Major Adverse Events One Year after Acute Kidney Injury after Contrast-Enhanced Computed Tomography

Alice Mitchell, Jeffrey Kline, Alan E. Jones, James A. Tumlin

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Study objective Recent studies have demonstrated that a single episode of acute kidney injury from a number of causes can increase the risk of severe long-term outcomes, including major cardiovascular events and death. We tested the hypothesis that patients who develop acute kidney injury consistent with contrast-induced nephropathy after contrast-enhanced computed tomography (CT) imaging are at increased risk of major adverse events at 1 year. Methods We followed a prospective, heterogeneous cohort of consecutive emergency department patients undergoing contrast-enhanced CT for the outcomes of acute kidney injury consistent with contrast-induced nephropathy and major adverse events, defined as the combined outcome of death (all cause), renal failure, myocardial infarction, and stroke or other arterial vascular events, in any anatomic territory, requiring invention within 1 year. The primary outcome, major adverse events, was determined by the consensus of 2 of 3 blinded adjudicators. Results We followed 633 patients undergoing contrast-enhanced CT, of whom 11% developed acute kidney injury consistent with contrast-induced nephropathy and 15% (95/633; 95% confidence interval [CI] 12% to 18%) experienced at least 1 major adverse event within 1 year, including 7% (46/633; 95% CI 5% to 9%) who died. The development of acute kidney injury after contrast-enhanced CT was associated with an increased risk of 1-year major adverse event: the incident risk ratio was 4.01 (95% CI 2.61 to 6.05) and was 2.36 (95% CI 1.49 to 3.75) after adjusting for age, existing coronary artery disease, active malignancy, and 1 or more additional exposures to intravascular iodinated contrast media. Conclusion The development of acute kidney injury after contrast-enhanced CT was associated with a 2-fold increase in 1-year major adverse events. Further research is needed to validate this observation.

Original languageEnglish (US)
Pages (from-to)267-274.E4
JournalAnnals of Emergency Medicine
Volume66
Issue number3
DOIs
StatePublished - Sep 1 2015

Fingerprint

Acute Kidney Injury
Tomography
Confidence Intervals
Contrast Media
Renal Insufficiency
Blood Vessels
Hospital Emergency Service
Coronary Artery Disease
Cause of Death
Stroke
Odds Ratio
Myocardial Infarction
Research
Neoplasms

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Major Adverse Events One Year after Acute Kidney Injury after Contrast-Enhanced Computed Tomography. / Mitchell, Alice; Kline, Jeffrey; Jones, Alan E.; Tumlin, James A.

In: Annals of Emergency Medicine, Vol. 66, No. 3, 01.09.2015, p. 267-274.E4.

Research output: Contribution to journalArticle

@article{ce8f5256d3f44e0b9a269480156c9e79,
title = "Major Adverse Events One Year after Acute Kidney Injury after Contrast-Enhanced Computed Tomography",
abstract = "Study objective Recent studies have demonstrated that a single episode of acute kidney injury from a number of causes can increase the risk of severe long-term outcomes, including major cardiovascular events and death. We tested the hypothesis that patients who develop acute kidney injury consistent with contrast-induced nephropathy after contrast-enhanced computed tomography (CT) imaging are at increased risk of major adverse events at 1 year. Methods We followed a prospective, heterogeneous cohort of consecutive emergency department patients undergoing contrast-enhanced CT for the outcomes of acute kidney injury consistent with contrast-induced nephropathy and major adverse events, defined as the combined outcome of death (all cause), renal failure, myocardial infarction, and stroke or other arterial vascular events, in any anatomic territory, requiring invention within 1 year. The primary outcome, major adverse events, was determined by the consensus of 2 of 3 blinded adjudicators. Results We followed 633 patients undergoing contrast-enhanced CT, of whom 11{\%} developed acute kidney injury consistent with contrast-induced nephropathy and 15{\%} (95/633; 95{\%} confidence interval [CI] 12{\%} to 18{\%}) experienced at least 1 major adverse event within 1 year, including 7{\%} (46/633; 95{\%} CI 5{\%} to 9{\%}) who died. The development of acute kidney injury after contrast-enhanced CT was associated with an increased risk of 1-year major adverse event: the incident risk ratio was 4.01 (95{\%} CI 2.61 to 6.05) and was 2.36 (95{\%} CI 1.49 to 3.75) after adjusting for age, existing coronary artery disease, active malignancy, and 1 or more additional exposures to intravascular iodinated contrast media. Conclusion The development of acute kidney injury after contrast-enhanced CT was associated with a 2-fold increase in 1-year major adverse events. Further research is needed to validate this observation.",
author = "Alice Mitchell and Jeffrey Kline and Jones, {Alan E.} and Tumlin, {James A.}",
year = "2015",
month = "9",
day = "1",
doi = "10.1016/j.annemergmed.2015.04.028",
language = "English (US)",
volume = "66",
pages = "267--274.E4",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Major Adverse Events One Year after Acute Kidney Injury after Contrast-Enhanced Computed Tomography

AU - Mitchell, Alice

AU - Kline, Jeffrey

AU - Jones, Alan E.

AU - Tumlin, James A.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Study objective Recent studies have demonstrated that a single episode of acute kidney injury from a number of causes can increase the risk of severe long-term outcomes, including major cardiovascular events and death. We tested the hypothesis that patients who develop acute kidney injury consistent with contrast-induced nephropathy after contrast-enhanced computed tomography (CT) imaging are at increased risk of major adverse events at 1 year. Methods We followed a prospective, heterogeneous cohort of consecutive emergency department patients undergoing contrast-enhanced CT for the outcomes of acute kidney injury consistent with contrast-induced nephropathy and major adverse events, defined as the combined outcome of death (all cause), renal failure, myocardial infarction, and stroke or other arterial vascular events, in any anatomic territory, requiring invention within 1 year. The primary outcome, major adverse events, was determined by the consensus of 2 of 3 blinded adjudicators. Results We followed 633 patients undergoing contrast-enhanced CT, of whom 11% developed acute kidney injury consistent with contrast-induced nephropathy and 15% (95/633; 95% confidence interval [CI] 12% to 18%) experienced at least 1 major adverse event within 1 year, including 7% (46/633; 95% CI 5% to 9%) who died. The development of acute kidney injury after contrast-enhanced CT was associated with an increased risk of 1-year major adverse event: the incident risk ratio was 4.01 (95% CI 2.61 to 6.05) and was 2.36 (95% CI 1.49 to 3.75) after adjusting for age, existing coronary artery disease, active malignancy, and 1 or more additional exposures to intravascular iodinated contrast media. Conclusion The development of acute kidney injury after contrast-enhanced CT was associated with a 2-fold increase in 1-year major adverse events. Further research is needed to validate this observation.

AB - Study objective Recent studies have demonstrated that a single episode of acute kidney injury from a number of causes can increase the risk of severe long-term outcomes, including major cardiovascular events and death. We tested the hypothesis that patients who develop acute kidney injury consistent with contrast-induced nephropathy after contrast-enhanced computed tomography (CT) imaging are at increased risk of major adverse events at 1 year. Methods We followed a prospective, heterogeneous cohort of consecutive emergency department patients undergoing contrast-enhanced CT for the outcomes of acute kidney injury consistent with contrast-induced nephropathy and major adverse events, defined as the combined outcome of death (all cause), renal failure, myocardial infarction, and stroke or other arterial vascular events, in any anatomic territory, requiring invention within 1 year. The primary outcome, major adverse events, was determined by the consensus of 2 of 3 blinded adjudicators. Results We followed 633 patients undergoing contrast-enhanced CT, of whom 11% developed acute kidney injury consistent with contrast-induced nephropathy and 15% (95/633; 95% confidence interval [CI] 12% to 18%) experienced at least 1 major adverse event within 1 year, including 7% (46/633; 95% CI 5% to 9%) who died. The development of acute kidney injury after contrast-enhanced CT was associated with an increased risk of 1-year major adverse event: the incident risk ratio was 4.01 (95% CI 2.61 to 6.05) and was 2.36 (95% CI 1.49 to 3.75) after adjusting for age, existing coronary artery disease, active malignancy, and 1 or more additional exposures to intravascular iodinated contrast media. Conclusion The development of acute kidney injury after contrast-enhanced CT was associated with a 2-fold increase in 1-year major adverse events. Further research is needed to validate this observation.

UR - http://www.scopus.com/inward/record.url?scp=84940453292&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940453292&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2015.04.028

DO - 10.1016/j.annemergmed.2015.04.028

M3 - Article

VL - 66

SP - 267-274.E4

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 3

ER -