Epidemiology of Contrast Associated Acute Kidney Injury in ICU patients

Eric AJ Hoste1, 2, Severine Doom1, 3, Jan De Waele1, Louke J Delrue4, Luc Defreyne5, Dominique D Benoit1, Johan Decruyenaere1.

1Intensive Care Unit, Ghent University Hospital, Ghent University, Gent, Belgium.

2Research Foundation-Flanders (Belgium) (FWO).

3Department of Anaesthesia, Lievensberg Ziekenhuis, Bergen op Zoom, The Netherlands.

4Department of Radiology, Ghent University Hospital, Ghent University, Gent, Belgium.

5Department of Interventional Radiology, Ghent University Hospital, Ghent University, Gent, Belgium.

Correspondence:

Eric AJ Hoste MD, PhD

ICU, 2K12 C

Ghent University Hospital,

De Pintelaan 185

9000 Gent, Belgium

Phone: +32 9 332 4197

Fax: +32 9 332 4995

e-mail:


Electronic data supplement


Tables:

e-Table 1: Kidney and patient outcomes in CA-AKI patients defined according to 2 different definitions.

Data are presented as N (%) or median (interquartile range).

Classic definition for CA-AKI / KDIGO, modified RIFLE definition
n / 128 / 175
Kidney outcomes
RRT ≤10d after contrast administration / 21 (16.4%) / 40 (22.9%)
Duration of RRT (d) / 9 (2, 22) / 6 (2, 17)
Number of RRT treatments / 7 (2, 17) / 5 (2, 13)
RRT at time of hospital discharge (% of RRT) / 1 (4.8%) / 1 (0.6%)
Creatininedischarge (mg/dL) / 0.91 (0.52, 1.90) / 1.03 (0.59, 1.97)
eGFRdischarge (mL/min/1.73m2) / 77 (30.6, 145.6) / 68.0 (29.6, 127.9)
Creatininedischarge > creatinine before contrast / 56 (48.3%) / 50 (32.5%)
Patient outcomes:
LOS ICU (d) / 16 (8.5, 29.4) / 18 (9.5, 30.5)
LOS ICU after contrast administration (d) / 12 (5.1, 24.1) / 14 (4.9, 24.8)
LOS hospital after contrast administration (d) / 26 (7.9, 58.0) / 26 (13.0, 61.8)
ICU mortality (%) / 45 (35.2%) / 64 (36.6%)
Mortality 28 d after contrast administration / 46 (35.9%) / 64 (36.6%)
Mortality 60 d after contrast administration / 57 (44.5%) / 76 (43.4%)
Mortality 90 d after contrast administration / 61 (47.7%) / 80 (45.7%)
Mortality 1y after contrast administration / 71 (55.5%) / 92 (52.6%)

Legend: CA-AKI = contrast associated acute kidney injury, KDIGO = Kidney Disease: Improving Global Outcomes, RIFLE = Risk Injury, Failure, Loss, End Stage renal disease classification for acute kidney injury, RRT = renal replacement therapy, eGFR = estimated glomerular filtration rate, LOS : length of stay, ICU = intensive care unit

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e-table 2: Effect of preventive measures on occurrence of contrast associated acute kidney injury in the whole study cohort and in patients with eGFR lower and greater than 60 mL/min.

Prevention / Patients with prevention / CA-AKI in no prevention / CA-AKI in prevention / P
BIC / All patients (n=787) / 34.1% / 13.3% / 22.0% / 0.002
eGFR<60 (n=211) / 55.9% / 21.5% / 22.0% / 0.926
eGFR>60 (n=470) / 25.1% / 10.2% / 20.3% / 0.004
NAC / All patients (n=787) / 26.6% / 14.5% / 21.1% / 0.029
eGFR<60 (n=211) / 38.9% / 20.9% / 23.2% / 0.701
eGFR>60 (n=470) / 20.0% / 10.6% / 21.3% / 0.006
BIC or NAC / All patients (n=787) / 39.0% / 12.9% / 21.5% / 0.001
eGFR<60 (n=211) / 61.6% / 21.0% / 22.3% / 0.821
eGFR>60 (n=470) / 29.1% / 9.6% / 20.4% / 0.001
BIC and NAC / All patients (n=787) / 21.6% / 14.7% / 21.8% / 0.028
eGFR<60 (n=211) / 33.2% / 21.3% / 22.9% / 0.793
eGFR>60 (n=470) / 16.0% / 11.1% / 21.3% / 0.015
NAC, no BIC / All patients (n=787) / 5.0% / 16.2% / 17.9% / 0.770
eGFR<60 (n=211) / 5.7% / 21.6% / 25.0% / 0.782
eGFR>60 (n=470) / 4.0% / 12.4% / 21.1% / 0.269
BIC, no NAC / All patients (n=787) / 12.5% / 15.4% / 22.4% / 0.076
eGFR<60 (n=211) / 22.7% / 22.1% / 20.8% / 0.853
eGFR>60 (n=470) / 9.1% / 12.2% / 18.6% / 0.229

Legend: CA-AKI = contrast associated acute kidney injury, injury, eGFR = estimated glomerular filtration rate, BIC = bicarbonate, NAC = N-acetylcysteine

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Figures:

e-Figure 1: Patient flow chart

18,866 ICU patients

1419 patients met the inclusion criteria

632 patients excluded

·  137 on RRT

·  159 second procedure ≤ 3 d

·  336 patients not included in the PDMS

787 patients evaluated

Legend: ICU = intensive care unit, RRT = renal replacement therapy, PDMS = electronic patient database management system

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