Hypotension at Hospital Presentation and Post-Contrast Acute Kidney Injury following Computed Tomography with Contrast Media

Nephron. 2023;147(3-4):170-176. doi: 10.1159/000526268. Epub 2022 Sep 12.

Abstract

Introduction: Post-contrast acute kidney injury (PC-AKI) is a major complication of contrast media usage; risks for PC-AKI are generally evaluated before computed tomography (CT) with contrast at the emergency department (ED). Although persistent hypotension (systolic blood pressure [sBP] <80 mm Hg for 1 h) is associated with increased PC-AKI incidence, it remains unclear whether transient hypotension that is haemodynamically stabilized before CT is a risk of PC-AKI. We hypothesized that hypotension on ED arrival would be associated with higher PC-AKI incidence even if CT with contrast was performed after patients are appropriately resuscitated.

Methods: This multicentre retrospective observational study was conducted at three tertiary care centres during 2013-2014. We identified 280 patients who underwent CT with contrast at the ED. Patients were classified into two groups based on sBP on arrival (<80 vs. ≥80 mm Hg); hypotension was considered as transient because CT with contrast has always been performed after patients were stabilized at participating hospitals. PC-AKI incidence was compared between the groups; inverse probability weighting (IPW) was conducted to adjust background characteristics.

Results: Eighteen patients were excluded due to chronic haemodialysis, cardiac arrest on arrival, or death within 72 h; 262 were eligible for this study. PC-AKI incidence was higher in the transient hypotension group than the normotension group {7/27 (28.6%) vs. 24/235 (10.2%), odds ratio (OR) 3.08 (95% confidence interval [CI] 1.18-8.03), p = 0.026}, which was confirmed by IPW (OR 3.25 [95% CI 1.99-5.29], p < 0.001).

Conclusion: Transient hypotension at the ED was associated with PC-AKI development.

Keywords: Computed tomography with contrast; Emergency department; Post-contrast acute kidney injury; Transient hypotension.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Acute Kidney Injury* / chemically induced
  • Acute Kidney Injury* / diagnostic imaging
  • Acute Kidney Injury* / epidemiology
  • Contrast Media / adverse effects
  • Hospitals
  • Humans
  • Hypotension* / chemically induced
  • Hypotension* / diagnostic imaging
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed / methods

Substances

  • Contrast Media

Grants and funding

There are no sources of financial support for the work.