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Association between intravenous contrast media exposure and non-recovery from dialysis-requiring septic acute kidney injury: a nationwide observational study

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Abstract

Purpose

This study aimed to examine the association between the use of intravenous contrast and non-recovery from dialysis-requiring acute kidney injury (AKI-D) and in-hospital mortality among patients with sepsis.

Methods

This was a retrospective observational study using the Japanese Diagnosis Procedure Combination inpatient database between January 2011 and December 2016. We identified patients with septic AKI who began continuous renal replacement therapy (RRT) within 2-days of admission and underwent computed tomography. We compared patients with AKI-D with and without the use of intravenous contrast for computed tomography and performed propensity score matching to adjust for confounders for the association between exposure to intravenous contrast and outcomes, including a composite outcome of in-hospital mortality and RRT dependence at discharge and RRT duration.

Results

From 3782 and 6619 patients with septic AKI-D with and without intravenous contrast exposure, respectively, 3485 propensity score-matched pairs were generated. No significant differences were found in the outcomes between the propensity score-matched groups: a composite outcome of in-hospital mortality and RRT dependence, 49.6% vs. 50.2% (odds ratio (OR) 0.98; 95% CI (confidence interval) 0.88, 1.07); in-hospital mortality, 45.3% vs. 46.1% (OR 0.97; 95% CI 0.87, 1.06); RRT dependence, 4.4% vs 4.1% (OR 1.08; 95% CI 0.85, 1.31); and median (interquartile range) of RRT duration, 4 [2–11] days vs. 4 [2–11] days (P = 0.58).

Conclusions

This large observational study did not support an association between intravenous contrast media and adverse in-hospital outcomes in patients with septic AKI-D. Further studies are warranted to assess the generalizability.

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Abbreviations

AKI:

Acute kidney injury

AKI-D:

Acute kidney injury requiring dialysis

CCI:

Charlson comorbidity index

CKD:

Chronic kidney disease

CRRT:

Continuous renal replacement therapy

CT:

Computed tomography

ICD:

The international classification of diseases

IV:

Intravenous

RRT:

Renal replacement therapy

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Acknowledgements

HY and KF received grant support from the Japanese government. This work was supported by grants for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (H29-Policy-Designated-009 and H29-ICT-General-004); the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141); and the Japan Agency for Medical Research and Development (AMED). The funders had no role in the execution of this study or the interpretation of the results.

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Authors and Affiliations

  1. Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Yoshihisa Miyamoto, Yoshifumi Hamasaki & Masaomi Nangaku

  2. Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan

    Masao Iwagami

  3. Department of Non-Communicable Disease Epidemiology, School of Hygiene and Tropical Medicine, London, UK

    Masao Iwagami

  4. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Shotaro Aso, Hideo Yasunaga & Hiroki Matsui

  5. Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan

    Kiyohide Fushimi

  6. Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Yoshifumi Hamasaki & Masaomi Nangaku

  7. Department of Acute Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Kent Doi

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  1. Yoshihisa Miyamoto
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Contributions

YM, MI, HY and KD designed the study. YM, SA, HM and HY were involved in acquiring data. YM, MI and SA were responsible for the statistical analysis. YM and MI interpreted the data and wrote the first draft of the report. SA, HY, YM, MN, and KD revised the report critically for important intellectual content. All authors approved the final version of the manuscript. The corresponding author confirms to have had full access to the data in the study and final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Kent Doi.

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Ethics approval and consent for each institution to participate in the study was approved by the institutional research ethics committee in accordance with local ethical regulations.

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Miyamoto, Y., Iwagami, M., Aso, S. et al. Association between intravenous contrast media exposure and non-recovery from dialysis-requiring septic acute kidney injury: a nationwide observational study. Intensive Care Med 45, 1570–1579 (2019). https://doi.org/10.1007/s00134-019-05755-2

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