Hypotension in patients on arrival to the emergency department is associated with an increased risk for post-contrast acute kidney injury following computed tomography (CT) with contrast media, according to a recent study.

Jo Yoshizawa, MD, of Keio University School of Medicine in Tokyo, Japan, and colleagues studied 262 patients who underwent CT with contrast media at an emergency department. They classified patients into 2 groups based on systolic blood pressure on arrival: less than 80 mm Hg (transient hypotension) or 80 mm Hg or higher (normotension). Dr Yoshizawa’s team explained that they considered hypotension to be transient because CT with contrast media has always been performed following stabilization of patients, with systolic blood pressure increased to more than 90 mm Hg with fluid resuscitation.

The investigators defined post-contrast acute kidney injury as an absolute increase in serum creatinine level by 0.5 mg/dL or higher or a 25% or greater increase in serum creatinine from baseline within 72 hours after CT with contrast media.

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The incidence of post-contrast acute kidney injury was higher in the transient hypotension group than the normotension group (28.6% vs 10.2%), the investigators reported in Nephron. Transient hypotension was significantly associated with nearly 3.1-fold increased odds of post-contrast acute kidney injury compared with normotension in adjusted analyses.

Dr Yoshizawa and colleagues observed a significant association between post-contrast acute kidney injury and transient hypotension in subgroup analyses. Transient hypotension vs normotension was significantly associated with 24.4-fold greater odds of post-contrast acute kidney injury among patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m2, 2.9-fold greater odds among patients aged 65 years or older, 6.8-fold greater odds among patients with anemia, and 3.6-fold greater odds among patients with an APACHE II score less than 18.

The authors concluded that their results “suggest that transient hypotension in the [emergency department] was associated with the development of [post-contrast acute kidney injury] after the usage of contrast media. Therefore, a careful risk-benefit discussion must be performed before conducting CT with contrast for patients with hypotension on hospital arrival.”


Yoshizawa J, Yamamoto R, Homma K, et al. Hypotension at hospital presentation and post-contrast acute kidney injury following computed tomography with contrast media. Nephron. Published online September 12, 2022. doi:10.1159/000526268