Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study

Yun-Ju Shih; Yu-Ting Kuo; Chung-Han Ho; Chia-Chun Wu; Ching-Chung Ko

doi:10.7717/peerj.7757

Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study

PeerJ. 2019 Sep 30:7:e7757. doi: 10.7717/peerj.7757. eCollection 2019.

Authors

Yun-Ju Shih¹, Yu-Ting Kuo^{1

2

3}, Chung-Han Ho^{4

5}, Chia-Chun Wu^{6

7}, Ching-Chung Ko^{1

8}

Affiliations

¹ Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.
² Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
³ Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
⁵ Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
⁶ Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁷ Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
⁸ Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.

Abstract

Background: Patients with chronic kidney disease (CKD) are considered at risk of contrast-induced acute kidney injury and possible subsequent need for dialysis therapy. Computed tomography (CT) is the most commonly performed examination requiring intravenous iodinated contrast media (ICM) injection. The actual risk of dialysis in CKD patients undergoing CT with ICM remains controversial. Furthermore, it is also uncertain whether these at-risk patients can be identified by means of administrative data. Our study is conducted in order to determine the incidence and risk of dialysis within 30 days after undergoing contrast enhanced CT in CKD coded patients.

Methods: This longitudinal, nation-wide, populated-based study is carried out by analyzing the Taiwan National Health Insurance Research Database retrospectively. Patients coded under the diagnosis of CKD who underwent CT are identified within randomly selected one million subjects of the database. From January 2012 to December 2013, 487 patients had undergone CT with ICM. A total of 924 patients who underwent CT without ICM are selected as the control group. Patients with advanced CKD or intensive care unit (ICU) admissions are assigned to the subgroups for analysis. The primary outcome is measured by dialysis events within 30 days after undergoing CT scans. The cumulative incidence is assessed by the Kaplan-Meier method and log-rank test. The risk of 30-day dialysis relative to the control group is analyzed by the Cox proportional hazards model after adjusting for age, sex, and baseline comorbidities.

Results: The numbers and percentages of dialysis events within 30 days after undergoing CT scans are 20 (4.1%) in the CT with ICM group and 66 (7.1%) in the CT without ICM group (p = 0.03). However, the adjusted hazard ratio (aHR) for 30-day dialysis was 0.84 (95% CI [0.46-1.54], p = 0.57), which is statistically non-significant. In both advanced CKD and ICU admission subgroups, there are also no significant differences in 30-day dialysis risks with the aHR of 1.12 (95% CI [0.38-3.33], p = 0.83) and 0.95 (95% CI [0.44-2.05], p = 0.90), respectively.

Conclusions: Within 30 days of receiving contrast-enhanced CT scans, 4.1% of CKD coded patients required dialysis, which appear to be lower compared with subjects who received non-contrast CT scans. However, no statistically significant difference is observed after adjustments are made for other baseline conditions. Thereby, the application of administrative data to identify patients with CKD cannot be viewed as a risk factor for the necessity to undergo dialysis within 30 days of receiving contrast-enhanced CT scans.

Keywords: Chronic kidney disease; Computed tomography; Dialysis; Iodinated contrast media.

Grants and funding

This work was supported by the Chi Mei Medical Center, Tainan, Taiwan (No. CMFHR10789). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.