Hospital-acquired renal insufficiency: A prospective study

Hou, Susan; Bushinsky, David A.; Wish, Jay B.; Cohen, Jordan J.; Harrington, John T.

doi:10.1016/0002-9343(83)90618-6

Cited by 1,100 publications

(410 citation statements)

References 14 publications

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“…It is associated with prolonged in-hospital stay and increased morbidity, mortality, and costs. Previous studies have shown that 12-14% of patients who develop acute renal insufficiency during hospitalization do so after procedures involving radiographic contrast [5,42]. A retrospective analysis of 16,248 patients exposed to contrast media showed that even apparently small decreases in renal function can lead to excessive mortality rates independent of other risk factors, and given that small rises in serum creatinine levels actually represent a significant drop in GFR [43].…”

Section: Prognosis Of Cinmentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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Section: Prognosis Of Cinmentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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“…This association is most robust among people with eGFR Ͻ45 ml/ min per 1.73 m 2 (3). Although CKD is a widely known risk factor for acute renal failure (ARF; also known as acute kidney injury [AKI]) (4,5), surprisingly little is known about clinical outcomes, especially long-term outcomes, among patients who have CKD and experience superimposed ARF (acute on chronic renal failure). Most published studies about ARF have focused exclusively on in-hospital outcomes with often scant, if any, follow-up after discharge.…”

mentioning

confidence: 99%

Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure

Hsu

Chertow

McCulloch

et al. 2009

Clinical Journal of the American Society of Nephrology

359

273

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“…In 1983, Hou et al (4) prospectively evaluated 2216 patients with hospital-acquired AKI and found decreased renal perfusion and major surgery to be the leading causes of AKI. Contrast medium (CM) was the next most common cause, accounting for 12% of cases of AKI, and was associated with an in-hospital mortality of 6%.…”

mentioning

confidence: 99%

Contrast-Induced Nephropathy

Rudnick

Goldfarb

Tumlin

2008

Clinical Journal of the American Society of Nephrology

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A lthough the clinical features of contrast-induced nephropathy (CIN) have been well described for some time (1,2), during the past 15 yr, interest among physicians on the subject of CIN has dramatically increased. A PubMed search of the phrase "contrast-induced nephropathy" between 1990 and 2007 produced 347 citations. During the past 5 yr alone, there were 290 citations, 159 of which appeared since 2006 (3).Intravascular administration of contrast is widely known to be a common cause of hospital-acquired acute kidney injury (AKI). In 1983, Hou et al. (4) prospectively evaluated 2216 patients with hospital-acquired AKI and found decreased renal perfusion and major surgery to be the leading causes of AKI. Contrast medium (CM) was the next most common cause, accounting for 12% of cases of AKI, and was associated with an in-hospital mortality of 6%. In 1987, Shusterman et al. (5) demonstrated that CM was one of four major factors contributing to hospital acquired AKI (the others being volume depletion, congestive heart failure, and aminoglycosides).The exact risk for CIN is difficult to determine. It is widely known that in patients with normal renal function, even in the presence of diabetes, the risk for CIN is Յ1 to 2% (1). In patients with chronic kidney disease (CKD), it is also well accepted that the risk for CIN is significantly increased and rises in proportion to the severity of underlying renal impairment (1,6,7). Another established observation is that the coupling of CKD and diabetes dramatically increases the risk for CIN compared with that observed for CKD alone (6). Recent studies on CIN in "high-risk" patients have demonstrated a wide range of incidences from 1 to 45% (8,9). Reasons for this wide variation in CIN risk include study differences in the number and severity of underlying risk factors, definition of CIN used, prospective or retrospective collection of data, exclusion or nonexclusion of patients with other AKI etiologies, timing of the baseline serum creatinine (SCr) relative to hydration administration, type and amount of CM used, type and amount of hydration, and presence or absence of other prophylactic measures. Unfortunately, the consequence of these multiple factors makes it difficult to state with reasonable accuracy the clinical risk for CIN in a "high-risk" patient. Additional problems caused by the apparently observed wide range of CIN incidences are methodologically inadequate comparisons of studies for the value of procedural or prophylactic strategies to minimize CIN risk and prospective, randomized, controlled trials that are underpowered to answer the question for which they were designed.Despite the uncertainty of the incidence of CIN in "high-risk" patients, there are a number of reasons to believe that CIN will be an increasing cause of hospital-and outpatient-acquired AKI. Use of intravascular contrast is widespread and continues to expand. In 2003, 80 million doses of CM were administered worldwide (10,11). As of 2004, 3.3 million coronary angiograms, 25.7 million c...

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Hospital-acquired renal insufficiency: A prospective study

Cited by 1,100 publications

References 14 publications

Contrast‐induced nephropathy

Contrast‐induced nephropathy

Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure

Contrast-Induced Nephropathy

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