Contrast Induced Nephropathy in Trauma: A Real Phenomenon?

Abstract

Background

The goal of this study was to evaluate the impact of contrast administration on the subsequent development of acute kidney injury (AKI) in trauma patients.

Methods

Trauma patients at a level one trauma center were identified and stratified by administration of contrast during their initial diagnostic evaluation. Outcomes including mortality, AKI, and need for renal replacement therapy were collected and compared. Multivariable logistic regression analysis was performed to determine the impact of contrast administration on the development of AKI in trauma patients.

Results

839 patients were identified: 551 who received contrast and 288 who did not. Only 58 (6.9%) developed AKI and 3 (0.3%) required new renal replacement therapy (RRT). Those exposed to contrast had a higher injury severity score (10 vs 9, P < .001), admission serum creatinine (1.02 vs 0.91, P < .001), initial vasopressor requirements (3.8% vs 0.3%, P = .003), and 24-hour packed red blood cell transfusions (PRBC) (4 vs 2 units, P < .001). Despite this, those exposed to intravenous contrast had lower rates of acute kidney injury (9.4% vs 5.6%, P = .042) and no difference in the need for new RRT (0.5% vs 0%, P = .2). Multivariable logistic regression identified age, 24-hour PRBC transfusions, admission SBP, and admission serum creatinine as the only independent predictors of acute kidney injury.

Discussion

In the diagnostic evaluation of trauma patients, the administration of intravenous contrast was not associated with the subsequent development of acute kidney injury.