Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Renal Safety of Repeated Intravascular Administrations of Iodinated or Gadolinium-Based Contrast Media within a Short Interval

  • Chiheon Kwon (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Koung Mi Kang (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Young Hun Choi (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Roh-Eul Yoo (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Chul-Ho Sohn (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Seung Seok Han (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Soon Ho Yoon (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital)
  • Received : 2020.09.22
  • Accepted : 2021.03.05
  • Published : 2021.09.01
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Abstract

Objective: We aimed to investigate whether repeated intravascular administration of iodinated contrast media (ICM) or gadolinium-based contrast agents (GBCAs) within a short interval was associated with an increased risk of post-contrast acute kidney injury (PC-AKI). Materials and Methods: This retrospective study included 300 patients (mean age ± standard deviation, 68.5 ± 8.1 years; 131 male and 169 female) who had undergone at least one ICM-enhanced perfusion brain CT scan, had their baseline and follow-up serum creatinine levels available, and had not undergone additional contrast-enhanced examinations 72 hours before and after a time window of interest were included. The study population was divided into three groups: single-dose group and groups of patients who had received multiple contrast administrations in the time window of interest with the minimum contrast repeat interval either within 4 hours (0-4-hour group) or between 4 to 48 hours (4-48-hour group). Multivariable logistic regression analysis was conducted to evaluate the association between AKI and repeated ICM administrations. A similar supplementary analysis was performed including both ICM and GBCA. Results: When ICM was only considered ignoring GBCA, among 300 patients, 207 patients received a single dose of ICM, 58 had repeated doses within 4 hours (0-4-hour group), and 35 patients had repeated doses between 4 to 48 hours (4-48-hour group). Most patients (> 95%) had a baseline estimated glomerular filtration rate (eGFR) of ≥ 30 mL/min/1.73 m2. AKI occurred in 7.2%, 13.8%, and 8.6% of patients in the single-dose, 0-4-hour, and 4-48-hour groups, respectively. In the 0-4-hour and 4-48-hour groups, additional exposure to ICM was not associated with AKI after adjusting for comorbidities and nephrotoxic drugs (all p values > 0.05). Conclusion: Repeated intravascular administrations of ICM within a short interval did not increase the risk of AKI in our study patients suspected of acute stroke with a baseline eGFR of ≥ 30 mL/min/1.73 m2.

Keywords

Acknowledgement

The authors would like to acknowledge Andrew Dombrowski, PhD (Compecs, Inc.) for his assistance in improving the use of English in this manuscript.

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