Abstract
Purpose
To investigate the incidence and risk factors of contrast induced nephropathy (CIN) after contrast enhanced (CE) computed tomography (CT) in patients with renal dysfunction.
Materials and methods
Two hundred sixteen inpatients with estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m2 underwent CE CT using iodine doses of 420 or 480 mg I/kg. Data of all enrolled patients was collected for baseline serum creatinine level (SCr), post-CE CT SCr within 3 days after CE CT, and conditions considered risk factors for CIN [renal dysfunction, contrast media dose, advanced age, diabetes mellitus, no intravenous hydration, cardiac dysfunction (left ventricular ejection fraction <60%) and intensive-care unit (ICU) admission]. CIN was defined as an increase in SCr level of more than 0.5 mg/dl or more than 25% from baseline within 3 days post-CE CT without any other identifiable cause of acute kidney injury.
Results
The incidence of CIN was 11/216 (5.1%) and was associated with cardiac dysfunction [odds ratio (OR) 6.540; 95% confidence interval (CI) 1.090–39.300; p = 0.040] and ICU admission (OR 11.500; 95% CI 2.050–64.100; p = 0.005).
Conclusion
Our results suggested that cardiac dysfunction and ICU admission may be risk factors for CIN in patients with preexisting renal dysfunction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
European Society of Urogenital Radiology. ESUR guidelines on contrast media, version 9.0; 2015.
ACR Committee on Drugs and Contrast Media. ACR manual on contrast media version 10.1; 2015.
Mitchell AM, Jones AE, Tumlin JA, Kline JA. Incidence of contrast-induced nephropathy after contrast-enhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol. 2010;5:4–9.
Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6.
Weisbord SD, Mor MK, Resnick AL, Hartwig KC, Palevsky PM, Fine MJ. Incidence and outcomes of contrast-induced AKI following computed tomography. Clin J Am Soc Nephrol. 2008;3:1274–81.
Kim SM, Cha RH, Lee JP, Kim DK, Oh KH, Joo KW, et al. Incidence and outcomes of contrast-induced nephropathy after computed tomography in patients with CKD: a quality improvement report. Am J Kidney Dis. 2010;55:1018–25.
Katzberg RW, Newhouse JH. Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe? Radiology. 2010;256:21–8.
McDonald RJ, McDonald JS, Carter RE, Hartman RP, Katzberg RW, Kallmes DF, et al. Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. Radiology. 2014;273:714–25.
Lameire N, Adam A, Becker CR, Davidson C, McCullough PA, Stacul F, et al. Baseline renal function screening. Am J Cardiol. 2006;98:21–6.
La Manna G, Pancaldi LG, Capecchi A, Maska E, Comai G, Cappuccilli ML, et al. Risk for contrast nephropathy in patients undergoing coronarography. Artif Organs. 2010;34:E193–9.
Ohno I, Hayashi H, Aonuma K, Horio M, Kashihara N, Okada H, et al. Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version. Jpn J Radiol. 2013;31:546–84.
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl. 2013;48:452–8.
McDonald JS, McDonald RJ, Carter RE, Katzberg RW, Kallmes DF, Williamson EE. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology. 2014;271:65–73.
Gruberg L, Mintz GS, Mehran R, Dangas G, Lansky AJ, Kent KM, et al. 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. 2000;36:1542–8.
Gross P, Büssemaker E. Endothelin: what role in acute contrast nephropathy? Nephrol Dial Transpl. 1996;11:1716–8.
Carlsson M, Andersson R, Bloch KM, Steding-Ehrenborg K, Mosén H, Stahlberg F, et al. Cardiac output and cardiac index measured with cardiovascular magnetic resonance in healthy subjects, elite athletes and patients with congestive heart failure. J Cardiovasc Magn Reson. 2012;14:51.
Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013;268:719–28.
Acknowledgements
The authors thank Junya Fukuda, RT; Keisuke Arai, RT; and Naoto Yamaguchi, RT of Gunma University Hospital for collecting data for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Financial support
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
Yoshito Tsushima receives honoraria for visiting lectures from Daiichi-Sankyo Co, Ltd.; Eisai, Co, Ltd.; and Bayer-Yakuhin. The other authors have no conflict of interest to declare.
Ethical statement
A committee headed by Professor Takashi Minegishi, Dean of Faculty of Medicine, Gunma University, issued IRB approval of this study on 17 May 2016.
About this article
Cite this article
Fukushima, Y., Miyazawa, H., Nakamura, J. et al. Contrast-induced nephropathy (CIN) of patients with renal dysfunction in CT examination. Jpn J Radiol 35, 427–431 (2017). https://doi.org/10.1007/s11604-017-0649-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-017-0649-4