The accumulative risk of acute kidney injury in trauma patients following repetitive contrast medium exposure

Abstract text (incl. references and figure legends)

Introduction: Multiple contrast-enhanced radiology examinations (i.e. computed tomography or angiography) in trauma patients are commonly required for both diagnostic and therapeutic purposes. The actual risk of contrast-associated acute kidney injury (CA-AKI) is still unclear. This study evaluates the association of the accumulative contrast medium doses to CA-AKI.

Materials and methods: Data from a level 1 trauma center during 2019-2021 were retrospectively reviewed. Patients receiving intravascular contrast-enhanced examinations (CE) for torso trauma within 7 days after injury were included. Those without serum creatinine levels at admission and 48 hours after the last exposure of contrast medium were excluded. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) grading system. Multivariate logistic regression (MLR) was performed to identify independent risk factors of AKI. The total amount of contrast medium (OminipaqueTM) exposed within 7 days were summed, and the cut-off point to predict AKI was determined by Youden index. Inverse probability of treatment weighting (IPTW) was used to adjust other factors and see if contrast dose was associated with AKI.

Results: Among the 312 patients, 11.5% (36/312) had AKI and 5.1% (16/312) were KDIGO stage 3. Fifty-seven percent of patients received CE at least twice. The median amount of total contrast medium given was 156 mL. On MLR, for every 10ml increase of contrast dose, the odds ratio of AKI was 1.12 (95% CI 1.03-1.21, p=.010). By using 160 ml as a cut-off value and adjusting other factors by IPTW, patients with contrast dose ≥160 ml (which was roughly equivalent to the amount required for one CT and one angiography) had a significantly higher risk of AKI (19.3% vs 9.8%, p=.001).

Conclusion: While repetitive CE are sometimes inevitable, it does come with costs. The CA-AKI risk increases as the amount of contrast medium accumulates in trauma patients who require repetitive examinations.

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