First name
Madhura
Last name
Pradhan

Title

Risk of Acute Kidney Injury Following Contrast-enhanced CT in a Cohort of 10 407 Children and Adolescents.

Year of Publication

2023

Number of Pages

e210816

Date Published

04/2023

ISSN Number

1527-1315

Abstract

Background Previous studies have challenged the concept of contrast material-induced acute kidney injury (AKI) in adults; however, limited data exist for children and adolescents. Purpose To calculate the incidence and determine the risks of AKI in patients who received intravenous iodinated contrast media for CT. Materials and Methods This retrospective study was performed at a children's hospital from January 2008 to January 2018 and included patients aged 0-17 years in whom serum creatinine levels were measured within 48 hours before and after CT with or without contrast media. The incidence of AKI was measured according to the AKI Network guidelines. A subgroup analysis with propensity score matching of cases with control patients was performed. Differences before and after stratification based on estimated glomerular filtration rate (eGFR) were explored. Adjusted risk models were developed using log-binomial generalized estimating equations to estimate relative risk (RR). Results From a total of 54 000 CT scans, 19 377 scans from 10 407 patients (median age, 8.5 years; IQR, 3-14; 5869 boys, 4538 girls) were included in the analysis. Incidence rate of AKI for the entire sample was 1.5%; it was 1.4% (123 of 8844) in the group that underwent contrast-enhanced CT and 1.6% (171 of 10 533) in the group that did not ( = .18). In the contrast-enhanced CT group, AKI incidence was higher in the group with eGFR of at least 60 mL/min/1.73 m and in the group with eGFR lower than 60 mL/min/1.73 m (1.3% and 8.5%, respectively; < .001) compared with the noncontrast group (0.1% and 2.7%, respectively; < .001). Age was found to be a protective factor against AKI, with an RR of 0.96 (95% CI: 0.94, 0.99; = .01), and contrast media increased risk in the subgroup analysis, with an RR of 2.19 (95% CI: 1.11, 4.35; = .02). Conclusion The overall incidence of acute kidney injury after contrast-enhanced CT in children and adolescents was very low, and exposure to contrast media did not increase the risk consistently for acute kidney injury among different groups and analyses. © RSNA, 2022 See also the editorial by McDonald in this issue.

DOI

10.1148/radiol.210816

Alternate Title

Radiology

PMID

36472537
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Title

Heart Retransplant Recipients Have Better Survival With Concurrent Kidney Transplant Than With Heart Retransplant Alone.

Year of Publication

2015

Number of Pages

Date Published

2015 Dec

ISSN Number

2047-9980

Abstract

<p><strong>BACKGROUND: </strong>Heart retransplant (HRT) recipients represent a growing number of transplant patients. The impact of concurrent kidney transplants (KTs) in this population has not been well studied. We tested the hypothesis that recipients of HRT with concurrent KT (HRT-KT) would have worse survival than recipients of HRT alone.</p>

<p><strong>METHODS AND RESULTS: </strong>A retrospective analysis of the United Network of Organ Sharing database was performed for all patients undergoing HRT from 1987 to 2011. There were 1660 HRT patients, of which 116 (7%) received concurrent KT. Those who received HRT-KT had older age, longer wait-list time, worse kidney function, and more known diabetes. Survival among recipients of HRT-KT was significantly better than that of recipients of HRT alone (P=0.005). A subgroup of 323 HRT patients with severe kidney dysfunction (estimated glomerular filtration rate &lt;30 mL/min per 1.73 m(2) or on dialysis) was studied in more detail, and 76 (24%) received concurrent KT. Those on dialysis at the time of HRT had better survival with versus without concurrent KT (P&lt;0.0001). On multivariable analysis, concurrent KT was independently associated with better outcomes for all patients with HRT and for the subgroup of patients with severe kidney dysfunction.</p>

<p><strong>CONCLUSIONS: </strong>Recipients of HRT-KT have better survival than recipients of HRT alone. Further research is needed to determine which HRT patients may benefit the most from concurrent KT.</p>

DOI

10.1161/JAHA.115.002435

Alternate Title

J Am Heart Assoc

PMID

26656863
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