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Table 1 Studies comparing the incidence of acute kidney injury between patients exposed and unexposed to intravenous contrast medium in various acute care settings

From: Iodinated contrast medium: Is there a re(n)al problem? A clinical vignette-based review

Reference

Setting/design

Contrast group (patients)

Control group (patients)

Additional means to delineate the renal risk attributable to contrast medium

Comments

Polena et al. [67]

ICU,

Retrospective cohort (single-centre)

N = 75

AKI: 18.6%

N = 75

AKI: 2%

None

 

Tremblay et al. [68]

Trauma centre;

Retrospective cohort (single-centre)

N = 56

AKI: 3%

N = 39

AKI: 16%

None

Proportion of ICU patients unclear

Oleinik et al. [69]

ED, patients with intracerebral haemorrhage;

Retrospective cohort (single-centre)

N = 368

AKI: 6%

OR 1.4 (95%CI 0.6–3.2)

N = 130

AKI: 14%

Multivariate regression

Proportion of ICU patients unclear

Lima et al. [70]

Stroke patients;

Retrospective cohort (single-centre)

N = 575

AKI: 5%

OR 0.42 (95%CI 0.24–0.71)

N = 343

AKI: 10%

Multivariate regression

Proportion of ICU patients unclear

Aulicky et al. [71]

Stroke patients;

Retrospective cohort (single-centre)

N = 164

AKI: 3%

N = 77

AKI: 4%

Multivariate regression

Proportion of ICU patients unclear

Mc Gillicuddy et al. [72]

Trauma centre, elderly trauma patients;

Retrospective cohort (single-centre)

N = 822

AKI: 1.9%

N = 249

AKI: 2.4%

None

Proportion of ICU patients unclear

Ng et al. [73]

ICU patients (oncology);

Retrospective cohort (single-centre)

N = 81

AKI: 17%

N = 81

AKI: 17%

1-to-1 matching on baseline serum creatinine, SOFA score and age

 

Cely et al. [19]

ICU;

Prospective cohort (single-centre)

N = 53

AKI: 9.4%

N = 53

AKI: 15%

1-to-1 matching on baseline creatinine clearance, diabetes, mechanical ventilation, vasopressor use

 

Sinert et al. [74]

ED patients with normal renal function;

Retrospective cohort (2 centres)

N = 773

AKI: 5.7%

N = 2956

AKI: 9.0%

None

 

Kim et al. [75]

ICU, trauma patients;

Retrospective cohort (single-centre)

N = 389

AKI: 30%

OR 0.99 (CI 95% 0.78–1.25)

N = 182

AKI: 29%

None

 

Ehrmann et al. [20]

ICU;

Prospective cohort (2 centres)

N = 146

AKI: 5.5%

N = 146

AKI: 5.5%

1-to-1 propensity score matching**

 

Christ et al. [76]

ICU patients after cardiac arrest;

Retrospective cohort

N = 89

AKI: 15.7%

N = 53

AKI: 37.7%

None

 

Gao et al. [77]

ICU;

Retrospective cohort (single-centre)

N = 474

AKI: 14.8%

OR 1.66 (95% CI 0.72–3.90)

N = 1,896

AKI: 12.4%

Multivariate regression

 

Sonhaye et al. [78]

ED;

Prospective cohort (single-centre)

N = 620

AKI: 3%

OR: 95%CI is missing

N = 672

AKI: 2%

Multivariate regression

Proportion of patients admitted to the ICU unclear

Heller et al. [79]

ED patients admitted to the hospital;

Retrospective cohort (single-centre)

N = 6954

AKI: 8.6%

N = 909

AKI: 9.6%

None

8% of patients admitted to the ICU

McDonald et al. [16]

ICU;

Retrospective cohort (single-centre)

N = 1223 with eGFR > 45

AKI: 31%

OR 1.21 (CI 95% 0.87–1.68)

N = 285 with eGFR ≤ 45

AKI: 50%

OR 0.88 (CI95% 0.75–1.05)

N = 1223 with eGFR > 45

AKI: 34%

N = 285 with eGFR ≤ 45

AKI: 45%

1-to-1 propensity score matching**

An increased risk of dialysis was observed in patients with pre-contrast eGFR ≤ 45 ml/min/1.73 m2

Hinson et al. [25]

ED patients admitted to the hospital;

Retrospective cohort (single-centre)

N = 7,201

AKI: 6.8%

OR 1.00 (95% CI 0.99–1.01)

N = 10,733

AKI: 8.5%

1-to-1 propensity-score matching**

ED critical care designation in 9% of patients

Proportion of patients admitted to the ICU unclear

Miyamoto et al. [17]

ICU, patients with sepsis-associated AKI receiving continuous RRT;

Retrospective cohort (national database)

N = 3485

Composite outcome (in-hospital death or RRT dependence at discharge):

49.6%

OR 0.98 (95% CI 0.88–1.07)

RRT dependence at discharge: 4.4%

OR 1.08 (95% CI 0.85–1.31) median duration of RRT: 4 [IQR 2–11] days

N = 3485

Composite outcome (in-hospital death or RRT dependence at discharge):

50.2%

RRT dependence at discharge: 4.1% median duration of RRT: 4 [IQR 2–11] days

1-to-1 propensity score matching**

 

Shih et al. [80]

ICU (subgroup analysis), patients with CKD;

Retrospective cohort (national database)

N = 51

30-day RRT: 25.5%

aHR 0.95 (95% CI 0.44–2.05)

N = 176

30-day RRT: 25.6%

Cox proportional hazard model adjusted for age, sex and comorbid conditions

Analysis of the Taiwan National Health Insurance Research Database

Goto et al. [81]

ICU (patients with sepsis and AKI);

Retrospective cohort (single-centre)

N = 100 further deterioration of renal function = 34%

N = 100 further deterioration of renal function = 35%

1-to-1 propensity score matching**

 

Hinson et al. [82]

ED, patients with sepsis;

Retrospective cohort (single-centre)

N = 1464

AKI: 7.2

OR 0.99 (95% CI 0.97–1.02)

N = 2707

AKI: 9.6%

1-to-1 propensity score matching**

ED critical care designation in 4% of patients

Proportion of patients admitted to the ICU unclear

McGaha et al. [83]

Paediatric trauma centre, severely injured patients;

Retrospective cohort (single-centre)

N = 164

AKI: 7.3%

N = 47

AKI: 8.5%

None

57% of patients admitted to the ICU

Williams et al. [18]

ICU;

Retrospective cohort (6-hospital health system)

N = 2306

AKI: 19.3%

OR 1.11 (95% CI 0.95–1.29)

N = 2306

AKI: 18.0%

1-to-1 propensity score matching**

 
  1. ICU intensive care unit, AKI acute kidney injury*, Contrast iodinated contrast media, OR odds ratio, SOFA sequential organ failure assessment, 95% CI: 95% confidence interval, eGFR estimated glomerular filtration rate, ED emergency department, RRT renal replacement therapy, IQR interquartile range, CKD chronic kidney disease, aHR adjusted hazard ratio, DRF deterioration of kidney function
  2. *The definition for AKI may differ from one study to another. This may, in part, account for the between-studies discrepancies in the reported incidence for AKI
  3. **Patients exposed and patients unexposed to contrast were matched on their propensity to be administered contrast. This approach aims at mimicking randomization in an observational study design