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. 2024 Feb 8;37(2):218-226.
doi: 10.1080/08998280.2023.2296692. eCollection 2024.

Impact of iodinated contrast shortage on contrast-associated acute kidney injury: a single center experience

Karim M Al-Azizi  1 , Ghadi Moubarak  2 , Molly I Szerlip  1 , Austin Kluis  2 , Ahmed Kazem  1 , Monica M Bennett  2 , Lisa Foster  2 , Sibi Thomas  1 , Chadi Dib  1 , Sameh Sayfo  1 , Jai Varma  1 , Imran Baig  1 , J Michael DiMaio  2   3 , Michael J Mack  2   3 , Srinivasa P Potluri  1
Affiliations

Impact of iodinated contrast shortage on contrast-associated acute kidney injury: a single center experience

Karim M Al-Azizi et al. Proc (Bayl Univ Med Cent). .

Abstract

Background: In March 2022, a COVID-19 outbreak disrupted the global supply of iodine contrast media (ICM). Healthcare systems implemented contrast-saving strategies to maintain their remaining ICM supplies. This study sought to determine the impact of contrast shortage on the incidence of contrast-associated acute kidney injury (CA-AKI).

Methods: This was a retrospective study of 265 patients undergoing 278 percutaneous coronary interventions (PCI) during 4-month periods prior to (9/1/2021 to 12/31/2021) and during (5/1/2022 to 8/31/2022) contrast shortage at a single center. The primary endpoint was the incidence of CA-AKI between study periods.

Results: A total of 148 and 130 PCIs were performed before and during contrast shortage, respectively. The incidence of CA-AKI significantly decreased from 11.5% to 4.6% during contrast shortage (P = 0.04). During the shortage, average contrast volume per PCI was significantly lower (123 ± 62 mL vs 88 ± 46 mL, P < 0.001), while coronary imaging was significantly higher (34.3% vs 50%, P = 0.009) compared to preshortage. All-cause mortality at discharge was comparable between study periods (2.8% vs 3.3%, respectively; P = 0.90).

Conclusion: The scarcity of ICM for PCI procedures in this single-center experience was associated with a significant increase in the utilization of intravascular imaging and a significant reduction in CA-AKI.

Keywords: Contrast-associated acute kidney injury; contrast shortage; iodinated contrast media; percutaneous coronary intervention.

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Conflict of interest statement

Karim Al-Azizi is a proctor and consultant for Edwards LifeSciences, a consultant and advisory board member for Medtronic, a consultant for Boston Scientific, and on a speaker’s bureau for Philips. Srinivasa Potluri is an advisory board member, proctor, and speaker for Medtronic, Boston Scientific, Abbott, and Cordis Proctor and a speaker for Edwards, Terumo, and AstraZeneca. Molly Szerlip is a proctor, speaker, and consultant for Edwards LifeSciences; an advisory board member, consultant, and proctor for Abbott Vascular; on the steering committee for Medtronic; and a speaker and consultant for Boston Scientific. Michael Mack is a trial co–principal investigator for Abbott and for Edwards Life Sciences and a trial study chair for Medtronic—all uncompensated. The other authors report no disclosures.

Figures

Figure 1.
Figure 1.
Flow chart. *A multivessel PCI in the same access session was considered a single PCI (episode). More than one PCI on the same patient, implying at least two sessions, regardless of the number of vessels treated during each, was considered as two or three different PCIs (episodes). Five patients contributed to more than two PCIs each. AKI indicates acute kidney injury; CA-AKI, contrast-associated acute kidney injury; PCI, percutaneous coronary intervention; SCr, serum creatinine.
Figure 2.
Figure 2.
Variation in the average amount of contrast volume (mL) per PCI across entire study months.
Figure 3.
Figure 3.
Impact of contrast shortage on the incidence of CA-AKI. Values are presented as numbers (%). The denominator represents the total number of PCIs performed during each study period.
See this image and copyright information in PMC

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