Incidence of acute kidney injury among high-risk adult patients undergoing iso-osmolar contrasted computed tomography scans at three selected centers in Kampala

Abstract

Introduction: With the increased need for medical imaging in Uganda, the use of iodinated contrast media (CM) has increased greatly. Whether iso-osmolar contrast media (IOCM) is safe for use in high-risk adult patients in our setting is unknown as no studies have been carried out in this line in Uganda while studies done in other countries show great variability among the different populations. Objective: This study seeks to ascertain the incidence of contrast-induced acute kidney injury (CIAKI) and other adverse effects among high-risk adult patients undergoing iso-osmolar contrasted Computed Tomography (CT) scans at three selected centers in Kampala to come up with appropriate recommendations can be made. Methodology: This was a prospective descriptive cohort study that consecutively enrolled patients 18years and above. Questionnaires were used to collect patients’ clinical and examination findings. Blood samples were collected before and within 48 hours of administration of iso-osmolar contrast media (IOCM) to assess changes in serum creatinine. Data obtained was analyzed at univariate, bivariate and multivariate level using STATA version 17.0. Those found to have ≥ 0.5mg/dl absolute increase in serum creatinine from the baseline within 48 hours of contrast administration were considered to have developed contrast-induced acute kidney injury (CIAKI) and referred to an appropriate clinician for further management. All independent factors that had a Chi-square p-value less than 0.2 level of significance (80% Confidence Interval) were considered to have an association with the development of CIAKI. At the multivariate analysis all factors with a p-value less than 0.05 were considered to be statistically significant. Results: 223 consenting high-risk adult patients referred were enrolled. The mean age of participants was 56.5 (SD 14.5) years, 52.5% (117) were female. The incidence of CIAKI was estimated to be 9% (20/223). The common adverse effects experienced were mild pain at injection site, nausea and vomiting. There were no factors that were independently associated with development of CIAKI in this study. Conclusion: In this study of IOCM use in high-risk adult patients, the incidence of CIAKI was 9%. There were no factors significantly associated with the development of CIAKI. IOCM should therefore be considered safe for use among high-risk adult patients undergoing contrasted CT scan exams.