Researchers from the Mayo Clinic Rochester performed a retrospective study of data from 5758 adults with chronic kidney disease (CKD; stages 1−5) who underwent either noncontrast CT or iodixanol-enhanced contrast CT and who had pre- and post-CT serum creatinine measurements. All of the CT scans were performed with iodixanol, the iso-osmolar agent that generally was being used for patients perceived to be at high risk for postcontrast acute kidney injury (AKI).
Propensity-score matching yielded contrast-exposed and noncontrast groups (≈1500 patients in each group) who were statistically very similar on a broad range of clinical and demographic variables, including baseline renal function. Contrast exposure was not associated with excess AKI incidence, need for dialysis, or mortality — regardless of baseline renal function. Although relatively few patients with CKD stages 4 and 5 could be propensity-matched (76 contrast-exposed patients vs. 198 noncontrast patients), no hint of contrast-associated worsening of renal function was apparent even in these patients with advanced renal disease. An additional analysis of data from Mayo Clinic sites in Florida and Arizona yielded similar findings.
McDonald JS et al. Is intravenous administration of iodixanol associated with increased risk of acute kidney injury, dialysis, or mortality? A propensity score–adjusted study. Radiology 2017 Nov; 285:414.