Elsevier

Journal of Critical Care

Volume 27, Issue 3, June 2012, Pages 322.e1-322.e5
Journal of Critical Care

Incidence, morbidity, and mortality of contrast-induced acute kidney injury in a surgical intensive care unit: A prospective cohort study,☆☆,

https://doi.org/10.1016/j.jcrc.2011.08.005Get rights and content

Abstract

Purpose

Data on contrast-induced acute kidney injury (CI-AKI) in intensive care unit (ICU) are scarce and controversial. The objectives of the study were to evaluate the incidence and characteristics of CI-AKI in a surgical ICU.

Materials and Methods

We conducted a 13-month prospective observational study. Three definitions were compared to characterize CI-AKI: Barrett and Parfrey criteria; Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End stage renal disease (RIFLE) classification; and Acute Kidney Injury Network (AKIN) criteria. Patients hospitalized in surgical ICU who had received an injection of contrast medium, who were not on renal replacement therapy, who had stable serum creatinine before injection, and no other etiology for new acute kidney injury were included.

Results

One hundred one patients were included. The frequency of CI-AKI was 17%, 19%, and 19% according to Barrett and Parfrey criteria; RIFLE classification; and AKIN criteria, respectively. Diabetes mellitus, creatinine clearance less than 60 mL/min, and concomitant aminoglycoside administration were associated with CI-AKI. Statistically significant associations were found between CI-AKI and renal replacement therapy with all 3 definitions and between CI-AKI and mortality when AKIN criteria were used.

Conclusions

These results show that CI-AKI is not inconsequential in critically ill patients. In the present study, AKIN criteria appear to be most relevant to define CI-AKI. Further studies are required to explore CI-AKI prevention in ICU.

Introduction

The incidence, risk factors, morbidity, and mortality of contrast-induced acute kidney injury (CI-AKI) have been studied, mainly after percutaneous coronary interventions [1], [2], [3], [4]. In the intensive care unit (ICU), several radiologic procedures, including computed tomography (CT) and angiography, are widely performed for diagnosis and treatment of critically ill patients. Consequently, ICU patients are exposed to repetitive contrast medium (CM) administration and are at risk for CI-AKI. Up to the present time, a few studies have reported disparate results regarding CI-AKI epidemiology in ICU patients. Contrast-induced acute kidney injury frequency in critically ill patients varied between less than 2% and 18%, depending on the study populations and CI-AKI definitions used [5], [6], [7], [8], [9].

The definition of CI-AKI commonly used in non-ICU patients is that proposed by Barrett and Parfrey [10]. Clearly, CI-AKI has never been prospectively evaluated in ICU patients in whom specific definitions of acute kidney injury (AKI) are already used. Indeed, risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function and end stage renal disease classification (RIFLE) and Acute Kidney Injury Network (AKIN) criteria are validated for AKI diagnosis in ICU patients, using both serum creatinine value and urine output criteria [11], [12], [13], [14]. AKIN criteria for CI-AKI diagnosis, first proposed by McCullough [15], had already been used in non-ICU patients [16].

The aims of the present study were to evaluate CI-AKI incidence and characteristics in a surgical ICU and to compare Barrett and Parfrey, AKIN, and RIFLE criteria for CI-AKI diagnosis.

Section snippets

Materials and methods

This was a prospective observational study conducted in a 30-bed surgical ICU during a predefined 13 months period from May 2007 to June 2008. The study was approved by an independent ethics committee (Comité de protection des personnes nord ouest III). Because there was no randomization or change in patient management, no written informed consent from patients or their relatives was required.

We included patients in whom imaging procedures with intravenous CM administration were performed.

Results

One hundred one consecutive patients were included during the study period. The main characteristics of patients are reported in Table 2. Ten patients (10%) had an history of diabetes mellitus, and 2 patients (2%), of chronic kidney disease. Four patients with diabetes had renal insufficiency but with a plasma creatinine value less than 1.5 mg/dL. No patients had chronic heart failure or myeloma. At enrollment, 20 patients (20%) had a calculated creatinine clearance of less than 60 mL/min, and

Discussion

The present study showed that CI-AKI incidence in the surgical ICU was 17% and 19%, according to the definition used. Diabetes mellitus, calculated creatinine clearance of less than 60 mL/min, and aminoglycoside therapy were associated with CI-AKI development. Statistically significant associations were found between CI-AKI and RRT whatever the definition used. An association between CI-AKI and mortality was found only when the AKIN criteria were used.

In a retrospective study, Haveman et al [5]

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Previous presentation: This work was presented in part at the 51th congress of the Société Francaise Anesthésie Réanimation 2009 (abstract R226) and at the 10th congress of the World Federation of Society of Intensive and Critical Care Medicine 2009 (abstract 382).

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