Incidence of contrast-associated acute kidney injury (CA-AKI) in trauma patients undergoing contrast-enhanced computed tomography using iso-osmolar contrast media

OBJECTIVE: This study aimed to evaluate the incidence and severity of CA-AKI, and its predictive factors in trauma patients. MATERIALS AND METHODS: Trauma patients from the Regional Korea Trauma Center who underwent iodixanol-enhanced CT and were monitored for 72 hours post-scan were included. Demographics, co-morbidities, and lab results were collected. CA-AKI was defined by the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Severity of CA-AKI was classified by the risk, injury, failure, loss of kidney function, and end-stage renal failure (RIFLE) criteria. Trauma severity was assessed by the injury severity score (ISS) category. Predictive factors of CA-AKI were evaluated by univariate and multivariate logistic regression. RESULTS: Of 1115 patients undergoing iodixanol-enhanced CT, 799 with complete data were included. Overall CA-AKI incidence was 3.80% (30/799) and severe renal failure occurred in 2.87% (23/799). CA-AKI incidence by ISS category was 1.52% (minor), 3.95% (moderate), 42.30% (serious), and 75.0% (severe). Upon univariate analysis, significant predictive factors of CA-AKI included hypertension odds ratio (OR) 2.87, heart disease (OR 4.06), serious ISS (OR 47.50), and severe ISS (OR 194.33). Upon multivariate analysis, significant predictive factors were ISS serious category (OR 48.20), and ISS severe category (OR 245.22). CONCLUSION: In trauma patients who underwent iodixanol-enhanced CT, incidence of CA-AKI was considerably low at 3.8%, with trauma severity as a significant predictive factor. ADVANCES IN KNOWLEDGE: Iodixanol-enhanced CT demonstrates low CA-AKI incidence and favorable safety in trauma patients. These findings support its clinical utility in high-trauma cases where renal risk is elevated.