Contrast Media in Hospitalized Patients with AKI: Renal and Clinical Outcomes

Hospital teams often weigh diagnostic yield against renal risk when considering iodinated contrast in patients with acute kidney injury (AKI). In Contrast Media in Hospitalized Patients with AKI, the authors reported renal and in-hospital outcomes among adults with established AKI who underwent CT imaging with intravenous contrast or without contrast.

A total of 481 patients were analyzed, including 282 who received intravenous contrast and 188 who underwent CT without contrast. Outcomes focused on short-term changes in kidney function after imaging and in-hospital clinical endpoints, outlining how recovery and other events were defined and assessed between groups.

The authors described the work as a prospective observational cohort enrolling patients between January 2023 and March 2024. The primary endpoint was renal recovery within 7 days, defined as return of serum creatinine to baseline. Secondary outcomes were renal improvement within 72 hours, dialysis requirement after CT, hospital length of stay, and in-hospital mortality. For comparative analyses, the authors’ main approach was adjustment using inverse probability weighting, with propensity-score matching presented as a secondary robustness analysis. These methods were used to compare outcomes between contrast and non-contrast imaging groups, without detailing care protocols or imaging indications in the primary outcome definition.

In the authors’ inverse probability weighting analysis, renal recovery within 7 days was reported in 61.7% of patients who received intravenous contrast versus 47.3% of those who did not (OR 1.7, 95% CI 1.0–2.97; p = 0.05). The authors interpreted these findings as not showing worse renal outcomes associated with intravenous contrast administration in this cohort of hospitalized patients with established AKI. The authors concluded that intravenous contrast administration was not associated with worse renal or clinical outcomes in this cohort, suggesting that contrast-enhanced CT may be acceptable in selected clinical settings. Overall, interpretation was presented as grounded in adjusted comparisons between the contrast and non-contrast CT groups within the enrolled cohort.

Across secondary endpoints, the authors reported that renal improvement at 72 hours, dialysis after CT, length of stay, and in-hospital mortality were similar between the contrast and non-contrast groups, with a similar pattern noted in the propensity-score matched analysis. They also reported multivariable associations within the overall cohort identifying factors linked to recovery: higher AKI stage and the presence of acute tubular injury were independently associated with lower odds of renal recovery. These predictor findings were presented alongside the outcome comparisons rather than as subgroup-interaction results, and no additional endpoints were introduced in that context.

Taken together, the study reported broadly similar in-hospital secondary outcomes between groups while highlighting baseline AKI severity and acute tubular injury as characteristics associated with reduced odds of recovery.

Key Takeaways:

• In a prospective cohort of hospitalized adults with AKI (Jan 2023–Mar 2024), outcomes after contrast-enhanced CT were compared with outcomes after non-contrast CT using renal recovery at 7 days and renal improvement at 72 hours time windows.
• Using IPW adjustment, the authors reported higher 7-day renal recovery in the contrast group (OR 1.7, 95% CI 1.0–2.97; p = 0.05) and interpreted the overall findings as not showing worse renal outcomes associated with contrast in this cohort.
• Secondary outcomes were reported as similar between groups and consistent in propensity-score matched analyses, while higher AKI stage and acute tubular injury were reported as independently associated with lower odds of recovery.