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Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography
M Heras Benito1, M Garrido Blázquez2, Y Gómez Sanz3
1Servicio de Nefrología, Hospital General de Segovia, Segovia, España.
Insights
Contrast-induced nephropathy (CIN) incidence was not significant in patients undergoing CT scans with iodinated contrast. This study evaluated N-acetylcysteine
Area of Science:
- Radiology and Imaging
- Nephrology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a risk following computed tomography (CT) with iodinated contrast.
- Prophylactic strategies are crucial for high-risk patients.
Purpose of the Study:
- To analyze CIN incidence in patients undergoing CT with intravenous iodinated contrast.
- To evaluate N-acetylcysteine's efficacy in preventing CIN.
Main Methods:
- Prospective observational study of 202 patients undergoing CT scans.
- Measured creatinine and urea pre- and post-CT; calculated glomerular filtration rate (GFR) using MDRD-4.
- Recorded contrast type/dose and N-acetylcysteine administration.
Main Results:
- No CIN incidents detected in 202 patients (mean age 63.9 years, 57.4% male).
- Most common CT indication was oncologic (81.2%); iopamidol was the sole contrast agent.
- Only 13 patients received N-acetylcysteine, with no significant difference observed.
Conclusions:
- Low CIN incidence observed, potentially due to scheduled examinations and low nonionic contrast doses.
- Further research is needed to confirm N-acetylcysteine's role in CIN prevention.
Objective:
To analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography (CT) with intravenous iodinated contrast material. To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy.
Patients And Methods:
This prospective observational study was carried out in the months comprising March 2016 through July 2016. We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form. We recorded patients' cardiovascular histories, chronic treatments, and indications for the CT examination. We measured blood levels of creatinine and urea before and after the CT examination. We used the Modification of Diet in Renal Disease (MDRD-4) equation to estimate the glomerular filtration rate. We analyzed the type and dose of contrast material. We recorded whether N-acetylcysteine was administered before the CT examination. We used SPSS 15.0® to compare means and proportions. Statistical significance was set at p < 0.05.
Results:
No incidents of contrast-induced nephropathy were detected in any of the 202 patients included [mean age, 63.92 ± 12 years (range 22-87); 57.4% male; 21.8% diabetic; 39.6% hypertensive; 87.1% had MDRD4 ≥ 60 ml/min/1.73 m2 (89.45 ± 14, range 62.36-134.14) and 12.9% had MDRD4 < 60 ml/min/1.73 m2 (45.38 ± 11, range 9.16-58.90)]. The most common indication for CT examinations was oncologic (81.2%). The only contrast agent administered was iopamidol; the mean dose was 107.83 ± 11 ml (range 70-140). The mean interval between pre-CT and post-CT laboratory tests was 4.06 ± 1 days. Only 13 patients received N-acetylcysteine; 9 of these had MDRD < 60 ml/min/1.73 m2 and 4 had MDRD4 ≥ 60 ml/min/1.73 m2 (p = 0.000).
Conclusions:
The incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30 ml/min/1.73 m2: these favorable results might be due to analyzing only scheduled examinations and to using relatively low doses of a "nonionic" iodinated contrast agent.
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