Contrast-Associated AKI in Hospitalized Adults With Sickle Cell Disease

Introduction: Patients with sickle cell disease (SCD) are at risk of chronic kidney disease (CKD) and acute kidney injury (AKI). The risk of AKI associated with contrast media (CM) exposures in this population is uncertain. The objective of this study was to investigate this temporal association in a multicentric case series. Methods: We performed a retrospective self-controlled case series (SCCS) in adults followed-up in SCD centers of the Greater Paris University Hospitals who experienced AKI during hospitalization between 2013 and 2022. SCCS estimates the relative incidence (RI) of events during exposure periods (around CM exposure) compared with control periods within the same individual. Analyses were restricted to hospitalizations periods and accounted for time-varying confounders such as age, presence of albuminuria, reduced estimated glomerular filtration rate, and stay in a medical ward or intensive care unit (ICU). Results: In the main analysis, that included 529 patients and 755 cases of AKI, AKI incidence increased significantly during the 7-day pre-exposure period (RI: 2.53, 95% confidence interval [CI]: 2.02-3.16), the 0 to 3 days postexposure (RI: 2.52, 95% CI: 1.99-3.19) and the 4 to 7 days postexposure (RI: 1.57, 95% CI: 1.20-2.06). Similar patterns were observed for stage 2 or 3 AKI, with higher RI. Conclusion: In this cohort of hospitalized adults with SCD, mainly young patients with preserved kidney function and few comorbidities, the RI of AKI was twice as high both before and after CM exposure, suggesting the role of underlying clinical conditions and related medical interventions rather than a causal effect of CM.