ArticleCureus2026
Risk Factors, Not Low-Osmolar Contrast, Predict Acute Kidney Injury Following Contrast-Enhanced Computed Tomography: A Comparative Retrospective Cohort Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe safety of a low-osmolar contrast agent, iopromide (Ultravist, Bayer, Leverkusen, Germany), currently being used is unknown. This study aimed to evaluate whether iopromide use was associated with acute kidney injury (AKI) in patients undergoing contrast-enhanced computed tomography (CT) imaging.
methodsThis retrospective cohort study included 1915 participants who had CT scans during 2023. AKI was defined as an absolute rise in serum creatinine (sCr) ≥26.5 µmol/L within 48 hours or ≥1.5 times increase from baseline within seven days. The differences in the means of pre-CT and post-CT sCr with and without contrast exposure were determined using the independent samples t-test and variance ratio (F-test). Paired t-test was used to find the mean difference between pre- and post-CT creatinine levels. Pearson's chi-squared (X
resultsOf 1915 participants who underwent CT imaging, 869 (45.4%) were exposed to contrast, while 1046 (54.6%) were not exposed to contrast. No statistically significant difference was found between exposed and non-exposed groups for the development of AKI (10.6% vs. 8.8%; p=0.188). Both groups were found to have lower mean post-procedure sCr compared to pre-procedure sCr (-2.2 and -12.7 µmol/L, respectively). The AKI occurrence was not directly associated with whether patients were exposed to iopromide or not (r=0.03; p=0.178). Noteworthy risk factors identified were active malignancy (aOR: 2.43; 95% CI: 1.54-3.84; p<0.001), pre-existing renal dysfunction (aOR: 2.31; 95% CI: 1.27-4.18; p=0.006), and cardiac disease (aOR: 2.09; 95% CI: 1.22-3.58; p=0.007).
conclusionUse of low-osmolar contrast agents for CT imaging was not independently associated with AKI. Our results suggest that contrast-enhanced CT may be considered when clinically indicated without unnecessary delay while acknowledging that individual patient risk assessment remains essential. Greater emphasis should instead be placed on identifying and optimizing certain factors, like active malignancy, pre-existing renal dysfunction, and cardiac diseases, to prevent CA-AKI.
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