Association between intravenous contrast media exposure and non-recovery from dialysis-requiring septic acute kidney injury: a nationwide observational study
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.
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.
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).
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.
KeywordsAcute kidney injury Sepsis Continuous renal replacement therapy Contrast-induced nephropathy
Acute kidney injury
Acute kidney injury requiring dialysis
Charlson comorbidity index
Chronic kidney disease
Continuous renal replacement therapy
The international classification of diseases
Renal replacement therapy
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.
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 was not required due to the observational and anonymous nature of data collection.
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