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Original article
DOI: 10.1016/j.rxeng.2020.02.005
Available online 11 July 2020
Incidence of contrast-induced nephropathy after a computed tomography scan
Incidencia de nefropatía inducida por contraste tras una tomografía computarizada
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A. Barrios Lópeza,
Corresponding author
andresjavierbarrios@gmail.com

Corresponding author.
, F. García Martíneza, J.I. Rodrígueza, B. Montero-San-Martínb, R. Gómez Riojab, J. Diezc, C. Martín-Hervása
a Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
b Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain
c Servicio de Bioestadística, IdiPAZ – Hospital Universitario La Paz, Madrid, Spain
Received 17 March 2019. Accepted 13 February 2020
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Tables (4)
Table 1. Demographic and clinical variables of patients.
Table 2. Overall changes in laboratory parameters of kidney function.
Table 3. Variation in mean differences of serum creatinine and glomerular filtration rate, before and after the CT scan with intravenous contrast, in relation to risk factors.
Table 4. Correlation between differences in serum creatinine and glomerular filtration rate, before and after the CT scan with intravenous contrast and the quantitative variables included.
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Abstract
Background and aims

The term contrast-induced nephropathy is used to describe acute deterioration of renal function after the intravenous administration of iodinated contrast material. We aimed to estimate the incidence of contrast-induced nephropathy and to analyze the evolution of different biomarkers of renal function in patients who underwent computed tomography with intravenous contrast administration after premedication with oral hydration and N-acetylcysteine.

Material and methods

This prospective observational study included 112 patients with chronic renal failure (glomerular filtration rate (GFR) 30ml–60ml/min/1.73m2) scheduled for computed tomography with intravenous iodinated contrast material. We recorded demographic variables, dose of contrast material, diabetes mellitus, hypertension, and serum hemoglobin. We measured serum creatinine and GFR after premedication and after the CT examination. We summarized variables as means, standard deviations, and percentages. We used the Wilcoxon and Mann–Whitney tests to compare pre- and post-CT values and Pearson's r to analyze correlations.

Results

Incidence acute kidney injury: 0.9%; 95%CI: 0.36–1.4. Mean difference between pre- and post-CT creatinine: 0.04; 95%CI: 0.002–0.09, p<0.004. Mean difference between pre- and post-CT GFR: −3.06; 95%CI: −4.66 to −1.47), p<0.001.

Conclusions

The incidence of contrast-induced nephropathy in patients with chronic renal failure and GFR 30ml–60ml/min/1.73m2 is low. The biomarkers of renal function analyzed improve in patients who receive premedication and the minimum dose of contrast material.

Keywords:
Multidetector computed tomography
Contrast enhancement
Renal failure
Acute kidney injury
Resumen
Antecedentes y objetivo

Nefropatía inducida por contraste (NIC) es el deterioro agudo de la función renal tras la administración intravascular de contraste yodado. Nuestros objetivos son estimar la incidencia de NIC y analizar la evolucion de distintos biomarcadores de funcion renal, en pacientes tras una tomografía computarizada (TC) con contraste yodado intravenoso (CIV) y premedicación (hidratación oral y N-acetilcisteína).

Material y métodos

Estudio observacional prospectivo. Fueron seleccionados 112 pacientes, con una TC con CIV programada y enfermedad renal crónica (ERC) con un filtrado glomerular (FG) entre 30 y 60ml/min/1,73 m2. Se obtuvieron datos demográficos, dosis del CIV, diabetes mellitus, hipertensión arterial y hemoglobina sérica. Se midió la creatinina sérica y el FG posterior a la premedicación y a la TC. Se utilizaron medias, desviaciones estándar y porcentajes, así como las pruebas de Wilcoxon y Mann-Whitney para determinar diferencias significativas, y la de Pearson para análisis de correlación.

Resultados

Incidencia de insuficiencia renal aguda: 0,9%; intervalo de confianza (IC) 95%: 0,36 a 1,4. Media de la diferencia de creatinina pre- y post-TC: 0,04 (IC: 0,002 a 0,09), p < 0,004. Media de la diferencia de FG pre- y post-TC: -3,06 (IC: -4,66 a -1,47), p < 0,001.

Conclusiones

La incidencia de NIC en pacientes con ERC y FG entre 30 y 60ml/min/1,73 m2 es baja. Los pacientes que recibieron premedicación y la mínima dosis de CIV presentaron mejoría en los biomarcadores de función renal analizados.

Palabras clave:
Tomografía computarizada multidetector
Realce de imagen
Insuficiencia renal
Insuficiencia renal aguda

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