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CT Contrast Media Does Not Increase Kidney Injury Risk

By MedImaging International staff writers
Posted on 09 Feb 2017

Image: A new study suggests intravenous contrast media used in CT is not linked to increased risk of acute kidney injury (Photo courtesy of News Medical).

Intravenous (IV) contrast media administration for computerized tomography (CT) is not associated with an increased frequency of acute kidney injury (AKI), according to a new study.

Researchers at Johns Hopkins University School of Medicine conducted a retrospective cohort analysis involving 17,934 emergency department (ED) visits for patients who underwent contrast-enhanced, unenhanced, or no CT between 2009 and 2014. The primary outcome was incidence of AKI, with secondary outcomes including new chronic kidney disease (CKD), dialysis, and renal transplantation at six months.

In addition, treatment decisions, including administration of contrast media--typically iohexol or iodixanol--and IV fluids were examined. The results showed that 57.2% of all CT scans were contrast-enhanced. Contrast administration was not associated with increased incidence of AKI, in all subgroup analyses, regardless of baseline renal function. The probability of developing acute kidney injury was 6.8% for patients undergoing contrast-enhanced CT, 8.9% for patients receiving unenhanced CT, and 8.1% for patients not receiving CT at all.

In addition, IV contrast administration was not associated with increased incidence of any of the secondary outcomes. Clinicians were less likely to prescribe contrast to patients with decreased renal function and more likely to prescribe IV fluids if contrast was administered. The study was published on January 27, 2017, in Annals of Emergency Medicine.

“Our results clearly demonstrate that in emergency departments such as ours where practice patterns have evolved to protect patients' kidneys, contrast media is not associated with increased risk of kidney injury,” said lead author Jeremiah Hinson, MD. “Our data also suggest that in cases where contrast-enhanced CT is indicated to avoid delayed or missed diagnosis of critical disease, the potential morbidity and mortality resulting from a failure to diagnose potentially life-threatening conditions likely outweigh any potential risk of kidney injury.”

AKI is an abrupt loss of kidney function that develops within seven days, generally caused by decreased renal ischemia, exposure to substances harmful to the kidney, an inflammatory process in the kidney, or an obstruction of the urinary tract. AKI can lead to several complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects on other organ systems. Those who have experienced AKI may have an increased risk of CKD in the future.

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67 (27.179718017578): select jos_linkedin.link from jos_linkedin where cat=10

68 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294768090 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294768090 AND published='1' LIMIT 1

69 (43.869018554688): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (195.98007202148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 1024.0077972412): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1045.9423065186): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.200088500977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (26.941299438477): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (29.802322387695): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (642.06123352051): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (98.943710327148): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 1786.9472503662): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (385.99967956543): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (234.12704467773): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (173.09188842773): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (720.02410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (351.90582275391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (169.03877258301): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (286.10229492188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

105 (!!!!! 2918.004989624): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

106 (221.01402282715): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294768090 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (723.12355041504): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294768090 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1859.188079834): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

109 (!!!!! 6850.004196167): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

110 (416.04042053223): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294768090 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 5115.9858703613): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294768090 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 7860.8989715576): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 6690.0253295898): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 2425.9090423584): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

115 (!!!!! 1042.8428649902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

116 (885.96343994141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

117 (664.94941711426): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

118 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

119 (245.09429931641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

120 (414.84832763672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

121 (245.09429931641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

122 (725.98457336426): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 133309.84115601): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 1413.8221740723): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768090 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768090 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 36736.011505127): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (262.97569274902): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (190.01960754395): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (78.916549682617): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (!!!!! 1316.0705566406): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (498.05641174316): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (172.13821411133): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (34.093856811523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (526.18980407715): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (782.96661376953): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 2480.0300598145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (282.04917907715): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (575.06561279297): SELECT name FROM jos_deeppockets WHERE id=211

138 (221.96769714355): SELECT name FROM jos_deeppockets WHERE id=211

139 (706.91108703613): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (492.81120300293): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1985.0730895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

142 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

143 (!!!!! 24593.114852905): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1789.0930175781): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294768090 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (655.8895111084): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294768090 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2758.0261230469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (662.80364990234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2140.998840332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

149 (591.03965759277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

150 (!!!!! 4062.8910064697): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (!!!!! 2108.097076416): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

152 (803.94744873047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

153 (857.83004760742): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768090 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768090 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (391.96014404297): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (129.93812561035): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (545.02487182617): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2511.0244750977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

158 (267.98248291016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768090 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768090 AND published='1' LIMIT 1

159 (!!!!! 1217.8421020508): select jos_twitters.link from jos_twitters where cat=10

160 (174.99923706055): select jos_facebook.link from jos_facebook where cat=10

161 (159.02519226074): select jos_google_plus.link from jos_google_plus where cat=10

162 (193.11904907227): select jos_linkedin.link from jos_linkedin where cat=10

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