Changes in Renal Function in Elderly Patients Following Intravenous Iodinated Contrast Administration: A Retrospective Study

Abstract

Background. Contrast-induced nephropathy (CIN) is a recognised complication of intravascular administration of iodinated contrast media (ICM). Previous studies suggest a higher incidence in the elderly, but no large study has assessed this to date. We set out to assess changes in creatinine in elderly inpatients following computed tomography (CT) examination and compare those who received intravenous contrast to those who did not. Methods. Using the Radiology Information System in two teaching hospitals, inpatients over the age of seventy who had a CT examination and a baseline creatinine were identified and their follow-up creatinine levels were analysed. Elderly inpatients who underwent a noncontrast CT over the same period were used as controls. Results. 677 elderly inpatients who received ICM were compared with 487 controls. 9.2% of patients who received ICM developed acute kidney injury (AKI) compared to 3.5% of inpatient controls (P < 0.0001). Patients with higher baseline eGFR had a higher incidence of post-CT AKI. Conclusions. The incidence of post-CT AKI is higher in patients who received IV ICM compared to those who did not; the difference may be partly attributable to contrast-induced nephropathy. This suggests that the incidence of CIN in the elderly may not be as high as previously thought.

Risk Factors and Pathophysiology of Contrast- Induced Nephropathy after Contrast Enhanced Multidetector Computed Tomography

“…Alsafi A. и соавт. (2014) [70] выполнили близкое по сути исследование. Они изучили две группы пациентов старше 70 лет.…”

Acute kidney injury after contrast-enhanced examination among elderly

“…Contrasts that have high osmolarity are demonstrably more nephrotoxic than those with low osmolarity ( 7 ) . The main factors of preexisting risk for AKI are: renal failure, diabetes mellitus, heart failure, hypotension, dehydration, and the use of medications such as diuretics and non-steroidal anti-inflammatories ( 8 ) .…”

“…Contrast-induced nephropathy (CIN) is an increase of >25% in the baseline levels of serum creatinine. Some studies report that an increase of creatinine occurs within 48 hours ( 6 , 13 ) , and others between 48-72 hours ( 4 , 8 , 15 ) after the administration of the contrast agent.…”

“…Renal lesions caused by the use of contrast are classified into acute tubular necrosis (ATN) and acute tubulointerstitial nephritis (ATIN) ( 6 ) . The pathophysiology of ATN is multifactor and involves changes in renal hemodynamics and the renal tubules due to a biphasic response: interspersed vasodilation with vasoconstriction which decreases renal blood flow, causing renal ischemia ( 8 , 15 ) . CIN is characterized by the damage of epithelial cells of the renal tubules causing decreased renal blood flow that leads to hypoxia in the renal medulla, and also by the appearance of granular cylinders, erythrocytes and inflammatory cells in the urine; ATIN can manifest in a milder form ( 6 ) .…”

“…However, definitive diagnosis is established after renal biopsy ( 6 ) . For the prevention of contrast-induced AKI, the use of diuretics is indicated, as well as that of vasodilators, hydration, pharmacological vasoconstrictors, and antioxidants inhibitors ( 8 , 16 ) .…”