Acute Kidney Injury After Contrast-Enhanced Computed Tomography in The Emergency Department: Incidence and Clinically Predicted Risk Factors

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Abstract
Aim: This study aimed to determine the incidence of contrast-induced acute kidney injury (CI-AKI) and to identify the clinical factors associated with it in patients undergoing contrast-enhanced computed tomography (CECT) in the emergency department (ED).Material and Methods: This prospective observational study, reported in accordance with the STROBE statement, enrolled 125 consecutive adults (≥18 years) who underwent CECT in the ED between October 2023 and May 2024. The sample size was estimated a priori. CI-AKI was defined as an increase in serum creatinine of ≥0.5 mg/dL or ≥25% at 48–120 hours after contrast administration. Demographic, clinical, and laboratory variables were compared between patients who did and did not develop CI-AKI.Results: CI-AKI developed in 17 of 125 patients (13.6%, 95% confidence interval [CI] 8.7–20.7%). CI-AKI was not associated with age, sex, hemoglobin, diabetes, hypertension, coronary artery disease, heart failure, or contrast volume. Pre-procedural hypotension (p=0.001) and atrial fibrillation (p=0.031) were significantly associated with CI-AKI, and CI-AKI was more frequent among patients requiring intensive care unit (ICU) admission (31.6% vs 5.7%; risk difference 25.8%, 95% CI 11.5–42.0%; p=0.001), interpreted as a marker of illness severity rather than a pre-procedural predictor.Conclusion: CI-AKI occurred in 13.6% of ED patients undergoing CECT; pre-procedural hypotension and atrial fibrillation were significantly associated with its development.
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