Estimated Radiation Exposure from Medical Imaging in Hemodialysis Patients

Mauri, Andreana De; Brambilla, Marco; Chiarinotti, Doriana; Matheoud, Roberta; Carriero, Alessandro; Leo, Martino De

doi:10.1681/asn.2010070784

Cited by 38 publications

(20 citation statements)

References 34 publications

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“…Furthermore, if the presence of detectable calcifications on conventional chest radiographs provides important information, the much higher radiation exposure required for CT scans could be avoided in this population, which already undergoes many diagnostic radiology tests. 14 …”

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confidence: 99%

Associations Between Coronary Calcification on Chest Radiographs and Mortality in Hemodialysis Patients

Abdelmalek

Stark

Walther

et al. 2012

American Journal of Kidney Diseases

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Background KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend lateral abdominal radiographs to assess vascular calcification in incident dialysis patients. However, nearly all dialysis patients in the US receive chest radiographs at dialysis inception which may provide readily available information on coronary artery calcification (CAC) and aortic arch calcification (AAC). We determined the prevalence of CAC and AAC visible on plain chest radiographs and their associations with mortality in our dialysis population. Study Design Retrospective Analysis Setting & Participants 93 participants who received maintenance hemodialysis at the San Diego VAMC in 2009–2010 Predictor Presence of CAC and AAC as evaluated by a radiologist Outcome All cause mortality Results The average age was 64; 22% were African-American, and 97% were male. CAC and AAC prevalence were 25% and 58%, respectively. During 20 months’ follow-up, 28% died. CAC was strongly associated with mortality in models including cardiovascular (HR, 2.41; 95% CI 1.04–5.59) and dialysis-related (HR, 2.86; 95% CI 1.24–6.6) risk factors. AAC was associated with a HR of 5.25 (95% CI, 1.46–17.72) in cardiovascular risk-factor adjusted models and 7.31 (95% CI, 2.03–26.34) in dialysis models. When CAC and AAC were both included in models, both CAC (HR, 3.40; 95% CI, 1.24–9.36) and AAC (HR, 6.23; 95% CI, 1.64–23.66) remained significantly associated with mortality. Limitations The study sample is relatively small and mostly male. Conclusions CAC and AAC are highly prevalent on chest radiographs in dialysis patients, and strongly associated with mortality independent of one another. Since these images are nearly ubiquitous, inexpensive, and often already obtained for other indications, they should be considered for risk assessment in hemodialysis patients. Future studies are required to determine whether CAC or AAC on chest radiography is additive or duplicative of the risk of aorto-iliac calcification on lateral abdominal radiographs currently suggested by KDIGO.

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confidence: 99%

Associations Between Coronary Calcification on Chest Radiographs and Mortality in Hemodialysis Patients

Abdelmalek

Stark

Walther

et al. 2012

American Journal of Kidney Diseases

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“…Previous studies have reported increased radiation exposure from medical imaging among the general population (7,8). In more recent studies, increased radiation exposure has been identified in hemodialysis patients and posttransplant recipients (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Ionizing Radiation Exposure among Kidney Transplant Recipients Due to Medical Imaging during the Pretransplant Evaluation

Nguyễn

Patel

Weng

2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Kidney transplant recipients are at increased risk for malignancies. One recognized risk for malignancy is ionizing radiation. The purpose of this study was to determine, among kidney transplant recipients, the medical imaging procedures that contribute to radiation exposure and their cumulative radiation exposure, as a result of their pretransplant evaluation.Design, setting, participants, & measurements Medical records of patients who received a first, kidney-alone transplant during 2008 at a single transplant center were examined. This study identified medical imaging procedures that were performed as prerequisites for deceased donor wait-listing or receipt of live donor kidney transplants and to maintain active status on the wait list. Frequencies of medical imaging procedures and cumulative effective doses of radiation were calculated.Results Among the 172 kidney transplant recipients, 905 procedures were performed. Seventy patients (40.7%) were exposed to low dose (0-20 mSv), 51 (29.7%) were exposed to moderate dose (.20-50 mSv), 28 (16.3%) were exposed to high dose (.50-100 mSv), and 23 (13.4%) were exposed to very high dose (.100 mSv) cumulative effective radiation. Nuclear stress tests accounted for 82.9% of the total radiation exposure. In multivariate analysis, older age, diabetes, and black race were associated with exposure to .20 mSv radiation during the pretransplant evaluation.Conclusions Kidney transplant recipients are exposed to large amounts of ionizing radiation from medical imaging during the pretransplant evaluation. The effects of radiation upon malignancy risk and strategies to reduce this radiation exposure warrant further investigation.

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“…At the present time, most devices employed to study VC take advantage of electron beam computed tomography (CT) and multislice spiral CT, which allow the physician to assess the development of VC via a quantitative calcium score over time, but do not allow the distinction between intimal and medial calcification [1,2]. However, the primary disadvantages of such techniques are the high risk of radiation exposure for patients [3] and the high cost. Furthermore, the technology can only be employed in specialized medical centers which are not physically capable of providing services to the majority of subjects affected by chronic renal failure.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Arterial Media Calcification in Chronic Kidney Disease

Marinelli¹,

Pistolesi

Pasquale³

et al. 2013

Cardiorenal Med

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Purpose: Arterial media calcification (AMC) is often the only vascular calcification (VC) present in young patients with chronic renal failure and its presence is associated with higher mortality rates. Currently, X-ray imaging (as a standard approach) is able to show AMC in areas without diffuse overlapping arterial intimal calcification (AIC), but X-ray imaging only allows us to identify this lesion when the vessel is widely calcified. The aim of this study was to evaluate the possibility of using ultrasonography as opposed to X-rays to visualize AMC in patients with chronic renal failure. Patients and Methods: In this cross-sectional study, we examined 105 patients (chronic kidney disease stage IV: 19 patients, hemodialysis: 48 patients, renal transplant: 26 patients; mean age: 54 ± 14 years; 65 males and 40 females); B-mode ultrasonography was performed to detect AMC or AIC on the superficial femoral artery (SFA). As a control, plain radiography of the thigh was performed in all patients. Results: Upon ultrasonography investigation, 12 subjects were excluded due to diffuse VC on the SFA that did not permit a distinction between AMC and AIC. In the remaining 93 patients, AMC was detected on the SFA in 43 patients using ultrasonography and in 20 patients using the standard approach. The sensitivity and specificity of the standard approach for the detection of AMC on the SFA were 47 and 100%, respectively. The positive and negative predictive values of the standard approach were 1 and 0.68, respectively. Conclusion: Ultrasonography is able to detect AMC better than the X-ray approach, focusing on individuals at higher risk.

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Estimated Radiation Exposure from Medical Imaging in Hemodialysis Patients

Cited by 38 publications

References 34 publications

Associations Between Coronary Calcification on Chest Radiographs and Mortality in Hemodialysis Patients

Associations Between Coronary Calcification on Chest Radiographs and Mortality in Hemodialysis Patients

Ionizing Radiation Exposure among Kidney Transplant Recipients Due to Medical Imaging during the Pretransplant Evaluation

Diagnosis of Arterial Media Calcification in Chronic Kidney Disease

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