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Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study

  • Pasqualina CastaldoEmail author
  • Giovanni M. Frascà
  • Fabiana Brigante
  • Luigi Ferrante
  • Simona Magi
  • Marianna Pavani
  • Edlira Skrami
  • Gian Marco Giuseppetti
  • Gabriele Polonara
  • Salvatore Amoroso
Contrast Media
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Abstract

Objectives

To estimate the incidence of contrast-induced acute kidney injury (CI-AKI) after intravenous (iv) iodinated contrast material (ICM) exposure.

Methods

This prospective cohort study included all consecutive patients who underwent radiological investigations using low-osmolar iopamidol 370 mg/ml in a regional hospital over a period of 36 months, without any exclusion criteria. The estimated glomerular filtration rate (eGFR) was evaluated using the MRDR equation before (2–10 days) and after (24–36 h) radiological investigations. CI-AKI was defined as a ≥ 25% decrease in eGFR from baseline. CI-AKI incidence was estimated using a binomial distribution. The association between CI-AKI and demographic and clinical characteristics was modeled using logistic regression.

Results

The study included 1541 patients with a median age of 68 (1st–3rd quartiles 58–76) years with various comorbidities, 30% of whom had pre-existing CKD. Patients affected by stage III or IV chronic kidney disease (CKD) received an infusion of 0.9% normal saline (1.0–1.5 ml/kg/h) before and after iso-osmolar iodixanol administration. CI-AKI was observed in 33 patients (2.1%, 95% CI 1.5–3.0). The logistic regression analysis showed that antibiotic and statin therapies were significantly associated with CI-AKI. The probability of developing CI-AKI decreased by 80% in patients taking statins (OR = 0.20, 95% CI 0.03; 0.68) and increased approximately three times in patients with antibiotic therapy compared with those who did not take statins and antibiotics (OR = 2.92, 95% CI 1.21; 6.36).

Conclusions

Our data suggest that low-osmolar iopamidol carries a low incidence of nephrotoxicity, even in subjects with various comorbid conditions or reduced renal function.

Key Points

• IV administration of ICM carries a low incidence of nephrotoxicity, which was transient in observed patients.

• Statin therapy is negatively associated with AKI in patients exposed to ICM.

• Pre-existing impairment of renal function is not associated with AKI in patients exposed to ICM.

Keywords

Contrast material Incidence Glomerular filtration rate Renal insufficiency 

Abbreviations

CI-AKI

Contrast-induced acute kidney injury

CIN

Contrast-induced nephropathy

CKD

Chronic kidney disease

eGFR

Estimated glomerular filtration rate

ICM

Intravenous iodinated contrast media

iv

Intravenous

Notes

Funding

This study has received funding by Agenzia Italiana del Farmaco (AIFA) (FARM823BHC).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Salvatore Amoroso.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Luigi Ferrante and Edlira Skrami have significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Performed at one institution

Supplementary material

330_2019_6147_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Pasqualina Castaldo
    • 1
    Email author
  • Giovanni M. Frascà
    • 2
  • Fabiana Brigante
    • 2
  • Luigi Ferrante
    • 1
  • Simona Magi
    • 1
  • Marianna Pavani
    • 1
  • Edlira Skrami
    • 1
  • Gian Marco Giuseppetti
    • 3
  • Gabriele Polonara
    • 3
  • Salvatore Amoroso
    • 1
  1. 1.Department of Biomedical Sciences and Public Health, School of MedicineUniversity “Politecnica delle Marche”AnconaItaly
  2. 2.Nephrology, Dialysis and Renal Transplantation Unit “Ospedali Riuniti of AnconaAnconaItaly
  3. 3.Department of Odontostomatologic and Specialized Clinical Sciences, School of MedicineUniversity “Politecnica delle Marche”AnconaItaly

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