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Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study

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Abstract

Objectives

To determine whether intravenous iodinated contrast material administration increases the risk of acute kidney injury (AKI) in patients with nephrotic syndrome undergoing contrast-enhanced CT.

Methods

Patients with nephrotic syndrome undergoing contrast-enhanced CT were retrospectively identified (n = 701). Control group consisted of patients with nephrotic syndrome receiving non-contrast CT (n = 1053). Two different 1:1 propensity score matching models using three or 10 variables were developed for each estimated glomerular filtration (eGFR) subgroup. Incidence of post-CT AKI for the two groups was assessed and compared by standard AKI criteria and Acute Kidney Injury Network (AKIN) criteria.

Results

After matching with three variables, the AKI incidence in the contrast-enhanced CT and non-contrast CT groups was 2.7% vs 2.5% (standard AKI criteria) and 4.2% vs. 6.7% (AKIN criteria) (p = 1.00 and 0.05), respectively. After matching with 10 variables, AKI incidences were 3.1% vs. 2.6% (standard AKI criteria) and 4.1% vs. 7.4% (AKIN criteria) (p = 0.72 and 0.03), respectively. AKI incidences of each eGFR subgroup in the contrast-enhanced CT group were not higher than in the non-contrast CT group (lowest p = 0.46).

Conclusion

Intravenous contrast material administration during CT was not found to be a risk factor for AKI in this large cohort of patients with nephrotic syndrome.

Key points

• AKI incidence of contrast-enhanced CT and non-contrast CT had no difference.

• AKI incidences of eGFR subgroup in contrast-enhanced CT were not increased.

• Studies without a non-contrast CT control group may overestimate CIN incidence.

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Abbreviations

AKI:

acute kidney injury

AKIN:

Acute Kidney Injury Network

CI:

Confidence interval

CIN:

Contrast–induced nephropathy

eGFR:

Estimated glomerular filtration rate

GFR:

Glomerular filtration rate

IQR:

Interquartile range

KDOQI:

Kidney disease outcome quality initiative

MDRD:

Modification of diet in renal disease

OR:

odds ratio

PC-AKI:

post-contrast acute kidney injury

SCr:

serum creatinine

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China

    Shu Min Tao, Xiang Kong, U. Joseph Schoepf, Chang Sheng Zhou, Guang Ming Lu & Long Jiang Zhang

  2. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29401, USA

    U. Joseph Schoepf, Julian L. Wichmann & Darby C. Shuler

  3. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany

    Julian L. Wichmann

Authors
  1. Shu Min Tao
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  2. Xiang Kong
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  3. U. Joseph Schoepf
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  4. Julian L. Wichmann
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  5. Darby C. Shuler
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  6. Chang Sheng Zhou
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  7. Guang Ming Lu
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  8. Long Jiang Zhang
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Corresponding author

Correspondence to Long Jiang Zhang.

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Guarantor

The scientific guarantor of this publication is Long Jiang Zhang.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Astellas, Bayer, Bracco, GE, Guerbet, Medrad and Siemens.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Tao, S.M., Kong, X., Schoepf, U.J. et al. Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study. Eur Radiol 28, 1585–1593 (2018). https://doi.org/10.1007/s00330-017-5109-0

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  • DOI: https://doi.org/10.1007/s00330-017-5109-0

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