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Prediction of presence of kidney disease in a general patient population undergoing intravenous iodinated contrast enhanced computed tomography

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess which risk factors can be used to reduce superfluous estimated glomerular filtration rate (eGFR) measurements before intravenous contrast medium administration.

Methods

In consecutive patients, all decreased eGFR risk factors were assessed: diabetes mellitus (DM), history of urologic/nephrologic disease (HUND), nephrotoxic medication, cardiovascular disease, hypertension, age > 60 years, anaemia, malignancy and multiple myeloma/M. Waldenström. We studied four models: (1) all risk factors, (2) DM, HUND, hypertension, age > 60 years; (3) DM, HUND, cardiovascular disease, hypertension; (4) DM, HUND, age > 75 years and congestive heart failure. For each model, association with eGFR < 60 ml/min/1.73 m2 or eGFR < 45 ml/min/1.73 m2 was studied.

Results

A total of 998 patients, mean age 59.94 years were included; 112 with eGFR < 60 ml/min/1.73 m2 and 30 with eGFR < 45 ml/min/1.73 m2. Model 1 detected 816 patients: 108 with eGFR < 60 ml/min/1.73 m2 and all 30 with eGFR < 45 ml/min/1.73 m2. Model 2 detected 745 patients: 108 with eGFR < 60 ml/min/1.73 m2 and all 30 with eGFR < 45 ml/min/1.73 m2. Model 3 detected 622 patients: 100 with eGFR < 60 ml/min/1.73 m2 and all 30 with eGFR < 45 ml/min/1.73 m2. Model 4 detected 440 patients: 86 with eGFR < 60 ml/min/1.73 m2 and all 30 with eGFR < 45 ml/min/1.73 m2. Associations were significant (p < 0.001).

Conclusion

Model 4 is most effective, resulting in the lowest proportion of superfluous eGFR measurements while detecting all patients with eGFR < 45 ml/min/1.73 m2 and most with eGFR < 60 ml/min/1.73 m2.

Key Points

• A major risk factor for contrast-induced nephropathy (CIN) is kidney disease.

• Risk factors are used to identify patients with pre-existent kidney disease.

• Evidence for risk factors to identify patients with kidney disease is limited.

• The number of eGFR measurements to detect kidney disease can be reduced.

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Abbreviations

CIN:

contrast-induced nephropathy

DM:

diabetes mellitus

eGFR:

estimated glomerular filtration rate

FN:

false negatives

FP:

false positives

HUND:

history of urologic or nephrologic disease

MDRD:

modification of diet in renal disease

NSAIDs:

non-steroidal anti-inflammatory drugs

TN:

true negatives

TP:

true positives

WHO:

World Health Organisation

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Acknowledgments

The scientific guarantor of this publication is S. Bipat, Ph.D. 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.The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: prospective, performed at one institution

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Authors and Affiliations

  1. Department of Radiology, G1-215, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Shira I. Moos, Jaap Stoker, Gajenthiran Nagan, Roderick S. de Weijert, David N.H. van Vemde & Shandra Bipat

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  1. Shira I. Moos
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  2. Jaap Stoker
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  3. Gajenthiran Nagan
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  4. Roderick S. de Weijert
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  5. David N.H. van Vemde
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  6. Shandra Bipat
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Correspondence to Shira I. Moos.

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Moos, S.I., Stoker, J., Nagan, G. et al. Prediction of presence of kidney disease in a general patient population undergoing intravenous iodinated contrast enhanced computed tomography. Eur Radiol 24, 1266–1275 (2014). https://doi.org/10.1007/s00330-014-3149-2

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  • DOI: https://doi.org/10.1007/s00330-014-3149-2

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