Contrast-induced nephropathy after computed tomography

Selistre, Luciano da Silva; Souza, Vandréa Carla de; Dubourg, Laurence; Wagner, Mário Bernardes; Hoefel Filho, João Rubião; Saitovitch, David

doi:10.5935/0101-2800.20150005

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Brazilian Journal of Nephrology

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Original Articles • J Bras Nefrol 37 (1) • Jan-Mar 2015 • https://doi.org/10.5935/0101-2800.20150005 copy

Contrast-induced nephropathy after computed tomography

Nefropatia induzida por contraste após tomografia computadorizada

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction:

Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase.

Objective:

We studied the risk factors to intravenous injection contrast nephropathy after computed tomography.

Methods:

We studied 400 patients prospectively.

Results:

The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively).

Conclusions:

We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure.

contrast media; risk factors; tomography

Characteristics	Patients (N = 400)
Age (years)	59.2 ± 14.8
Old-aged	161 (40.25%)
Female gender	198 (49.50%)
Ethnicity
White	323 (80.75%)
Afro-Brazilian	77 (19.25%)
Body Mass Surface (m²)	1.74 ± 0.21
Body Mass Index (kg/m²)	24.36 ± 1.74
Obesity	59 (14.75%)
SCr (mg/dL)	0.96 ± 0.38
eGFR < 60 mL/min/1.73 m²	78 (19.50%)
Diabetes	73 (18.25%)
Heart Failure	30 (7.50%)
Neoplasia	249 (62.25%)
MBP < 80 mmHg	60 (15%)
Hematocrit < 36%	200 (50%)
Contrast Volume mL/1.73 m²	142.2 ± 37.7
Metformin	25 (6.25%)
Prophylaxis	97 (24.25%)

Localization	N	Median volume contrast per 1.73 m² [IQR]*
Cranial	31(7.75%)	64.0 [54.5; 120.0]
Abdomen	64 (16%)	152.0 [105.5; 198.5]
Thorax	162 (40.5%)	156.0 [49.5; 229.5]
Thoracoabdominal	127 (31.75%)	198.5 [134.5; 249.0]
Others	16 (4%)	132.0 [30.0; 254.0]

Outcome
Creatinine (mg/dL)
Baseline	0.9 ± 0.38
48 hours	1.0 ± 0.47
eGFR (mL/min/1.73 m²)
Baseline	93.43 ± 14.8
48 hours	91.95 ± 14.7
Occurrence of CIN
SCr increases ≥ 25%	61 (15.75%)
SCr increases ≥ 0.5 mg/dL	15 (3.75%)

Risk factors	OR	95% CI	P
Old-age	6.3	1.8 to 22.5	< 0.01
Diabetes	10.2	3.4 to 31.0	< 0.01
Female gender	0.9	0.3 to 2.5	0.8
Obesity	1.4	0.4 to 5.5	0.5
Heart failure	13.8	4.5 to 42.0	< 0.01
eGFR < 60 mL/ min/1.73 m²	3.9	1.3 to 11.0	< 0.05
Neoplasia	0.4	0.1 to 1.1	0.6
MBP < 80 mmHg	0.4	0.0 to 2.0	0.4
Hematocrit < 36%	0.6	0.2 to 1.9	0.4

Risk factors	OR	95% CI	P
Old-age	1.0	0.6 to 1.8	0.9
Diabetes	3.5	1.9 to 6.4	< 0.01
Female gender	1.5	0.8 to 2.6	0.1
Obesity	1.7	0.8 to 3.3	0.1
Heart failure	2.6	1.1 to 5.9	< 0.05
eGFR < 60 mL/min/1.73 m²	0.5	0.2 to 1.0	0.1
Neoplasia	0.8	0.4 to 1.3	0.3
MBP < 80 mmHg	0.3	0.0 to 1.2	0.2
Hematocrit < 36%	0.8	0.5 to 1.4	0.5

Risk factors	Model	P
Entire population	Ϋ1 = 116X + 0.07	0.3
Diabetes	Ϋ2 = 112X + 0.22	< 0.01
Heart Failure	Ϋ3 = 114X + 0.23	< 0.01
eGFR < 60 mL/min/1.73 m²	Ϋ4 = 118X + 0.01	0.8
Old-age	Ϋ5 = 116X + 0.09	0.2

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E-mail: bjnephrology@gmail.com

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[1] Correspondência para: Luciano da Silva Selistre, Pontifical Catholic University of Rio Grande do Sul, Rua Adelino Roldo, nº 310, Caxias do Sul, RS, Brazil. CEP: 95052-020, Tel: 55 54 9122-4798. Fax: 55 54 32022540. E-mail: selistre71@gmail.com