P24
David Lewis 1 , Aliki Manoras 2 , Steven Alderson 1 , Joseph Papanikitas 3 , Suresh Pillai 4 , and
Stuart McKechnie 2
1 Acute General Medicine, 2 Intensive Care Unit, 3 Department of Radiology, Oxford
University Hospitals NHS Trust, Oxford, UK
4 Intensive Treatment Unit, Morriston Hospital, Swansea, UK.
INTRODUCTION: Up to 25% of adults admitted to critical care suffer acute kidney injury
(AKI), which is associated with increased mortality (1). Exposure to iodinated contrast increases the risk of AKI (2). Although Contrast Induced Nephropathy (CIN) has been studied in patients undergoing coronary angiography, it has not been investigated in large numbers of
ICU patients (3).
METHODS: In a retrospective, single centre, observational study, we searched our radiology electronic database for scans requested on adult ICU patients over a 3 year period (2009-2011), before matching these scans against ICU electronic patient records. We collected data on patient demographics, ICU admission characteristics, scan characteristics and post-scan outcome data on AKI, use of renal replacement therapy (RRT), ICU length of stay, and ICU mortality. We investigated univariate and multivariate associations with CIN, as defined by Harjaj et al.
(4).
RESULTS: Data on 570 scans involving 385 patients were obtained, of which 91 were excluded (patients undergoing RRT pre-scan; or with incongruent scan and admission dates; or with missing data). 303 scans (63%) involved males, median age 61 (interquartile range [IQR]
46-71) years, 119 (25%) diabetic, and 174 (36%) known hypertensive; 430 (90%) were emergency admissions to ICU. Median pre-scan CKD-EPI estimated glomerular filtration rate
(eGFR) was 85 (38-113) mL/min/1.73m
2 .
Scans occurred a median of 2.9 (0.8-8.8) days from admission. CIN developed after 266 (56%) scans: 167 (grade 0), 39 (grade 1) and 60 (grade 2). 54 (11%) patients required RRT post-scan.
In univariate analyses, only male gender was associated with the development of CIN at any grade (χ 2 p=0.01) and the trend test demonstrated greater proportions of male patients amongst those with higher grades of CIN (χ 2 p=0.02). Logistic regression models demonstrated independent associations between CIN and male gender (OR 1.75 [95% CI 1.20-2.56]) and diabetes (1.80 [1.15-2.81]). Linear regression models demonstrated independent associations between higher grades of CIN and male gender (1.30 [1.08-1.56]) and pre-scan oliguria (1.21
[1.11-1.33]).
CONCLUSIONS: CIN is common in adult ICU patients but does not usually require RRT.
Male gender, diabetes and pre-scan oliguria independently predict the development CIN in critically ill patients managed on adult ICU. The association with male gender is novel and requires confirmation.
REFERENCES:
1. Singbartl K and Kellum JA. Kidney Int (2012); 81: 819-25
2. McCullough PA. J Am Coll Card (2008); 51: 1419-28
3. Rashid AH, Brieva JL, Stokes B. Anaesth Intensive Care (2009); 37: 968-75
4. Harjaj KJ, Raizada A, Shenoy C, et al.
Am J. Cardiol (2008); 10(6):812-9