Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures
Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing...
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| description | Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare.
A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012-2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available.
During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p |
| doi_str_mv | 10.1186/s12882-016-0385-5 |
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A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012-2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available.
During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively).
This is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year.</description><identifier>ISSN: 1471-2369</identifier><identifier>EISSN: 1471-2369</identifier><identifier>DOI: 10.1186/s12882-016-0385-5</identifier><identifier>PMID: 27821094</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acute Disease ; Acute Kidney Injury - chemically induced ; Acute Kidney Injury - economics ; Acute Kidney Injury - epidemiology ; Acute Kidney Injury - therapy ; Aged ; Aged, 80 and over ; Cardiovascular diseases ; Cardiovascular Surgical Procedures - statistics & numerical data ; Chronic kidney failure ; Complications and side effects ; Contrast media ; Contrast Media - adverse effects ; Cross-Sectional Studies ; Diabetes Mellitus - epidemiology ; Diagnosis ; Dosage and administration ; Economic aspects ; Female ; France - epidemiology ; Health Care Costs ; Heart Failure - epidemiology ; Hospitalization - economics ; Hospitalization - statistics & numerical data ; Humans ; Incidence ; Iodine Compounds - adverse effects ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Nephrology ; Radiology, Interventional ; Renal Insufficiency, Chronic - epidemiology ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Shock, Cardiogenic - epidemiology</subject><ispartof>BMC nephrology, 2016-11, Vol.17 (1), p.167-167, Article 167</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-aa7009e0619a36e0bf15765f4a2a8651a842a5d81977f01046e53f37638b313a3</citedby><cites>FETCH-LOGICAL-c494t-aa7009e0619a36e0bf15765f4a2a8651a842a5d81977f01046e53f37638b313a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100322/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100322/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27821094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aubry, Pierre</creatorcontrib><creatorcontrib>Brillet, Georges</creatorcontrib><creatorcontrib>Catella, Laura</creatorcontrib><creatorcontrib>Schmidt, Aurélie</creatorcontrib><creatorcontrib>Bénard, Stève</creatorcontrib><title>Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures</title><title>BMC nephrology</title><addtitle>BMC Nephrol</addtitle><description>Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare.
A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012-2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available.
During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively).
This is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year.</description><subject>Acute Disease</subject><subject>Acute Kidney Injury - chemically induced</subject><subject>Acute Kidney Injury - economics</subject><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - therapy</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Surgical Procedures - statistics & numerical data</subject><subject>Chronic kidney failure</subject><subject>Complications and side effects</subject><subject>Contrast media</subject><subject>Contrast Media - adverse effects</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diagnosis</subject><subject>Dosage and administration</subject><subject>Economic aspects</subject><subject>Female</subject><subject>France - epidemiology</subject><subject>Health Care Costs</subject><subject>Heart Failure - epidemiology</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Iodine Compounds - adverse effects</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephrology</subject><subject>Radiology, Interventional</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Renal Replacement Therapy</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Shock, Cardiogenic - epidemiology</subject><issn>1471-2369</issn><issn>1471-2369</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptUstu1DAUjRCIlsIHsEGW2LAgxY7jxGGBVFW8pErdwNq6Y9_MeOrEgx9Fw3fxgThMKS1CXti6Pg_f61NVzxk9ZUx2byJrpGxqyrqacilq8aA6Zm3P6oZ3w8M756PqSYxbSlkvW_q4Omp62TA6tMfVz8uctJ8wvibBxisygk4-RAKzIRsElzZklYPBmfiRaD-nADHVdjZZoyGgc0JyZc2Me2LnbQ77t4VK_CpiuIZk_QyOxJTNfuH7GclknStlsvFxZxM4--M3LJLvtnjZCdZYr7M1RV1DMNZfQ9TZQSC74ItnDhifVo9GcBGf3ewn1dcP77-cf6ovLj9-Pj-7qHU7tKkG6CkdkHZsAN4hXY1M9J0YW2hAdoKBbBsQRrKh70fKaNuh4CPvOy5XnHHgJ9W7g-4uryY0Gpf2ndqF8sywVx6sun8z241a-2slGKW8aYrAqxuB4L9ljElNNmp0Dmb0OSomed9IweVQoC__gW59DmV8C6oVnLVF8i9qDQ6VnUdffPUiqs7angopOrmgTv-DKsvgZMsn4mhL_R6BHQg6-BgDjrc9MqqWqKlD1FSJmlqipkThvLg7nFvGn2zxX9eY0kI</recordid><startdate>20161108</startdate><enddate>20161108</enddate><creator>Aubry, Pierre</creator><creator>Brillet, Georges</creator><creator>Catella, Laura</creator><creator>Schmidt, Aurélie</creator><creator>Bénard, Stève</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161108</creationdate><title>Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures</title><author>Aubry, Pierre ; Brillet, Georges ; Catella, Laura ; Schmidt, Aurélie ; Bénard, Stève</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-aa7009e0619a36e0bf15765f4a2a8651a842a5d81977f01046e53f37638b313a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Disease</topic><topic>Acute Kidney Injury - chemically induced</topic><topic>Acute Kidney Injury - economics</topic><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - therapy</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Surgical Procedures - statistics & numerical data</topic><topic>Chronic kidney failure</topic><topic>Complications and side effects</topic><topic>Contrast media</topic><topic>Contrast Media - adverse effects</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diagnosis</topic><topic>Dosage and administration</topic><topic>Economic aspects</topic><topic>Female</topic><topic>France - epidemiology</topic><topic>Health Care Costs</topic><topic>Heart Failure - epidemiology</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Iodine Compounds - adverse effects</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nephrology</topic><topic>Radiology, Interventional</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Renal Replacement Therapy</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Shock, Cardiogenic - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aubry, Pierre</creatorcontrib><creatorcontrib>Brillet, Georges</creatorcontrib><creatorcontrib>Catella, Laura</creatorcontrib><creatorcontrib>Schmidt, Aurélie</creatorcontrib><creatorcontrib>Bénard, Stève</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aubry, Pierre</au><au>Brillet, Georges</au><au>Catella, Laura</au><au>Schmidt, Aurélie</au><au>Bénard, Stève</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures</atitle><jtitle>BMC nephrology</jtitle><addtitle>BMC Nephrol</addtitle><date>2016-11-08</date><risdate>2016</risdate><volume>17</volume><issue>1</issue><spage>167</spage><epage>167</epage><pages>167-167</pages><artnum>167</artnum><issn>1471-2369</issn><eissn>1471-2369</eissn><abstract>Despite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare.
A retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012-2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available.
During 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively).
This is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27821094</pmid><doi>10.1186/s12882-016-0385-5</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC nephrology, 2016-11, Vol.17 (1), p.167-167, Article 167 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; Springer Nature OA Free Journals; Springer Nature - Complete Springer Journals; PubMed Central |
| subjects | Acute Disease Acute Kidney Injury - chemically induced Acute Kidney Injury - economics Acute Kidney Injury - epidemiology Acute Kidney Injury - therapy Aged Aged, 80 and over Cardiovascular diseases Cardiovascular Surgical Procedures - statistics & numerical data Chronic kidney failure Complications and side effects Contrast media Contrast Media - adverse effects Cross-Sectional Studies Diabetes Mellitus - epidemiology Diagnosis Dosage and administration Economic aspects Female France - epidemiology Health Care Costs Heart Failure - epidemiology Hospitalization - economics Hospitalization - statistics & numerical data Humans Incidence Iodine Compounds - adverse effects Length of Stay - statistics & numerical data Male Middle Aged Nephrology Radiology, Interventional Renal Insufficiency, Chronic - epidemiology Renal Replacement Therapy Retrospective Studies Risk Factors Shock, Cardiogenic - epidemiology |
| title | Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures |
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