Can sodium fluorescein cause contrast-induced nephropathy?

Area of Science:

• Nephrology
• Ophthalmology
• Radiology

Background:

• Contrast-induced nephropathy (CIN) is a frequent cause of acute kidney injury (AKI).
• Fluorescent angiography (FAG) using fluorescein sodium dye is generally deemed safe for patients with kidney conditions.
• The potential for FAG to induce CIN remains uncertain.

Purpose of the Study:

• To investigate whether fluorescent angiography (FAG) can induce contrast-induced nephropathy (CIN).
• To assess the association between FAG and the progression of end-stage renal disease (ESRD).

Main Methods:

• Retrospective analysis of 979 patients from two tertiary hospitals undergoing FAG between 2001 and 2017.
• Exclusion of patients with concurrent iodinated contrast imaging or dialysis.
• Definition of CIN using established CIN and contrast-induced acute kidney injury (CIAKI) criteria based on serum creatinine changes.

Main Results:

• The incidence of CIN after FAG was 7.3% (CIN criteria) and 6.4% (CIAKI criteria) among eligible patients.
• CIN incidence showed a U-shaped distribution with chronic kidney disease (CKD) stages (CIN criteria) and a linear association (CIAKI criteria).
• Patients who developed CIN were significantly associated with ESRD progression (adjusted hazard ratios of 2.23 and 2.17).

Conclusions:

• FAG may induce CIN and poses a risk for ESRD progression.
• The diagnostic criteria for CIN and CIAKI may overestimate AKI, necessitating careful interpretation.
• Further research is needed to clarify the precise risk and management strategies.