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

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

doi:10.1016/j.mayocpiqo.2020.08.012

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

Mayo Clin Proc Innov Qual Outcomes. 2021 Feb 26;5(1):46-54. doi: 10.1016/j.mayocpiqo.2020.08.012. eCollection 2021 Feb.

Authors

Aisha Betoko¹, Matthew B Matheson¹, Mohammad R Ostovaneh², Julie M Miller², Jeffrey Brinker², Christopher Cox¹, João A C Lima², Armin Arbab-Zadeh²

Affiliations

¹ Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD.
² Johns Hopkins University School of Medicine, Baltimore, MD.

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.