Jennifer S. McDonald PhD, Presenter: Research Grant, General Electric Company

Robert J. McDonald MD, PhD, Abstract Co-Author: Nothing to Disclose

Caleb Brandon Leake BS, Abstract Co-Author: Nothing to Disclose

Rickey Carter PhD, Abstract Co-Author: Nothing to Disclose

Rajiv Gulati MD, PhD, Abstract Co-Author: Nothing to Disclose

Richard W. Katzberg MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Bayer AG Investigator, Siemens AG Investigator, Bayer AG

Eric E. Williamson MD, Abstract Co-Author: Research Grant, General Electric Company

David F. Kallmes MD, Abstract Co-Author: Research support, Terumo Corporation Research support, Covidien AG Research support, Sequent Medical, Inc Research support, Benvenue Medical, Inc Consultant, General Electric Company Consultant, Covidien AG Consultant, Johnson & Johnson

Purpose: Prior uncontrolled studies of contrast-induced nephropathy suggested that intra-arterial contrast administration is associated with a higher risk of acute kidney injury (AKI) compared to intravenous administration. We compared the risk of AKI following intravenous and intra-arterial contrast exposure in a cohort of patients that received both routes of contrast administration.

Materials and Methods: This retrospective study was HIPAA compliant and approved by our IRB. All patients who received both a contrast-enhanced CT or CT angiography scan and a diagnostic or interventional cardiac catheterization between 2000-2011 were identified. Patients who lacked sufficient pre- and post-procedure serum creatinine (SCr) results, who were on pre-existing renal dialysis, who underwent additional contrast-enhanced procedures within 14 days of either procedure, or whose baseline SCr changed more than 0.3 mg/dL between procedures were excluded. The incidence of AKI, defined as SCr ≥ 0.5mg/dl above baseline, was compared following CT scan and cardiac catheterization using McNemar’s test.

Results: A total of 1073 patients met all study inclusion criteria. The incidence of AKI following CT scan was similar to the incidence following catheterization when examining all patients (4.9% CT vs. 6.0% catheterization, p=.27). This similar AKI incidence was observed regardless of order of procedure (CT or catheterization) or type of cardiac catheterization performed (diagnostic or interventional).

Conclusion: In this paired cohort, the frequency of AKI following intra-arterial administration of iodinated contrast material is similar to the rate observed following intravenous contrast administration. These findings suggest that prior reports of excess incidence of AKI following intra-arterial contrast administration compared to intravenous administration may reflect differences in clinical status and baseline risk for AKI rather than differences in the nephrotoxic potential in these two routes of contrast administration.

Clinical Relevance: The nephrotoxic risk of intra-arterial contrast administration has been overstated in prior studies lacking a suitable control group.

McDonald, J, McDonald, R, Leake, C, Carter, R, Gulati, R, Katzberg, R, Williamson, E, Kallmes, D, Frequency of Acute Kidney Injury Following Intravenous and Intra-arterial Iodinated Contrast Material Administration in a Paired Cohort.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018478.html