Intravenous Contrast-Induced Nephropathy Risk in Acute Kidney Disease: Nationwide Taiwanese Cohort Study

Background: Current debate surrounds the clinical relevance of nephropathy post-iodinated contrast media (ICM) administration. Limited research exists on the specific impact of intravenous ICM on renal outcomes in acute kidney disease (AKD) patients. Methods: We conducted a nationwide retrospective cohort study in Taiwan from January 2015 to September 2022, identifying adult patients transitioning from acute dialysis to AKD status. Propensity score weighting and entropy balancing were used to minimize heterogeneity between contrast-enhanced computed tomography (CT) and non-contrast exposure groups. Primary outcome was redialysis, with MAKE as secondary outcomes, defined as redialysis or a ≥50% increase in serum creatinine from baseline AKD value. Follow-up extended up to one year. Results: A total of 19,505 AKD patients were included (mean age: 68.70 years, male 58.80%). Among them, 14.9% underwent intravenous ICM. Following propensity score weighting and entropy balancing adjustment, the ICM-exposed group did not exhibit a significantly elevated risk of redialysis compared to the non-contrast group (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.74–1.05) and entropy balancing adjustment (OR 0.81, 95% CI 0.69–0.94). Similarly, the risk of MAKE was not significantly different between the ICM and non-contrast groups (propensity score weighting: OR 1.00, 95% CI 0.88–1.12; entropy balancing: OR 0.94, 95% CI 0.84–1.05). Subgroup analysis for patients with an estimated glomerular filtration rate (eGFR) either ≥ 30 or <30 ml/min 1.73 m2 yielded similar results; for the patients with eGFR of ≥ 30 ml/min 1.73 m2, the OR of redialysis and MAKE were 0.93 (95% CI: 0.74-1.16) and 1.04 (95% CI: 0.92-1.18), respectively; for those with eGFR < 30 ml/min 1.73 m2, the OR of redialysis and MAKE were 1.15 (95% CI: 0.96-1.37) and 1.10 (95% CI: 0.95-1.30), respectively. Conclusion: In patients with AKD, intravenous administration of ICM for contrast-enhanced CT scans did not significantly increase the risk of redialysis or MAKE within one year