Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

Abstract

Introduction: Contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV) contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED) and were discharged home after computed tomography (CT) of the abdomen and pelvis (AP) with IV contrast.Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients' clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD) and congestive heart failure (CHF).Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%). Hypertension was present in 141 patients (26.3%), and 82 patients (15.3%) were on angiotensin-converting-enzyme inhibitors (ACEI). Five patients (0.9%) had documented CHF and all of them were taking furosemide. Seventy patients (13%) had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28%) followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5%) had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5%) developed CIN. One hundred ninety patients (35.4%) followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2%) had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15%) developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients).Conclusion: There was a poor outpatient follow up after CT of AP with IV contrast and biochemically CIN appears to be present in some patients. Unlike previous reports that CKD is the major risk factor for CIN, our results demonstrated that risk factors such as advanced age, DM and hypertension seem to predispose patients to CIN rather than abnormal baseline SCr. [West J Emerg Med. 2014;15(3):276–281.]

Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

“…The first is the risk of radiation-induced cancer [18][19][20][21][22], which is theoretically not a major issue in aged patients because of their short expected lifespan. The second is related to intravenous injection of iodinated contrast medium, which is a major concern in aged patients with advanced age, as it is reported to be an independent risk factor for contrast-induced nephropathy [23][24][25].…”

Adrenal and nephrogenic hypertension: an image quality study of low tube voltage, low-concentration contrast media combined with adaptive statistical iterative reconstruction

“…reported that an iterative reconstruction technique could reduce the radiation dose by 20%–51% and the iodine dose by 40% during abdominal dynamic enhancement CT scanning without deterioration of image quality. Compared with the general population, the reduction in contrast material (CM) provides more benefits because the occurrence of contrast‐induced nephropathy is higher among adrenal and nephrogenic hypertension patients …”

“…Compared with the general population, the reduction in contrast material (CM) provides more benefits because the occurrence of contrast-induced nephropathy is higher among adrenal and nephrogenic hypertension patients. 13 The purpose of this study was to assess the effect of a reduced iodine load on contrast enhancement, image quality and detection ability of renal artery stenosis and adrenal lesions in enhancement CT with a combination of an 80 kVp tube voltage setting and ASIR techniques in adrenal and nephrogenic hypertension patients.…”

Investigation of the relationship between contrast nephropathy development and body mass index in patients receiving contrast media in the emergency department

“…CIN is defined as an increase in serum creatinine greater than 25% or ≥ 0.5 mg/dL occurring within 3 days of intravenous contrast agent administration without an alternative cause and is defined as the third cause of hospital-acquired ARF [6]. It is associated with hospitalization, increased length of hospital stay, and high mortality rates [7].…”