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Contrast-Induced Nephropathy After Computed Tomography in Stable CKD Patients
With Proper Prophylaxis: 8-Year Experience of Outpatient Prophylaxis Program
#MMPMID27149474
Park S
; Kim MH
; Kang E
; Park S
; Jo HA
; Lee H
; Kim SM
; Lee JP
; Oh KH
; Joo KW
; Kim YS
; Kim DK
Medicine (Baltimore)
2016[May]; 95
(18
): e3560
PMID27149474
show ga
Conflicting data have been reported on the clinical significance of
contrast-induced nephropathy after CT scan (CT-CIN). In addition, the
epidemiologic characteristics and clinical outcomes of CT-CIN following proper
prophylactic intervention remain elusive.We examined the incidence, risk factors,
and outcomes of CT-CIN in stable chronic kidney disease (CKD) patients using data
collected from our outpatient CT-CIN prophylaxis program conducted between 2007
and 2014. The program recruited patients with an estimated glomerular filtration
rate (eGFR) <60?mL/min/1.73?m using an electronic health record-based pop-up
alert system and provided an identical protocol of CIN prophylaxis to all
patients.A total of 1666 subjects were included in this study, and 61 of the 1666
subjects (3.7%) developed CT-CIN. Multivariate analysis showed that baseline
eGFR, diabetes mellitus, and low serum albumin were significant risk factors for
CT-CIN. The generalized additive model analysis revealed a nonlinear relationship
between the baseline eGFR and the risk of CT-CIN. In this analysis, the risk of
CT-CIN began to increase below an eGFR threshold of 36.8?mL/min/1.73?m. To assess
the outcomes of CT-CIN, patients with and without CT-CIN were compared after
propensity score-based 1:2 matching. CT-CIN did not increase the mortality rate
of patients. However, patients with CT-CIN were significantly more likely to
start dialysis within 6 months of follow-up, but not after those initial 6
months.CT-CIN developed in only a small number of stable CKD patients who
received proper prophylactic intervention, and the risk of CT-CIN was increased
in patients with more advanced CKD. Despite the low incidence, CT-CIN conferred a
non-negligible risk for the initiation of dialysis in the acute period, even
after prophylaxis.
|Acute Kidney Injury/*chemically induced/prevention & control
[MESH]
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