Patients at risk for contrast-induced nephropathy and mid-term effects after contrast administration: a prospective cohort study

S I Moos, G Nagan, R S de Weijert, D N H van Vemde, J Stoker, S Bipat
Netherlands Journal of Medicine 2014, 72 (7): 363-71

OBJECTIVES: Determine the incidence of patients at risk for contrast-induced nephropathy (CIN), the incidence of CIN and mid-term effects (renal replacement therapy/death < one month) to measure the impact of CIN in a general patient population undergoing intravenous contrast-enhanced computed tomography (CECT).

METHODS: We conducted a prospective study in consecutive patients undergoing intravenous CECT from October 2012 to May 2013. Data were obtained through scripted interviews and the electronic patient records. Presence of risk factors and kidney function before and after CECT and the follow-up for one month were evaluated.

RESULTS: We included 998 patients (mean age: 60 years). Estimated GFR was ≥ 60 ml/mg/1.72 m2 in 886 (88.8%) patients, 30-59 ml/mg/1.72 m2 in 108 (10.8%) patients and < 30 ml/min/1.73 m2 in 4 (0.4%) patients. We found diabetes mellitus in 137 (13.7%), anaemia in 70 (7.0%) congestive heart failure in 92 (9.2%), peripheral arterial disease in 34 (3.4%), age > 75 years in 126 (12.6%) patients and 301 (30.2%) used nephrotoxic medication. Fifty-eight (5.8%) patients were at risk for CIN; 35 (60.3%) risk patients received intravenous prophylactic hydration. Of the hydrated patients, 11 underwent follow-up within one week; of the non-hydrated patients seven underwent follow-up within one week. Two (2/58: 3.4%) patients developed CIN (increased serum creatinine ≥ 44 μmol/l or ≥ 25%); there was no difference between hydrated and non-hydrated patients (1/35:1/23). The incidence of renal replacement therapy and death within one month was zero for both.

CONCLUSION: The number of patients at risk is low. CIN incidence is low, even in patients not receiving prophylactic hydration. No patients received renal replacement therapy or died. The impact of CIN is low. Extensive CIN prevention guidelines seem superfluous.

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