Is Contrast-Enhanced Imaging in the Emergency Department a Risk Factor for Contrast-Associated Acute Kidney Injury?

Abstract

Purpose: We aimed to determine the predisposing factors for contrast-associated acute kidney injury (CA-AKI) among patients exposed to contrast media during emergency department visits and follow-ups in internal medicine, and to evaluate subsequent outcomes such as mortality and intensive care unit (ICU) admission.

Patients and methods: A total of 1483 patients who presented to the internal medicine clinic from the emergency department or outpatient clinic and underwent contrast-enhanced computed tomography (CT) were retrospectively analyzed. A total of 382 cases with kidney function tests available for the study before contrast exposure and at 24, 72, and 120 hours after exposure were included in the study. An increase in serum creatinine by 25% or more from the baseline or an absolute increase of 0.5 mg/dl (44.20 µmol/L) or more after one hour was considered as contrast nephropathy.

Results: Contrast-associated acute kidney injury was observed in 17% of the study population, with the majority of cases emerging within the initial 24-hour period following contrast exposure. In 54% of these patients, contrast media had been administered in the internal medicine department. Among them, 13.9% subsequently required admission to the intensive care unit (ICU). Furthermore, individuals with a history of hypertension were found to have a 2.31-fold increased risk of developing CA-AKI compared to those without hypertension.

Conclusion: The likelihood of contrast-associated nephropathy appears to be markedly increased in hypertensive individuals undergoing contrast-enhanced CT in emergency departments. Prophylactic intravenous hydration has also been demonstrated to play a crucial role in reducing CA-AKI incidence.