Choi Byungjin, Heo Subin, Mcdonald Jennifer S, Choi Sang Hyun, Choi Won-Mook, Lee Jung Bok, Lee Eunyoung Angela, Park Seong Ho, Seol Soobeen, Gan Sujin, Park Bumhee, Choi Hee Jung, Kim Byoung Je, Rhee Sang Youl, Hong Seung Baek, Kim Kyung-Hee, Lee Young Hwan, Kim Seung Soo, Park Rae Woong
From the Department of Biomedical Informatics, Ajou University Graduate School of Medicine, Suwon, South Korea (B.C., S.S., S.G., B.P., R.W.P.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H., S.H.C., S.H.P.); Department of Radiology, Mayo Clinic Rochester, Rochester, MN (J.S.M.); Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (W.-M.C.); Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.B.L.); Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (E.A.L.); Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea (B.P.); Department of Nephrology, Ajou University School of Medicine, Suwon, South Korea (H.J.C.); Department of Radiology, Keimyung University, Dongsan Hospital, Daegu, South Korea (B.J.K.); Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea (S.Y.R.); Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (S.B.H.); Division of Cardiology, Incheon Sejong Hospital, Incheon, South Korea (K.-H.K.); Department of Radiology, School of Medicine, Catholic University of Daegu, South Korea (Y.H.L.); and Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Chungcheongnam-do, South Korea (S.S.K.).
Invest Radiol. 2025 Jun 1;60(6):376-386. doi: 10.1097/RLI.0000000000001141. Epub 2024 Nov 28.
Concern about contrast-induced acute kidney injury (CI-AKI) may delay the timely administration of contrast media for computed tomography (CT). The precise causative effect of iodinated contrast media on CI-AKI and its relevant risk factors remains an area of ongoing investigation. Therefore, this study aimed to determine the risk of CI-AKI following contrast-enhanced CT and its predisposing risk factors.
This study employed a 1:1 propensity score matching analysis using electronic medical records gathered between January 2006 and December 2022 from 16 institutions in South Korea. Contrast-enhanced and nonenhanced CT scans in patients aged 18 years and above were matched for baseline estimated glomerular filtration rate (eGFR), demographic characteristics, and clinical variables to assess the risk of CI-AKI. Subgroup analyses were conducted to evaluate any significant risk factors for CI-AKI.
A total of 182,170 CT scans with contrast were matched to 182,170 CT scans without contrast. The risk of CI-AKI in the entire study cohort was not statistically significant (odds ratio [OR], 1.036; 95% confidence interval [CI], 0.968-1.109; P = 0.34). Subgroup analyses revealed a significantly higher risk of CI-AKI in patients with eGFR <30 mL/min/1.73m 2 (OR, 1.176; 95% CI, 1.080-1.281; P = 0.011) or eGFR 30-45 mL/min/1.73m 2 (OR, 1.139; 95% CI, 1.043-1.244; P = 0.019), patients diagnosed with chronic kidney disease (OR, 1.215; 95% CI, 1.084-1.361; P = 0.011), and those administered with iso-osmolar contrast media (OR, 1.392; 95% CI, 1.196-1.622; P = 0.011).
The risk of CI-AKI following CT was minimal in the general population. However, caution is warranted for patients with chronic kidney disease and eGFR lower than 45 mL/min/1.73m 2 , or those administered with iso-osmolar contrast media.
对造影剂诱导的急性肾损伤（CI-AKI）的担忧可能会延迟计算机断层扫描（CT）造影剂的及时使用。碘化造影剂对CI-AKI的确切致病作用及其相关危险因素仍是一个正在研究的领域。因此，本研究旨在确定增强CT后发生CI-AKI的风险及其易感危险因素。
本研究采用1:1倾向评分匹配分析，使用2006年1月至2022年12月期间从韩国16家机构收集的电子病历。对18岁及以上患者的增强CT扫描和非增强CT扫描进行基线估计肾小球滤过率（eGFR）、人口统计学特征和临床变量的匹配，以评估CI-AKI的风险。进行亚组分析以评估CI-AKI的任何显著危险因素。
总共182,170次增强CT扫描与182,170次非增强CT扫描进行了匹配。整个研究队列中CI-AKI的风险无统计学意义（优势比[OR]，1.036；95%置信区间[CI]，0.968 - 1.109；P = 0.34）。亚组分析显示，eGFR <30 mL/min/1.73m²（OR，1.176；95% CI，1.080 - 1.281；P = 0.011）或eGFR 30 - 45 mL/min/1.73m²（OR，1.139；95% CI，1.043 - 1.244；P = 0.019）的患者、被诊断为慢性肾病的患者（OR，1.215；95% CI，1.084 - 1.361；P = 0.011）以及接受等渗造影剂的患者（OR，1.392；95% CI，1.196 - 1.622；P = 0.011）发生CI-AKI的风险显著更高。
在一般人群中，CT后发生CI-AKI的风险极小。然而，对于慢性肾病患者、eGFR低于45 mL/min/1.73m²的患者或接受等渗造影剂的患者，仍需谨慎。
