Incidence of contrast-induced acute kidney injury (CI-AKI) in high-risk oncology patients undergoing contrast-enhanced CT with a reduced dose of the iso-osmolar iodinated contrast medium iodixanol

Abstract

Objectives To determine the incidence of post-contrast acute kidney injury (PC-AKI) and presumed contrast-induced acute kidney injury (CI-AKI) following contrast-enhanced CT (CECT) with intravenous application of a reduced dose of the iso-osmolar contrast agent iodixanol in cancer patients with chronic kidney disease. Methods 198 oncology patients with a baseline estimated glomerular filtration rate (eGFR) <60ml/ min/1.73m2 undergoing a total of 237 CECTs using a reduced dose of 60ml iodixanol were retrospectively analyzed. Statistical analysis was performed for the entire cohort and subgroups. The effect of additional risk factors on the occurrence of PC-AKI was evaluated. Results The overall PC-AKI incidence was 6.3%. Excluding patients with concurrent medical conditions known to directly and independently impact kidney function and patients with AKI preceding the CT-scan resulted in a presumed CI-AKI incidence of 3.8%. No permanent post-contrast worsening of renal function and no AKI treatment were required. Subgroups considering baseline eGFR yielded PC-AKI incidences of 4.6% (eGFR 45-60ml/min/1.73m2, n = 130), 7.4% (eGFR 30-45ml/min/1.73m2, n = 95) and 16.7% (eGFR <30ml/min/1.73m2, n = 12). Additional patient related risk factors did not show any significant effect on the occurrence of PC-AKI. Conclusions Low incidences of PC-AKI/CI-AKI suggest that a reduced dose of an iso-osmolar contrast agent is safe in high-risk oncological patients with impaired renal function.