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Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures.
BMC Nephrol 2016; 17(1):167BN

Abstract

BACKGROUND

Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare.

METHODS

A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012-2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available.

RESULTS

During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively).

CONCLUSIONS

This is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year.

Authors+Show Affiliations

Hôpital Bichat-Claude Bernard, Paris, France.Centre de néphrologie de Châteauroux, Châteauroux, France.st[è]ve consultant, 30 rue Narcisse Bertholey, 69600, Oullins, France. lcatella@steve-consultants.com.st[è]ve consultant, 30 rue Narcisse Bertholey, 69600, Oullins, France.st[è]ve consultant, 30 rue Narcisse Bertholey, 69600, Oullins, France.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27821094

Citation

Aubry, Pierre, et al. "Outcomes, Risk Factors and Health Burden of Contrast-induced Acute Kidney Injury: an Observational Study of One Million Hospitalizations With Image-guided Cardiovascular Procedures." BMC Nephrology, vol. 17, no. 1, 2016, p. 167.
Aubry P, Brillet G, Catella L, et al. Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures. BMC Nephrol. 2016;17(1):167.
Aubry, P., Brillet, G., Catella, L., Schmidt, A., & Bénard, S. (2016). Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures. BMC Nephrology, 17(1), p. 167.
Aubry P, et al. Outcomes, Risk Factors and Health Burden of Contrast-induced Acute Kidney Injury: an Observational Study of One Million Hospitalizations With Image-guided Cardiovascular Procedures. BMC Nephrol. 2016 11 8;17(1):167. PubMed PMID: 27821094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures. AU - Aubry,Pierre, AU - Brillet,Georges, AU - Catella,Laura, AU - Schmidt,Aurélie, AU - Bénard,Stève, Y1 - 2016/11/08/ PY - 2016/07/29/received PY - 2016/10/30/accepted PY - 2016/11/9/entrez PY - 2016/11/9/pubmed PY - 2017/11/8/medline KW - Acute kidney injury KW - Cardiovascular procedure KW - Contrast media KW - Cost analysis KW - Epidemiology SP - 167 EP - 167 JF - BMC nephrology JO - BMC Nephrol VL - 17 IS - 1 N2 - BACKGROUND: Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare. METHODS: A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012-2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available. RESULTS: During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively). CONCLUSIONS: This is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/27821094/Outcomes_risk_factors_and_health_burden_of_contrast_induced_acute_kidney_injury:_an_observational_study_of_one_million_hospitalizations_with_image_guided_cardiovascular_procedures_ L2 - https://www.biomedcentral.com/1471-2369/17/167 DB - PRIME DP - Unbound Medicine ER -