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The Clinical Epidemiology of Contrast-Induced Nephropathy

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Abstract

Recent improvements in contrast agents and radiologic imaging tools have resulted in an increasing number of patients undergoing contrast media (CM)-enhanced examinations. Although the majority of patients undergoing these diagnostic and therapeutic procedures experience only mild adverse events, some patient subpopulations are at risk for developing contrast-induced nephropathy (CIN), an adverse event that is associated with high morbidity and mortality. Contrast-induced nephropathy is usually defined as an increase of ≥25% in the serum creatinine level relative to baseline. Pathophysiologic mechanisms underlying this disorder are not fully understood, but it is currently believed that disturbances in renal hemodynamics and a direct effect of CM on renal tubules are involved. In the general population, the incidence of CIN is estimated to be 1% to 6%. However, the risk may be as high as 50% in some patient subgroups. Patients with diabetes and pre-existing renal impairment are at high risk, and CIN incidence increases in patients with multiple comorbidities. The volume and osmolality of CM used also play a role in the development of CIN. Patients who develop CIN are more likely to die in-hospital and, for those who are discharged, 1-year mortality rates are high. Whether this is due to CM, comorbidity, or concurrent comorbid events is unclear. Randomized controlled trials that measure non-renal clinical outcomes are necessary to determine whether interventions that prevent CIN can also prevent non-renal adverse events. A review of the incidence, pathogenesis, and clinical consequences of CIN is provided.

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References

  1. King B, Segal A, Berg G, et al. (2004) Manual on Contrast Media. American College of Radiology. Reston, Virginia

    Google Scholar 

  2. Ferrone M (2004) Pharmacotherapeutic options to prevent radiocontrast-induced acute renal failure. Formulary 39:163–185

    CAS  Google Scholar 

  3. Waybill MM, Waybill PN (2001) Contrast media-induced nephrotoxicity: identification of patients at risk and algorithms for prevention. J Vasc Interv Radiol 12:3–9

    PubMed  CAS  Google Scholar 

  4. Liistro F, Falsini G, Bolognese L (2003) The clinical burden of contrast media-induced nephropathy. Ital Heart J 4:668–676

    PubMed  Google Scholar 

  5. Maitino AJ, Levin DC, Parker L, et al. (2003) Nationwide trends in rates of utilization of noninvasive diagnostic imaging among the Medicare population between 1993 and 1999. Radiology 227:113–117

    PubMed  Google Scholar 

  6. Toms AP, Cash CJ, Linton SJ, et al. (2001) Requests for body computed tomography: increasing workload, increasing indications and increasing age. Eur Radiol 11:2633–2637

    PubMed  CAS  Google Scholar 

  7. American Heart Association (2004) Heart Disease and Stroke Statistics: 2004 Update. Available at www.americanheart.org Accessed August 12, 2004

    Google Scholar 

  8. Berg KJ (2000) Nephrotoxicity related to contrast media. Scand J Urol Nephrol 34:317–322

    Article  PubMed  CAS  Google Scholar 

  9. Gleeson T, O’Dwyer J, Bulugahapitiya S, et al. (2004) Contrast-induced nephropathy. Br J Cardiol (Acute Interv Cardiol) 11:AIC 53–AIC 61

    Google Scholar 

  10. Alamartine E, Phayphet M, Thibaudin D, et al. (2003) Contrast medium-induced acute renal failure and cholesterol embolism after radiological procedures: incidence, risk factors, and compliance with recommendations. Eur J Intern Med 14:426–431

    Article  PubMed  Google Scholar 

  11. Birck R, Krzossok S, Markowetz F, et al. (2003) Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet 362:598–603

    Article  PubMed  CAS  Google Scholar 

  12. Morcos S (1999) Contrast medium-induced nephrotoxicity. In: Dawson P, Cosgrove D, Grainger R (eds) Textbook of Contrast Media. Isis Medical Media Ltd. Oxford, p 135–148

    Google Scholar 

  13. McCullough PA, Sandberg KR (2003) Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med 4 Suppl 5:S3–S9

    Google Scholar 

  14. Morcos SK, Thomsen HS, Webb JA (1999) Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol 9:1602–1613

    Article  PubMed  CAS  Google Scholar 

  15. Cox CD, Tsikouris JP (2004) Preventing contrast nephropathy: what is the best strategy? A review of the literature. J Clin Pharmacol 44:327–337

    PubMed  Google Scholar 

  16. Levey AS, Bosch JP, Lewis JB, et al. (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470

    PubMed  CAS  Google Scholar 

  17. Gault MH, Longerich LL, Harnett JD, et al. (1992) Predicting glomerular function from adjusted serum creatinine. Nephron 62:249–256

    PubMed  CAS  Google Scholar 

  18. Maeder M, Klein M, Fehr T, et al. (2004) Contrast nephropathy: Review focusing on prevention. J Am Coll Cardiol 44:1763–1771

    Article  PubMed  Google Scholar 

  19. Almen T (1994) The etiology of contrast medium reactions. Invest Radiol 29 Suppl 1:S37–45

    Article  PubMed  CAS  Google Scholar 

  20. Almen T (1995) Visipaque–a step forward. A historical review. Acta Radiol 399 Suppl:2–18

    CAS  Google Scholar 

  21. (2001) Iomeprol - A Promising New Nonionic Contrast Medium. Drug Ther Perspect 17:1–4

  22. Sovak M, Terry R, Abramjuk C, et al. (2004) Iosimenol, a low-viscosity nonionic dimer: preclinical physicochemistry, pharmacology, and pharmacokinetics. Invest Radiol 39:171–181

    PubMed  CAS  Google Scholar 

  23. Sandler CM (2003) Contrast-agent-induced acute renal dysfunction–is iodixanol the answer? N Engl J Med 348:551–553

    PubMed  Google Scholar 

  24. Morcos SK, Thomsen HS (2001) Adverse reactions to iodinated contrast media. Eur Radiol 11:1267–1275

    Article  PubMed  CAS  Google Scholar 

  25. Rudnick MR, Goldfarb S (2003) Pathogenesis of contrast-induced nephropathy: experimental and clinical observations with an emphasis on the role of osmolality. Rev Cardiovasc Med 4 Suppl 5:S28–33

    PubMed  Google Scholar 

  26. Lindholt JS (2003) Radiocontrast induced nephropathy. Eur J Vasc Endovasc Surg 25:296–304

    PubMed  CAS  Google Scholar 

  27. Jakobsen JA, Lundby B, Kristoffersen DT, et al. (1992) Evaluation of renal function with delayed CT after injection of nonionic monomeric and dimeric contrast media in healthy volunteers. Radiology 182:419–424

    PubMed  CAS  Google Scholar 

  28. Andersen PE, Bolstad B, Berg KJ, et al. (1993) Iodixanol and ioxaglate in cardioangiography: a double-blind randomized phase III study. Clin Radiol 48:268–272

    PubMed  CAS  Google Scholar 

  29. Pugh ND, Sissons GR, Ruttley MS, et al. (1993) Iodixanol in femoral arteriography (phase III): a comparative double-blind parallel trial between iodixanol and iopromide. Clin Radiol 47:96–99

    PubMed  CAS  Google Scholar 

  30. Parfrey PS, Griffiths SM, Barrett BJ, et al. (1989) Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 320:143–149

    Article  PubMed  CAS  Google Scholar 

  31. Rihal CS, Textor SC, Grill DE, et al. (2002) Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 105:2259–2264

    Article  PubMed  Google Scholar 

  32. Moore RD, Steinberg EP, Powe NR, et al. (1992) Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial. Radiology 182:649–655

    PubMed  CAS  Google Scholar 

  33. Heller CA, Knapp J, Halliday J, et al. (1991) Failure to demonstrate contrast nephrotoxicity. Med J Aust 155:329–332

    PubMed  CAS  Google Scholar 

  34. Cramer BC, Parfrey PS, Hutchinson TA, et al. (1985) Renal function following infusion of radiologic contrast material. A prospective controlled study. Arch Intern Med 145:87–89

    Article  PubMed  CAS  Google Scholar 

  35. Manske CL, Sprafka JM, Strony JT, et al. (1990) Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 89:615–620

    Article  PubMed  CAS  Google Scholar 

  36. Gruberg L, Mintz GS, Mehran R, et al. (2000) The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol 36:1542–1548

    Article  PubMed  CAS  Google Scholar 

  37. Rudnick MR, Goldfarb S, Wexler L, et al. (1995) Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int 47:254–261

    PubMed  CAS  Google Scholar 

  38. Nikolsky E, Aymong ED, Dangas G, et al. (2003) Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function. Rev Cardiovasc Med 4 Suppl 1:S7–S14

    PubMed  Google Scholar 

  39. McCullough PA, Wolyn R, Rocher LL, et al. (1997) Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 103:368–375

    Article  PubMed  CAS  Google Scholar 

  40. Rich MW, Crecelius CA (1990) Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study. Arch Intern Med 150:1237–1242

    PubMed  CAS  Google Scholar 

  41. Taliercio CP, Vlietstra RE, Fisher LD, et al. (1986) Risks for renal dysfunction with cardiac angiography. Ann Intern Med 104:501–504

    PubMed  CAS  Google Scholar 

  42. Vlietstra RE, Nunn CM, Narvarte J, et al. (1996) Contrast nephropathy after coronary angioplasty in chronic renal insufficiency. Am Heart J 132:1049–1050

    Article  PubMed  CAS  Google Scholar 

  43. Hall KA, Wong RW, Hunter GC, et al. (1992) Contrast-induced nephrotoxicity: the effects of vasodilator therapy. J Surg Res 53:317–320

    Article  PubMed  CAS  Google Scholar 

  44. Bartholomew BA, Harjai KJ, Dukkipati S, et al. (2004) Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol 93:1515–1519

    Article  PubMed  Google Scholar 

  45. Freeman RV, O’Donnell M, Share D, et al. (2002) Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. Am J Cardiol 90:1068–1073

    Article  PubMed  Google Scholar 

  46. Mehran R, Aymong ED, Nikolsky E, et al. (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399

    Article  PubMed  Google Scholar 

  47. Cigarroa RG, Lange RA, Williams RH, et al. (1989) Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 86:649–652

    PubMed  CAS  Google Scholar 

  48. Marenzi G, Lauri G, Assanelli E, et al. (2004) Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 44:1780–1785

    Article  PubMed  Google Scholar 

  49. Thomsen HS (2003) Guidelines for contrast media from the European Society of Urogenital Radiology. AJR Am J Roentgenol 181:1463–1471

    PubMed  Google Scholar 

  50. Barrett BJ, Carlisle EJ (1993) Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 188:171–178

    PubMed  CAS  Google Scholar 

  51. Aspelin P, Aubry P, Fransson SG, et al. (2003) Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348:491–499

    Article  PubMed  CAS  Google Scholar 

  52. Chalmers N, Jackson RW (1999) Comparison of iodixanol and iohexol in renal impairment. Br J Radiol 72:701–703

    PubMed  CAS  Google Scholar 

  53. Katzberg RW (1997) Urography into the 21st century: new contrast media, renal handling, imaging characteristics, and nephrotoxicity. Radiology 204:297–312

    PubMed  CAS  Google Scholar 

  54. Levy EM, Viscoli CM, Horwitz RI (1996) The effect of acute renal failure on mortality. A cohort analysis. JAMA 275:1489–1494

    PubMed  CAS  Google Scholar 

  55. Gruberg L, Mehran R, Dangas G, et al. (2001) Acute renal failure requiring dialysis after percutaneous coronary interventions. Catheter Cardiovasc Interv 52:409–416

    PubMed  CAS  Google Scholar 

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  1. Department of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland , NL, A1C 5S7, Canada

    Patrick Parfrey

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Correspondence to Patrick Parfrey.

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Parfrey, P. The Clinical Epidemiology of Contrast-Induced Nephropathy. Cardiovasc Intervent Radiol 28 (Suppl 2), S3–S11 (2005). https://doi.org/10.1007/s00270-005-0196-8

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