Time to Revisit the Problem of CIN? The Low Incidence of Acute Kidney Injury with and without Contrast in Hospitalized Patients: An Observational Cohort Study

Abstract

BackgroundAcute kidney injury (AKI) following imaging procedures with contrast medium in hospitalized patients is commonly attributed to contrast-induced nephropathy (CIN). This study sought to establish a benchmark of the incidence of AKI in hospitalized patients who underwent computed tomography (CT) scans, with and without intravenous contrast administration.MethodsThis was a multi-center observational cohort study. Hospitalized patients in four hospitals with CT scans during two time periods in 2012 and 2013 were included. AKI post-scan was defined as a change in serum creatinine (sCr) in absolute terms of ≥26.5 μmol/L (≥0.3 mg/dl), occurring within 7 days of the CT scan. AKI incidence was examined by study phases and CT-scan types using logistic regression models. Multinomial logistic regression was used to examine the proportions of sCr availability between two study phases.ResultsThree hundred and twenty-five patients in Period 1 and 518 patients in Period 2 were included in the study. The incidence of AKI in Period 1 was similar in those who received contrast and in those who did not (11.6 % [95 % C.I.: 6.5, 18.7] vs. 10.1 % [95 % C.I.: 5.1, 17.3]; p = 0.38). The incidence of AKI remained not significantly different between the two periods in those who received contrast (11.6 % [95 % C.I.: 6.5, 18.7] vs. 10.7 % [95 % C.I.: 6.8, 15.8]; p = 0.89) and those who did not (10.1 % [95 % C.I.: 5.1, 17.3] vs. 9.1 % [95 % C.I.: 5.2, 14.6]; p = 0.54). Among those who received contrast, there was a significant increase in the availability of both pre- and post- CT scan sCr in Period 2 compared to Period 1 (73.6 % [95 % C.I.: 67.7, 80.6] vs. 79.8 % [95 % C.I.: 75.2, 84.7]; p = 0.006).LimitationsOur study was not targeted to specifically assess the impact of a prevention protocol on the incidence of AKI and was limited to settings within one health authority in the province.ConclusionIn hospitalized patients, the incidence of AKI is low, not different between those who did and did not receive contrast, and was not impacted by improvement in the monitoring of sCr in at risk patients. A better understanding of the determinants of AKI post-contrast scan is required to improve strategies to reduce the incidence of AKI.

Contrast induced nephropathy

“…In a controlled prospective observational study, Hemmett et al 4 reported an incidence of AKI of about 11% in 843 inpatients. However, the incidence of AKI was similar in the group given contrast and in the group not given intravenous iodinated contrast.…”

Prevalence of contrast-induced nephropathy in cardiac patients in a hemodynamic sector

“…CIN, often underdiagnosed, is considered the third cause of ARF in a hospital setting, and may correspond to 12% of cases, remaining behind only prerenal and druginduced ARF [2][3] . In this study, a higher prevalence was observed, corresponding to 30.38% (n = 24) of the patients.…”

“…During last decade, CIN has been identified as the third leading cause of acute renal failure (ARF) in hospitalized patients and may reach 12% of cases. This complication increases mortality, morbidity, length of hospitalization and associated costs [2][3] .…”

Preoperative Assessment of Hepatocellular Carcinoma with Split-Bolus Combined Phase Contrast-Enhanced Computed Tomography

“…A split-bolus technique combines different contrast phases into one acquisition, thereby diminishing radiation exposure with only limited increase in the amount of contrast medium. Many studies showed that intravenous administration of contrast media was not as harmful as using the intra-arterial route [ 20 – 22 ]. Although the dose of the contrast medium was increased in the split-bolus MDCT protocol compared with the multiphase MDCT protocol, the radiation dose also clearly reduced.…”