Risk Factors for Radiocontrast Nephropathy After Emergency Department Contrast‐enhanced Computerized Tomography

Abstract

Objectives: Radiocontrast nephropathy (RCN) is a known complication of procedures in which intravascular iodinated contrast material is used. The authors sought to determine the risk factors for RCN after emergency department (ED) contrast-enhanced computerized tomography (CECT).Methods: This was a retrospective case-control study of patients presenting to a tertiary care ED between January 1, 2004, and December 31, 2006. Inclusion criteria were CECT performed in the ED, serum creatinine measured prior to CECT, and serum creatinine measured 48 to 96 hours after CECT. Exclusion criterion was dialysis-dependent renal failure prior to CECT. The outcome of RCN was defined as an absolute creatinine increase of greater than or equal to 0.5 mg/dL, or a 25% increase above baseline. The charts of all RCN patients and a random sample of non-RCN patients were reviewed to document the presence or absence of potential risk factors. Univariate analysis was performed using chisquare and multiple logistic regression applying a weighted technique to account for sampling of non-RCN patients.Results: Among the 5,006 patients meeting inclusion criteria, 349 (7%) developed RCN. Multiple regression analysis demonstrated that serum creatinine > 2 mg/dL, liver disease, heart failure, hematocrit < 30%, hypertension, and diabetes were risk factors for RCN, whereas age > 75 years, vascular disease, and serum creatinine > 1.5 mg/dL were not. The area under the curve (AUC) for the model was 0.65. Although the risk of RCN increased with the number of risk factors present, we could not develop a model with sufficient diagnostic accuracy to guide clinical decision-making. Conclusions:The authors report risk factors for RCN in a large case-control study, but could not develop an accurate decision tool to identify patients at increased risk for RCN after ED CECT.ACADEMIC EMERGENCY MEDICINE 2013; 20:40-45 © 2013 by the Society for Academic Emergency Medicine R adiocontrast nephropathy (RCN) is a known complication of procedures that use intravascular radiocontrast media. Although most of the medical literature regarding RCN describes patients undergoing coronary procedures, RCN may occur after emergency department (ED) contrast-enhanced computerized tomography (CECT) as well. RCN is usually defined as an absolute increase in serum creatinine of 0.5 mg/dL or a relative increase of 25% above baseline value several days after contrast administration. [1][2][3][4] RCN is a leading cause of hospital-acquired renal insufficiency 5 and is associated with increased mortality both during hospitalization and after discharge. 1,4,[6][7][8] The rate of RCN after ED CECT varies greatly by study and has been reported as 2% to 3% in patients undergoing computed tomography (CT) angiography for stroke, 9-11 2% to 5% in trauma patients undergoing various studies, [12][13][14][15] 4.5% in patients undergoing

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Association Between Acute Kidney Disease and Intravenous Dye Administration in Patients With Acute Stroke

“…Prior studies estimate that the incidence of CIN from IV dye given in an emergency department for all diagnoses is approximately 7%–11% 12, 13 . In a large, retrospective case-control study of 10,121 patients who received low osmolar iodinated contrast media and 10,121 control patients, a difference in nephrotoxicity was observed only in patients with eGFR < 30 mL/min/1.73m 2 .…”

Application of low dose radiation and low concentration contrast media in enhanced CT scans in children with congenital heart disease

“…Recent studies have demonstrated that the incidence of CIN was 7% after enhanced CT . The updated European Society of Urogenital Radiology contrast media safety committee guidelines stressed the importance of using a minimal dose of low‐osmolar or iso‐osmolar contrast medium for diagnostic examinations .…”