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DOI: 10.1055/s-0040-1721387
Risk of Acute Kidney Injury after Intravenous Contrast Media Administration in Patients with Suspected Pulmonary Embolism: A Propensity-Matched Study
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Abstract
Background Although computed tomography pulmonary angiography (CTPA) is the preferred diagnostic procedure in patients with suspected pulmonary embolism (PE), some patients undergo ventilation/perfusion (V/Q) lung scan due to concern of contrast-associated acute kidney injury (AKI).
Methods The study used a cohort of 4,565 patients with suspected PE. Patients who received contrast during CTPA were compared with propensity score-matched unexposed control patients who underwent V/Q lung scanning. AKI was defined as ≥50% increase in serum creatinine during the first 72 hours after either CTPA or V/Q lung scan.
Results Classification and regression tree analysis demonstrated that baseline creatinine was the strongest determinant of the decision to use CTPA. Propensity-score matching yielded 969 patient pairs. There were 44 AKI events (4.5%) in patients exposed to contrast media (CM) and 33 events (3.4%) in patients not exposed to CM (risk difference: 1.1%, 95% confidence interval [CI]: −0.6 to 2.9%; odds ratio [OR]: 1.39, 95% CI: 0.86–2.26; p = 0.18). Using different definitions for AKI and extending the time window for AKI diagnosis gave similar results. In a sensitivity analysis with the inverse probability weighting method, the OR for AKI in the CTPA versus V/Q scan was 1.14 (95% CI: 0.72–1.78; p = 0.58).
Conclusion Intravenous contrast material administration was not associated with an increased risk of AKI in patients with suspected PE. Given the diagnostic superiority of CTPA, these results are reassuring with regard to the use of CTPE in patients with suspected PE perceived to be at risk for AKI.
Publikationsverlauf
Eingereicht: 20. Juli 2020
Angenommen: 23. Oktober 2020
Artikel online veröffentlicht:
10. Dezember 2020
© 2020. Thieme. All rights reserved.
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References
- 1 Rudnick M, Feldman H. Contrast-induced nephropathy: what are the true clinical consequences?. Clin J Am Soc Nephrol 2008; 3 (01) 263-272
- 2 Weisbord SD, Palevsky PM. Contrast-induced acute kidney injury: short- and long-term implications. Semin Nephrol 2011; 31 (03) 300-309
- 3 Weisbord SD, Gallagher M, Jneid H. et al; PRESERVE Trial Group. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 2018; 378 (07) 603-614
- 4 Konstantinides SV, Torbicki A, Agnelli G. et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35 (43) 3033-3069
- 5 Mitchell AM, Kline JA. Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department. J Thromb Haemost 2007; 5 (01) 50-54
- 6 Reagle Z, Tringali S, Gill N, Peterson MW. Diagnostic yield and renal complications after computed tomography pulmonary angiograms performed in a community-based academic hospital. J Community Hosp Intern Med Perspect 2012; 2 (02) 2
- 7 Mitchell AM, Jones AE, Tumlin JA, Kline JA. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med 2012; 19 (06) 618-625
- 8 McDonald JS, McDonald RJ, Carter RE, Katzberg RW, Kallmes DF, Williamson EE. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology 2014; 271 (01) 65-73
- 9 McDonald RJ, McDonald JS, Carter RE. et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology 2014; 273 (03) 714-725
- 10 Caspi O, Habib M, Cohen Y. et al. Acute kidney injury after primary angioplasty: is contrast-induced nephropathy the culprit?. J Am Heart Assoc 2017; 6 (06) 6
- 11 McDonald RJ, McDonald JS, Bida JP. et al. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon?. Radiology 2013; 267 (01) 106-118
- 12 Ehrmann S, Aronson D, Hinson JS. Contrast-associated acute kidney injury is a myth: yes. Intensive Care Med 2018; 44 (01) 104-106
- 13 Lakhal K, Robert-Edan V, Ehrmann S. In the name of contrast-induced acute kidney injury…. Chest 2020; 157 (04) 751-752
- 14 Ehrmann S, Badin J, Savath L. et al. Acute kidney injury in the critically ill: is iodinated contrast medium really harmful?. Crit Care Med 2013; 41 (04) 1017-1026
- 15 Ehrmann S, Quartin A, Hobbs BP. et al. Contrast-associated acute kidney injury in the critically ill: systematic review and Bayesian meta-analysis. Intensive Care Med 2017; 43 (06) 785-794
- 16 Hinson JS, Ehmann MR, Fine DM. et al. Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med 2017; 69 (05) 577.e4-586.e4
- 17 PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263 (20) 2753-2759
- 18 Konstantinides SV, Meyer G, Becattini C. et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
- 19 Reid JH, Coche EE, Inoue T. et al; International Atomic Energy Agency Consultants' Group. Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary embolism in the era of MDCT. Eur J Nucl Med Mol Imaging 2009; 36 (03) 505-521
- 20 Onyedika C, Glaser JE, Freeman LM. Pulmonary embolism: role of ventilation-perfusion scintigraphy. Semin Nucl Med 2013; 43 (02) 82-87
- 21 Søgaard KK, Schmidt M, Pedersen L, Horváth-Puhó E, Sørensen HT. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 2014; 130 (10) 829-836
- 22 Kumar G, Sakhuja A, Taneja A. et al; Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012; 7 (10) 1584-1590
- 23 Turedi S, Erdem E, Karaca Y. et al. The high risk of contrast-induced nephropathy in patients with suspected pulmonary embolism despite three different prophylaxis: a randomized controlled trial. Acad Emerg Med 2016; 23 (10) 1136-1145
- 24 Kooiman J, Seth M, Nallamothu BK, Heung M, Humes D, Gurm HS. Association between acute kidney injury and in-hospital mortality in patients undergoing percutaneous coronary interventions. Circ Cardiovasc Interv 2015; 8 (06) e002212
- 25 Kooiman J, Sijpkens YW, van Buren M. et al. Randomised trial of no hydration vs. sodium bicarbonate hydration in patients with chronic kidney disease undergoing acute computed tomography-pulmonary angiography. J Thromb Haemost 2014; 12 (10) 1658-1666
- 26 Levey AS, Stevens LA, Schmid CH. et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150 (09) 604-612
- 27 Gaião S, Cruz DN. Baseline creatinine to define acute kidney injury: is there any consensus?. Nephrol Dial Transplant 2010; 25 (12) 3812-3814
- 28 Banerjee M, Reynolds E, Andersson HB, Nallamothu BK. Tree-based analysis. Circ Cardiovasc Qual Outcomes 2019; 12 (05) e004879
- 29 Kingsford C, Salzberg SL. What are decision trees?. Nat Biotechnol 2008; 26 (09) 1011-1013
- 30 Marshall RJ. The use of classification and regression trees in clinical epidemiology. J Clin Epidemiol 2001; 54 (06) 603-609
- 31 Austin PC. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J Thorac Cardiovasc Surg 2007; 134 (05) 1128-1135
- 32 Davenport MS, Perazella MA, Yee J. et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 294 (03) 660-668
- 33 Desai RJ, Franklin JM. Alternative approaches for confounding adjustment in observational studies using weighting based on the propensity score: a primer for practitioners. BMJ 2019; 367: l5657
- 34 Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015; 34 (28) 3661-3679
- 35 Anderson DR, Kahn SR, Rodger MA. et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 2007; 298 (23) 2743-2753
- 36 Hunsaker AR, Lu MT, Goldhaber SZ, Rybicki FJ. Imaging in acute pulmonary embolism with special clinical scenarios. Circ Cardiovasc Imaging 2010; 3 (04) 491-500
- 37 Righini M, Goehring C, Bounameaux H, Perrier A. Effects of age on the performance of common diagnostic tests for pulmonary embolism. Am J Med 2000; 109 (05) 357-361
- 38 Calvo-Romero JM, Lima-Rodríguez EM, Bureo-Dacal P, Pérez-Miranda M. Predictors of an intermediate ventilation/perfusion lung scan in patients with suspected acute pulmonary embolism. Eur J Emerg Med 2005; 12 (03) 129-131
- 39 Luk L, Steinman J, Newhouse JH. Intravenous contrast-induced nephropathy-the rise and fall of a threatening idea. Adv Chronic Kidney Dis 2017; 24 (03) 169-175
- 40 Elze MC, Gregson J, Baber U. et al. Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies. J Am Coll Cardiol 2017; 69 (03) 345-357