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2012 ; 19
(6
): 618-25
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Prospective study of the incidence of contrast-induced nephropathy among patients
evaluated for pulmonary embolism by contrast-enhanced computed tomography
#MMPMID22687176
Mitchell AM
; Jones AE
; Tumlin JA
; Kline JA
Acad Emerg Med
2012[Jun]; 19
(6
): 618-25
PMID22687176
show ga
OBJECTIVES: Contrast-enhanced computed tomography (CECT) of the pulmonary
arteries (CTPA) has become the mainstay to evaluate patients with suspected
pulmonary embolism (PE) and is one of the most common CECT imaging studies
performed in the emergency department (ED). While contrast-induced nephropathy
(CIN) is a known complication, this risk is not well defined in the ED or other
ambulatory setting. The aim of this study was to define the risk of CIN following
CTPA. METHODS: The authors enrolled and followed a prospective, consecutive
cohort (June 2007 through January 2009) of patients who received intravenous (IV)
contrast for CTPA in the ED of a large, academic tertiary care center. Study
outcomes included 1) CIN defined as an increase in serum creatinine (sCr) of ?
0.5 mg/dL or ? 25%, 2 to 7 days following contrast administration; and 2) severe
renal failure defined as an increase in sCr to ? 3.0 mg/dL or the need for
dialysis within 45 days and/or renal failure as a contributing cause of death at
45 days, determined by the consensus of three independent physicians. RESULTS: A
total of 174 patients underwent CTPA, which demonstrated acute PE in 12 (7%, 95%
confidence interval [CI]?= 3% to 12%). Twenty-five patients developed CIN (14%,
95% CI = 10% to 20%) including one with acute PE. The development of CIN after
CTPA significantly increased the risk of the composite outcome of severe renal
failure or death from renal failure within 45 days (relative risk = 36, 95% CI =
3 to 384). No severe adverse outcomes were directly attributable to complications
of venous thromboembolism (VTE) or its treatment. CONCLUSIONS: ? In this
population, CIN was at least as common as the diagnosis of PE after CTPA; the
development of CIN was associated with an increased risk of severe renal failure
and death within the subsequent 45 days. Clinicians should consider the risk of
CIN associated with CTPA and discuss this risk with patients.