference was computed as SCr at discharge minus baseline SCr. Correlation coefficient is 0.76 (95% CI, 0.68 to 0.81), the mean difference is 0.05 mg/dL (95% CI, −0.05 to 0.15), and the standard deviation ratio is 0.96 (95% CI, 0.86 to 1.07). Very little change is observed in SCr level at baseline and at discharge, after exposure to contrast media during computed tomography and invasive coronary angiography.
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