Acute kidney injury is a common complication in critically ill patients. One group often considered to have an increased risk of AKI are patients receiving iodine contrast media (ICM). The aim of this study was to investigate if ICM is associated with an increased incidence of AKI or long-term decline in renal function in critically ill patients. We hypothesized that ICM, in the form currently used to enhance CT, does not increase the risk of AKI or long-term decline in renal function.

This is a retrospective bicenter cohort study performed at Uppsala University Hospital, a tertiary university hospital and at Gävle sjukhus, a secondary county hospital. All patients referred to a CT examination from the general ICU at Uppsala University Hospital between January of 2013 and February of 2020, or at Gävle sjukhus from January of 2015 to December of 2017 were eligible for inclusion. The following exclusion criteria were used:

- ICU treatment

- Renal replacement therapy (RRT) before CT exam

- No plasma creatinine value for date of CT or any of the three following days

- Age

Plasma creatinine values were recorded at seven different times. The values were logged at three months before CT or earlier (referred to as the patient’s baseline value) at the day of ICU admission, at the day of the CT exam, daily for the first...

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Out of 7238 patients treated at any of the ICUs during the study period 1715 were referred for a CT. Out of those patients 611 patients had their first CT included (figure 1). The group who received ICM did not differ in gender distribution compared to the group not receiving ICM with slightly more than one third being women. The ICM group had a lower prevalence of AKI compared to baseline at the day of CT. They also had a lower prevalence of CKD. Regarding medical events and clinical markers, they had a lower SAPS III and plasma creatinine values both at baseline, day of CT and at follow-up. The groups did not differ in use of renal affecting and vasoactive drugs. Use of mechanical ventilation were also similar in both groups.

The unadjusted model demonstrates a significant association between AKI and ICM with an odds ratio of 0.53 (0.38-0.74, 95 % CI,...

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In this retrospective cohort study of critically ill subjects, no association was found between administration of ICM and AKI, based on both changes in plasma creatinine and urine output. Furthermore, ICM was not associated with long-term (>3 months) decrease in renal function. This indicates that a nephrotoxic effect of ICM used for CT in critically ill patients, if any, is weak and transient. These findings may be considered when weighing risks and benefits of performing ICM enhanced radiology in critically ill patients.