A novel risk factor of contrast associated acute kidney injury in patients after enhanced computed tomography: a retrospective study

You-Qi Li; Yongjun Shi; Wen-Feng Deng; Shaobin Xiao; Wenwen Hu; Chengwen Huang; Xun Tang; Jun Zhang

doi:10.7717/peerj.14224

A novel risk factor of contrast associated acute kidney injury in patients after enhanced computed tomography: a retrospective study

PeerJ. 2022 Oct 20:10:e14224. doi: 10.7717/peerj.14224. eCollection 2022.

Authors

You-Qi Li^{1

2}, Yongjun Shi², Wen-Feng Deng³, Shaobin Xiao², Wenwen Hu², Chengwen Huang², Xun Tang¹, Jun Zhang¹

Affiliations

¹ Nephrology, Zhujiang Hospital, Southern Medical University, GuangZhou, GuangDong, China.
² Nephrology, Huizhou Central People's Hospital, Huizhou, Guangdong, China.
³ Huizhou Center for Disease Control and Prevention, Huizhou, Guangdong, China.

Abstract

Background: Contrast associated acute kidney injury (CA-AKI) is a major cause of acute renal failure and the incidence of CA-AKI is still high in recent years. Risk stratification is traditionally based on glomerular filtration rate(GFR). Hence, the aim of this study was to explore the novel risk factors for CA-AKI after enhanced computed tomography (CT).

Methods: A retrospective cohort study was conducted in 632 in-hospital patients undergoing enhanced CT. The patients were divided into CA-AKI and no-CA-AKI groups. For comparative analyses, we applied one-to-four cohorts of those two groups using propensity score-matching methods addressing the imbalances of age, gender, weight, and smoking. The baseline clinical and biochemical data were compared. Logistic regression analysis was employed to investigate the CA-AKI risk factors. The receiver operating characteristic (ROC) curve was adopted to test the value of RDW in predicting CA-AKI after enhanced CT.

Results: 25 (3.96%) patients suffered from CA-AKI. Those subjects who developed CA-AKI had advanced age, severer renal functional injury, lower albumin, higher baseline RDW, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) than those without CA-AKI. It also exhibited more severe anemia including decreased hemoglobin and red blood cell count (all p < 0.05). The baseline RDW, albumin and PLR between the two groups were statistically significant different after PSM. Binary logistic regression analysis showed that baseline RDW, albumin and eGFR were correlated with CA-AKI after contrast-enhanced CT examination. The RDW exhibited moderated discrimination ability for predicting CA-AKI beyond eGFR, with an AUC of 0.803 (95% CI [0.702-0.90]) vs 0.765 (95% CI [0.70-0.83]).

Conclusion: Increased baseline RDW and decreased eGFR are risk factors for CA-AKI after enhanced CT. RDW exhibited good predictive value and can be used as an early warning marker for patients suffering from CA-AKI after enhanced CT.

Keywords: Computed tomography; Contrast associated acute kidney injury; Red blood cell distribution width.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury* / chemically induced
Humans
ROC Curve
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed* / adverse effects

Grants and funding

This work was supported by the Medical Scientific Research Foundation of Huizhou (No. 2020Y103). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.