Open AccessContrast-Induced Nephropathy After Computed Tomography in Stable CKD Patients With Proper Prophylaxis
Author(s) -
Sehoon Park,
Myoung Hee Kim,
Eunjeong Kang,
Seokwoo Park,
Hyung Ah Jo,
Hajeong Lee,
Sun Moon Kim,
Jung Pyo Lee,
Kook Hwan Oh,
Kwon Wook Joo,
Yon Su Kim,
Yon Su Kim
Publication year - 2016
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000003560
Subject(s) - medicine , contrast induced nephropathy , kidney disease , renal function , propensity score matching , diabetes mellitus , dialysis , nephropathy , incidence (geometry) , medical record , radiology , physics , optics , endocrinology
Conflicting data have been reported on the clinical significance of contrast-induced nephropathy after CT scan (CT-CIN). In addition, the epidemiologic characteristics and clinical outcomes of CT-CIN following proper prophylactic intervention remain elusive. We examined the incidence, risk factors, and outcomes of CT-CIN in stable chronic kidney disease (CKD) patients using data collected from our outpatient CT-CIN prophylaxis program conducted between 2007 and 2014. The program recruited patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 using an electronic health record-based pop-up alert system and provided an identical protocol of CIN prophylaxis to all patients. A total of 1666 subjects were included in this study, and 61 of the 1666 subjects (3.7%) developed CT-CIN. Multivariate analysis showed that baseline eGFR, diabetes mellitus, and low serum albumin were significant risk factors for CT-CIN. The generalized additive model analysis revealed a nonlinear relationship between the baseline eGFR and the risk of CT-CIN. In this analysis, the risk of CT-CIN began to increase below an eGFR threshold of 36.8 mL/min/1.73 m 2 . To assess the outcomes of CT-CIN, patients with and without CT-CIN were compared after propensity score-based 1:2 matching. CT-CIN did not increase the mortality rate of patients. However, patients with CT-CIN were significantly more likely to start dialysis within 6 months of follow-up, but not after those initial 6 months. CT-CIN developed in only a small number of stable CKD patients who received proper prophylactic intervention, and the risk of CT-CIN was increased in patients with more advanced CKD. Despite the low incidence, CT-CIN conferred a non-negligible risk for the initiation of dialysis in the acute period, even after prophylaxis.