Association Between IV Contrast Media Exposure and Acute Kidney Injury in Patients Requiring Emergency Admission: A Nationwide Observational Study in Japan

Abstract

Objective: This study aimed to elucidate the association between IV contrast media CT and acute kidney injury (AKI) and in-hospital mortality among patients requiring emergency admission.

Design: In this retrospective observational study, we examined AKI within 48 hours after CT, renal replacement therapy (RRT) dependence at discharge, and in-hospital mortality in patients undergoing contrast-enhanced CT or nonenhanced CT. We performed 1:1 propensity score matching to adjust for confounders in the association between IV contrast media use and outcomes. Subgroup analyses were performed according to age, sex, diagnosis at admission, ICU admission, and preexisting chronic kidney disease (CKD).

Setting and patients: This study used the Medical Data Vision database between 2008 and 2019. This database is Japan's largest commercially available hospital-based claims database, covering about 45% of acute-care hospitals in Japan, and it also records laboratory results.

Interventions: None.

Measurements and main results: The study included 144,149 patients with (49,057) and without (95,092) contrast media exposure, from which 43,367 propensity score-matched pairs were generated. Between the propensity score-matched groups of overall patients, exposure to contrast media showed no significant risk of AKI (4.6% vs. 5.1%; odds ratio [OR], 0.899; 95% CI, 0.845-0.958) or significant risk of RRT dependence (0.6% vs. 0.4%; OR, 1.297; 95% CI, 1.070-1.574) and significant benefit for in-hospital mortality (5.4% vs. 6.5%; OR, 0.821; 95% CI, 0.775-0.869). In subgroup analyses regarding preexisting CKD, exposure to contrast media was a significant risk for AKI in patients with CKD but not in those without CKD.

Conclusions: In this large-scale observational study, IV contrast media was not associated with an increased risk of AKI but concurrently showed beneficial effects on in-hospital mortality among patients requiring emergency admission.

Figure 1.

Flowchart for patient selection. IVR = interventional radiology, PCI = percutaneous coronary intervention.

Figure 2.

Association between IV contrast media administration and the risk of acute kidney injury (AKI) in several subsets based on patient characteristics. The risk of AKI between: 1) overall, 2) elderly patients (65 yr and older) and younger patients (younger than 65 yr), 3) men and women, 4) primary diagnoses such as trauma, sepsis, macrovascular disease, and cerebrovascular disease, 5) patients with chronic kidney disease (CKD) and without CKD, 6) admission to ICU and general ward, and 7) patients with organ dysfunction and without organ dysfunction was evaluated by propensity score-matched analysis. OR = odds ratio.