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Intensive Care Medicine

, Volume 45, Issue 11, pp 1570–1579 | Cite as

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

  • Yoshihisa Miyamoto
  • Masao Iwagami
  • Shotaro Aso
  • Hideo Yasunaga
  • Hiroki Matsui
  • Kiyohide Fushimi
  • Yoshifumi Hamasaki
  • Masaomi Nangaku
  • Kent DoiEmail author
Original

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.

Keywords

Acute kidney injury Sepsis Continuous renal replacement therapy Contrast-induced nephropathy 

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

Notes

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.

Author 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.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

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.

Informed consent

Informed consent was not required due to the observational and anonymous nature of data collection.

Supplementary material

134_2019_5755_MOESM1_ESM.docx (50 kb)
Supplementary material 1 (DOCX 49 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yoshihisa Miyamoto
    • 1
  • Masao Iwagami
    • 2
    • 3
  • Shotaro Aso
    • 4
  • Hideo Yasunaga
    • 4
  • Hiroki Matsui
    • 4
  • Kiyohide Fushimi
    • 5
  • Yoshifumi Hamasaki
    • 1
    • 6
  • Masaomi Nangaku
    • 1
    • 6
  • Kent Doi
    • 7
    Email author
  1. 1.Division of Nephrology and EndocrinologyThe University of TokyoTokyoJapan
  2. 2.Department of Health Services ResearchUniversity of TsukubaTsukubaJapan
  3. 3.Department of Non-Communicable Disease EpidemiologySchool of Hygiene and Tropical MedicineLondonUK
  4. 4.Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
  5. 5.Department of Health Policy and InformaticsTokyo Medical and Dental University, Graduate School of MedicineTokyoJapan
  6. 6.Department of Hemodialysis and ApheresisThe University of Tokyo HospitalTokyoJapan
  7. 7.Department of Acute Care MedicineThe University of Tokyo HospitalTokyoJapan

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