Risk of Major Cardiovascular Disease after Exposure to Contrast Media: A Nationwide Population-Based Cohort Study on Dialysis Patients

Contrast associated kidney injury is caused by side effects of iodinated contrast media (ICM), including inflammation. Chronic inflammation among dialysis patient contributes to atherosclerosis, which leads to simultaneous conditions of the kidney, brain, and vasculature. Data to investigate the pathologic effects of ICM on cardiovascular complications in dialysis patients are lacking. Dialysis patients who had been exposed to ICM from computed tomography (ICM-CT) were allocated as the ICM-CT cohort (N = 3751), whereas dialysis patients without ICM exposure were randomly allocated as the non-ICM cohort (N = 17,196). Furthermore, 540 pairs were selected for analyses through propensity score-matching in terms of age, sex, comorbidities, dialysis vintage, and index date. During a median follow-up of 10.3 years, ICM-CT cohort had significantly higher risks in the following, compared with non-ICM cohort: all-cause mortality (adjusted hazard ratio [aHR], 1.36; 95% confidence interval [CI], 1.26–1.47), cardiovascular events (aHR,1.67; 95% CI, 1.39–2.01), acute coronary syndrome (adjusted HR: 2.92; 95% CI, 1.72–4.94), sudden cardiac arrest (aHR, 1.69; 95% CI, 0.90–3.18), heart failure (aHR, 1.71; 95% CI,1.28–2.27), and stroke (aHR, 1.84; 95% CI,1.45–2.35). The proinflammatory ICM is significantly associated with an increased risk of major cardiovascular events in patients on dialysis.