RICHMOND, VA — The administration of iodinated contrast media is not responsible for all changes in creatinine levels in patients undergoing the procedures.
The recent report in the American Journal of Medicine pointed out that recent studies have challenged the reported causal association between acute kidney injury and iodinated contrast administration.1
A study from the Hunter Holmes McGuire VAMC and Virginia Commonwealth University demonstrated that some cases of changes in renal function are independent of contrast administration. Researchers from the Buffalo, NY, VAMC also participated in the research.
The study team focused on 1,779 consecutive patients undergoing right heart catheterization (RHC) at a VAMC.
“We compared the incidence of acute kidney injury and of nephropathy at 3 months in veterans undergoing right and left heart catheterization and coronary angiography (R&LHC) to the incidence of acute kidney injury and of nephropathy at 3 months in patients undergoing RHC only,” the authors explained.
The results indicated that the incidence of acute kidney injury at 3 days was 47 (9.7%) in the R&LHC group and 58 (9.6%) in the RHC group (P=0.99). In addition, the incidence of nephropathy at 3 months was 115 (17%) in the L&RHC group and 141 (19.2%) in the RHC group (P=0.31).
“In a propensity score-paired analysis of 782 patients and after adjustment for baseline characteristics, the odds ratio (OR) for acute kidney injury at 3 days among patients undergoing R&LHC was 1.25 (95% confidence interval (CI) 0.65, 2.42; P=0.50) and the OR for nephropathy at 3 months was (0.69; 95% CI 0.46, 1.04; P=0.08),” according to the article.
The researchers emphasized that the incidence of changes in creatinine consistent with acute kidney injury at 3 days and of nephropathy at 3 months “was not significantly different in patients undergoing R&LHC compared to patients undergoing RHC only. This supports the thesis that not all changes in creatinine after procedures involving administration of contrast are caused by the contrast.”
- Min A, Roy S, Chaturvedi A, Choxi R, Wasilewski M, Arora P, Perera RA, Jovin IS. Acute Kidney Injury and Patients Undergoing Both Right and Left Heart Catheterization with Coronary Angiography Versus Right Heart Catheterization Only. Am J Med. 2024 Jan 31:S0002-9343(24)00046-9. doi: 10.1016/j.amjmed.2024.01.011. Epub ahead of print. PMID: 38307150.
