Anemia Identified as Risk Factor for Contrast-Induced Acute Kidney Injury

Anemia, red blood cells
Anemia, red blood cells
Anemia with a baseline hemoglobin

Contrast-induced acute kidney injury is significantly more likely to develop in people with anemia undergoing coronary angioplasty, according to the results of a study published in The American Journal of Cardiology.

Data from patients who underwent coronary angioplasty (n=2055) were reviewed retroactively. Patients were categorized by anemia severity (none, mild, moderate, or severe anemia) and the risk for contrast-induced acute kidney injury occurring was compared among the groups.

A total of 1149 study participants were categorized as having no anemia, 606 as having mild anemia, 224 as having moderate anemia, and 76 as having severe anemia. Anemia severity correlated positively with development of contrast-induced acute kidney injury following coronary angioplasty. Of those individuals in whom contrast-induced acute kidney injury developed, 5.8% were non-anemic, 17.5% had mild anemia, 37.9% had moderate anemia, and 46.1% had severe anemia (all P <.001).

Anemia at a baseline hemoglobin level <13 g/dL was associated with a 5.3-fold (95% CI, 3.8-7.3; P <.001) increased risk for contrast-induced acute kidney injury. In those with severe anemia, the risk for contrast-induced acute kidney injury increased to 13.7-fold (95% CI, 8.2-23.1; P <.001).

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The study authors wrote, “It is clear from our study that the risk of [contrast-induced acute kidney injury] is increasingly higher with increasing severity of anemia.” However, they were cautious about whether correcting the anemia prior to initialization of coronary angioplasty would be enough to offset the risk, adding, “To our knowledge, preprocedural blood transfusion to prevent [contrast-induced acute kidney injury] has not been studied.”


Sreenivasan J, Zhuo M, Khan MS, et al. Anemia (hemoglobin ≤ 13 g/dL) as a risk factor for contrast-induced acute kidney injury following coronary angiography [published online June 22, 2018]. Am J Cardiol. doi:10.1016/j.amjcard.2018.06.012