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Background <p>To compare the risk of contrast-associated acute kidney injury (CA-AKI) caused by iso-osmolarity contrast media (IOCM) and low-osmolarity contrast media (LOCM) in pediatric patients.</p> Methods <p>A retrospective cohort exposed to contrast-enhanced CT was constructed based on the inpatients from Beijing Children’s Hospital (2015–2020). The patients were divided into IOCM and LOCM exposure. AKI was defined by the pediatric version of Kidney Disease: Improving Global Outcomes (KDIGO, pKDIGO) criteria. After adjusting baseline differences with inverse probability of treatment weighting (IPTW), log-binomial regression was conducted to estimate the risk ratios (RR) and 95% confidence interval (CI) of AKI between the IOCM and LOCM groups. Subgroup analyses were performed by age (&lt; 2 vs. ≥2 years), ICU status, CT scan site, and sex.</p> Results <p>Of 6081 pediatric patients exposed to CT enhanced scans, 1004 children were eligible for inclusion and exclusion criteria, in which there were 545 (54.3%) and 459 (45.7%) patients in the IOCM and LOCM groups, respectively. The unadjusted incidence of AKI in the IOCM (12.1%) was higher than that in LOCM (6.1%). However, the adjusted relative risk (aRR) indicated a significantly lower risk of CA-AKI with IOCM compared to LOCM (aRR: 0.54, 95% CI: 0.40–0.73).</p> Conclusions <p>In the pediatric cohort, IOCM was associated with a significantly lower risk of CA-AKI compared to LOCM. This association was consistently observed across key subgroups, such as age, sex, and ICU status.</p>

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A comparative study on the risk of acute kidney injury in children induced by iso-osmolarity and low-osmolarity contrast media

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月12日

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  • Fang Hu,
  • Chen Wang,
  • Ruohua Yan,
  • Xiaohang Liu,
  • Jihang Sun,
  • Yun Peng,
  • Xiaoxia Peng

摘要

Background

To compare the risk of contrast-associated acute kidney injury (CA-AKI) caused by iso-osmolarity contrast media (IOCM) and low-osmolarity contrast media (LOCM) in pediatric patients.

Methods

A retrospective cohort exposed to contrast-enhanced CT was constructed based on the inpatients from Beijing Children’s Hospital (2015–2020). The patients were divided into IOCM and LOCM exposure. AKI was defined by the pediatric version of Kidney Disease: Improving Global Outcomes (KDIGO, pKDIGO) criteria. After adjusting baseline differences with inverse probability of treatment weighting (IPTW), log-binomial regression was conducted to estimate the risk ratios (RR) and 95% confidence interval (CI) of AKI between the IOCM and LOCM groups. Subgroup analyses were performed by age (< 2 vs. ≥2 years), ICU status, CT scan site, and sex.

Results

Of 6081 pediatric patients exposed to CT enhanced scans, 1004 children were eligible for inclusion and exclusion criteria, in which there were 545 (54.3%) and 459 (45.7%) patients in the IOCM and LOCM groups, respectively. The unadjusted incidence of AKI in the IOCM (12.1%) was higher than that in LOCM (6.1%). However, the adjusted relative risk (aRR) indicated a significantly lower risk of CA-AKI with IOCM compared to LOCM (aRR: 0.54, 95% CI: 0.40–0.73).

Conclusions

In the pediatric cohort, IOCM was associated with a significantly lower risk of CA-AKI compared to LOCM. This association was consistently observed across key subgroups, such as age, sex, and ICU status.