An evaluation of the relationship between traumatic injuries and the development of contrast-associated acute kidney injury

Abstract

Background

Intravenous contrast media-enhanced computed tomography is vitally important in the early identification of traumatic injuries. Contrast media, however, has the propensity to promote nephrotoxicity. Age, injury severity score, renal dysfunction, and hypotension upon presentation are factors associated with contrast-associated acute kidney injury in current trauma literature. This study endeavors to expand upon these findings and evaluate the relationship between traumatic injuries and contrast-associated acute kidney injury.

Methods

This is a retrospective cohort study conducted at a Level 1 Trauma Center between January 2005 and August 2013. Patients identified by the institution’s Trauma Registry were divided into two groups: contrast-associated acute kidney injury-positive and negative based on previously published definitions.

Results

The analysis consisted of 831 intensive care patients; 161 contrast-associated acute kidney injury-positive and 670 contrast-associated acute kidney injury-negative. Logistic regression using significant findings from univariate comparisons between the study groups indicated that genitourinary (OR = 2.859, 95% CI 1.587–5.152, p = 0.000), arterial injuries (OR = 2.464, 95% CI 1.294–4.690, p = 0.006), and concomitant exposure to medications that are potentially nephrotoxic or alter renal hemodynamics (OR = 1.483, 95% CI 1.018–2.158, p = 0.040) were independent risk factors for contrast-associated acute kidney injury. Increasing revised trauma score (OR = 0.874, 95% CI 0.790–0.966, p = 0.009) and fluid administration prior to contrast (OR = 0.445, 95% CI 0.301–0.656, p = 0.000) were independently associated with decreased risk of contrast-associated acute kidney injury.

Conclusion

The risk of contrast-associated acute kidney injury increases with escalating injury severity. Unless contraindicated, fluids should be administered prior to contrast, and concomitant exposure to agents that may increase the potential for contrast-associated acute kidney injury should be limited. These practices are increasingly important in patients presenting with arterial or genitourinary trauma.

Keywords

Traumatic injuries contrast-associated acute kidney injury risk factors

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