Iodinated contrast safe for imaging critically ill patients
Contrast-enhanced CT imaging can be safely completed on critically ill patients without significantly increasing the likelihood of renal harm.
Historically, acute kidney injury was a concern for patients receiving iodinated contrast, as research at the time suggested that exposure could cause kidney dysfunction, especially in individuals with a history of nephropathy or in those who were deemed critically ill. However, the latest research has largely absolved the use of contrast in patients with kidney problems, particularly when newer agents are used. Despite this, many continue to practice more caution with critically ill patients since they are more vulnerable to acute kidney injury.
A new study published in Emergency Radiology is offering additional reassurance for those who utilize contrasted CT scans for sicker subjects. The investigation found no significant difference in the incidence of creatinine-defined acute kidney injury between patients who underwent contrast-enhanced CT and those who received noncontrast scans.
The retrospective study used information from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and analyzed the cases of more than 7,700 critically ill adults. It included adults who underwent CT during or immediately before intensive care admission and used patients’ electronic health records to determine post-imaging outcomes.
Of the 7,772 patients included, 5,319 underwent CT with contrast and another 2,453 went without it. Acute kidney injury within 48 hours occurred in 19.3% of patients in the contrast-enhanced group compared with 20.4% of those who underwent scans without it, indicating that the issues were likely not associated with the contrast itself, but more likely the patients’ general deterioration. To that end, the researchers found no association between contrast administration and acute kidney injury when examining outcomes through 72 hours or cumulatively through seven days. Contrast-enhanced CT was likewise not associated with time to first kidney injury, renal replacement therapy within seven days, or longitudinal changes in creatinine levels.
For radiology departments, the findings could have implications for decisions about withholding contrast in critically ill patients solely because of concerns about nephrotoxicity, researchers suggested. The study does not establish that contrast is universally safe for patients at risk of acute kidney injury, but it suggests that the perceived renal risk of contrast should be considered alongside the diagnostic value of enhanced imaging and the patient's overall clinical condition.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.