Incidence and predictors of postcontrast acute kidney injury following computed tomography angiography and bronchial artery embolization in hemoptysis patients

Performing computed tomography angiography (CTA) before emergency bronchial artery embolization (BAE) plays a critical role in improving the hemoptysis-free survival rate in patients with hemoptysis, but excessive contrast medium may lead to kidney injury deficits within a short duration. In this study, we examined the incidence and predictors of postcontrast acute kidney injury (CA-AKI) when CTA and BAE were performed sequentially to manage hemoptysis. A retrospective review was conducted on consecutive patients with hemoptysis who underwent emergent CTA and BAE treatment from January 2015 to June 2024. Acute kidney injury(AKI)was assessed at 24 to 72 hours following BAE and was defined as a rise of 26.5 mol/L in serum creatinine from baseline or “1.5-fold” increase in serum creatinine. A Cox proportional hazards regression model was used to identify predictors of postcontrast acute kidney injury. The final analysis included 171 patients (mean ± SD age 65.9 ± 11.8 years; 109 females). Postcontrast acute kidney injury occurred in 13/171 (7.6%) patients. None of them required renal replacement therapy. The multivariate analysis results revealed that age over 75 years (HR 3.84(95% CI 1.56–5.42; P = 0.001), diabetes mellitus (HR 3.51, 95% CI 1.45–3.65; P = 0.022), chronic kidney disease(HR 4.86, 95% CI 2.29–12.88; P = 0.001), and a glomerular filtration rate < 30 mL/min/1.73 m2 (HR 4.86, 95% CI 2.29–12.88; P = 0.001) were independent risk factors for postcontrast acute kidney injury. The incidence of postcontrast acute kidney injury after sequential CTA and BAE is increased in patients with poor baseline renal function (glomerular filtration rate<30 mL/min/1.73 m2), especially those over 75 years of age with diabetes mellitus. However, we did not observe irreversible postoperative deterioration of kidney function in the patients. CTA and BAE should not be delayed by advanced age and renal insufficiency in patients with hemoptysis.