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Negligible Risk of Acute Renal Failure Among Hospitalized Patients After Contrast-Enhanced Imaging With Iodinated Versus Gadolinium-Based Agents

Gorelik, Yuri, MD*; Yaseen, Hiba, PhD; Heyman, Samuel N., MD; Khamaisi, Mogher, MD, PhD*,†,§

doi: 10.1097/RLI.0000000000000534
Original Articles

Introduction The potential adverse renal outcome among patients undergoing iodine-based contrast-enhanced computerized tomography (CT) has been questioned recently, given the caution undertaken in patients' selection, hydration protocols, and the low radiocontrast volume, used with advanced imaging equipment.

Materials and Methods This study is a retrospective assessment of renal outcome in 12,580 hospitalized patients undergoing contrast-enhanced CT, compared with 754 patients subjected to gadolinium-based magnetic resonance imaging, with subsequent propensity matching for clinical characteristics and potential risk factors.

Results The risk of postcontrast acute kidney injury (PC-AKI) was found to be negligible as compared with patients undergoing enhanced magnetic resonance imaging studies, before and after propensity matching (8% vs 7.3% rate of AKI in the nonmatched iodine-based contrast agents [IBCAs] and gadolinium-based contrast agents [GBCAs], respectively, P = 0.3, and 7% in the matched IBCA group, P = 0.9), including comparisons among subgroups with well-defined risk factors such as chronic renal failure, diabetes, older age, and hypertension. However, lower systolic blood pressure before imaging was associated with higher risk to develop PC-AKI after IBCA administration but not with GBCA (for systolic blood pressure lower than 110 mm Hg, odds ratio for AKI after IBCA was 1.49; 95% confidence interval, 1.16–1.88, and after GBCA; odds ratio, 0.12; 95% confidence interval, 0.003–0.73).

Conclusions With the current precautions undertaken, the real-life risk of PC-AKI among inpatients undergoing CT is insignificant. Possible reasons for the diverse impact of blood pressure on the propensity to develop acute kidney failure after iodine-based but not gadolinium-based enhancement imaging are discussed.

From the *Internal Medicine D, Rambam Health Care Campus;

Institute of Endocrinology, Diabetes & Metabolism, Rambam Health Care Campus, Haifa;

Department of Medicine, Hadassah Hebrew University Hospital Mt. Scopus, Jerusalem; and

§The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel.

Received for publication September 24, 2018; and accepted for publication, after revision, October 17, 2018.

Conflicts of interest and sources of funding: none declared.

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Correspondence to: Samuel N. Heyman, MD, Department of Medicine, Hadassah Hebrew University Hospital, Mt Scopus, PO Box 24035, Jerusalem 91240, Israel. E-mail:

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