The Impact of Serum Creatinine, Albumin, Age, and Gender on the Development of Contrast-Induced Nephropathy in Patients Exposed to Contrast Agent Upon Admission to the Emergency Department

Abstract

Background and objectives As the stage progresses in chronic kidney disease (CKD), the risk of contrast-induced nephropathy (CIN) also increases. Serum albumin level is the strongest predictor of CIN development in patients with CKD. It is widely known that females of age 75 are at risk for the development of CIN. Our study aims to investigate the impact of age, gender, serum creatinine, and albumin levels on the development of CIN in patients who were admitted to the emergency department and have had contrast-enhanced computerized tomography (CECT) for diagnosis. Materials and methods The study was planned retrospectively. Patients who applied to the emergency department between January 1, 2018, and January 1, 2020, and had CECT were included in the study. A 25% or 0.5 mg/dL increase in serum basal creatinine level within 72 hours following the implementation of contrast agent was accepted as CIN. The patients were divided into two groups: CIN (+) and CIN (-). Results One-hundred twenty-two patients (53 female and 69 male), whose average age was 72.27± 12, were included in the study. Forty-five of the patients were found to be CIN (+) and 77 CIN (-). There was no significant difference between the groups (p> 0.05) in terms of age. It was found that the serum creatinine level during admission to the emergency department was the determinant for the development of CIN (p = 0.024). In addition, it was observed that serum albumin levels during the admission had no impact on the development of CIN (p = 0.326). When the serum albumin values of female and male patients diagnosed with CIN measured at the first admission to the emergency service were compared, the mean values were found to be lower in male patients (p = 0.027). Conclusion Serum creatinine and albumin levels, age, and gender parameters should be considered in terms of the risk of CIN development in patients who are admitted to the emergency department and given contrast agents.

The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review

“…However, there are studies reporting varied CIN incidences despite using the same definition. Both McGillicuddy [ 13 ] and Akman and Bakirdogen [ 22 ] used an absolute increase of ≥0.5 mg/dL or ≥25% increase over baseline sCr within 72 h but demonstrated vastly different CIN incidences of 1.9% and 36.9%, respectively. This large difference could be attributed to the dissimilarities between the two studies in terms of the sample size and the type of patients recruited.…”

“…This large difference could be attributed to the dissimilarities between the two studies in terms of the sample size and the type of patients recruited. McGillicuddy [ 13 ] recruited a larger sample size of 822, focusing only on ED patients aged ≥55 years, whereas the Akman and Bakirdogen [ 22 ] study had a smaller sample size of 122 with ED patients aged ≥18 years. Moreover, this small sample size of 122 could have resulted in the large difference in CIN incidence between the Akman and Bakirdogen [ 22 ] study and the other 15 studies that also reported higher CIN incidence than the reference value of 4.96%.…”

“…McGillicuddy [ 13 ] recruited a larger sample size of 822, focusing only on ED patients aged ≥55 years, whereas the Akman and Bakirdogen [ 22 ] study had a smaller sample size of 122 with ED patients aged ≥18 years. Moreover, this small sample size of 122 could have resulted in the large difference in CIN incidence between the Akman and Bakirdogen [ 22 ] study and the other 15 studies that also reported higher CIN incidence than the reference value of 4.96%. Additionally, the abovementioned definitions had different post-CECT sCr collection times, which could have influenced the CIN incidence.…”

“…Furthermore, no association was found between gender and CIN development in the ED [ 18 , 26 ], even when CIN incidence was measured using two different definitions [ 26 ]. However, Akman and Bakirdogen [ 22 ] found a one-fold increased risk of CIN for older females, compared to younger males after receiving ICM in the ED.…”

“…In three studies, baseline sCr was associated with a higher risk of developing CIN after receiving ICM in the ED [ 21 , 22 , 26 ]. Although Traub et al [ 29 ] reported that pre-contrast sCr > 2.0 mg/dL is an independent predictor of CIN, Huang et al [ 28 ] showed that a pre-contrast sCr > 1.5 mg/dL was a risk factor only in elderly patients.…”