Economic burden of contrast-induced nephropathy: implications for prevention strategies

Subramanian, Sujha; Tumlin, James A.; Bapat, Bela; Zyczynski, Teresa

doi:10.3111/200710119134

Cited by 112 publications

(66 citation statements)

References 21 publications

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“…In a series of 200 patients undergoing PCI for acute MI, patients who developed contrast-induced AKI had a longer hospital stay, a more complicated clinical course, and a significantly increased risk of death compared to those without contrast-induced AKI [25]. A recent economic analysis of the direct costs associated with contrast-induced AKI showed that the average additional cost was USD 10,345 for the hospital stay and USD 11,812 for 1 year [29]. The major determinant of the increased costs associated with contrast-induced AKI was the cost of the longer initial hospital stay.…”

Section: Epidemiology and Prognostic Implications Of Contrast-inducedmentioning

confidence: 99%

Radiocontrast-Induced Acute Kidney Injury

McCullough¹

2008

Nephron Physiol

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Many radiographic studies and procedures use iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication, which accounts for a significant number of cases of hospital-acquired renal failure associated increased hospital length of stay and increased mortality. Sustained reductions in renal blood flow, hypoxic injury, direct cellular toxicity by the contrast media, and superimposed organ injury are all believed to play a role in this form of AKI. Avoidance of dehydration and multimodality prevention measures may reduce rates of this problem in patients at risk. Contrast-induced AKI is likely to remain a significant challenge for specialists in the future since the patient population is aging, chronic kidney disease and diabetes are coming more common, and use of iodinated contrast is growing.

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Section: Epidemiology and Prognostic Implications Of Contrast-inducedmentioning

confidence: 99%

Radiocontrast-Induced Acute Kidney Injury

McCullough¹

2008

Nephron Physiol

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“…[7][8][9] Finally, CI-AKI results in prolonged hospitalizations and additional costs. 10 To estimate the preprocedural risk of CI-AKI in interventional cardiology is of crucial importance, especially in patients with STEMI, whose renal function cannot yet be assessed accurately at the time of clinical presentation. Identifying patients at risk has a direct effect in targeting prophylactic interventions.…”

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confidence: 99%

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Andò

Gregorio

Morabito

et al. 2014

Circ: Cardiovascular Interventions

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Background-Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established. Methods and Results-Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function-adjusted CV (CV/eGFR 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ 2 of 5.973 (P=0.029). Conclusions-CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI. (Circ Cardiovasc Interv. 2014;7:465-472.)Key Words: acute kidney injury ◼ balloon coronary angioplasty ◼ contrast media adverse effects ◼ myocardial infarction

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“…Its occurrence has been linked to late cardiovascular events after percutaneous coronary intervention (such as myocardial infarction), bleeding requiring transfusion, and vascular complications. As a consequence of more serious adverse events, the in-hospital stay is longer with an estimated US$10,000 to US$12,000 added to the final bill during the first year (Subramanian et al, 2007).…”

Section: Negative Positive Coronary Angiography Negative Positivementioning

confidence: 99%