Are screening serum creatinine levels necessary prior to outpatient CT examinations?
OBJECTIVE
To determine the percentage of outpatients with elevated serum creatinine levels (>/=2.0 mg/dL [177 micromol/L]) and associated reported risk factors for contrast material-induced nephrotoxic reactions (eg, diabetes, renal disease, male, age >/= 60 years, chemotherapy) who undergo computed tomography (CT) and to define a true high-risk population.


METHODS
The serum creatinine levels were obtained in a total of 2,034 consecutive outpatients (969 male, 1,065 female) who underwent contrast material-enhanced CT. In addition, selected patient charts were reviewed to determine the presence of risk factors for contrast material-induced nephrotoxic reactions.


RESULTS
Only 66 (3.2%) had an elevated serum creatinine level. Risk factors were identified in 64 of the 66 (97%) patients with an elevated serum creatinine level. Renal disease was present in 62 of the 66 (94%) patients. Two of the 66 patients with an elevated creatinine level had no identifiable risk factors, representing 0.1% of the total number of patients.


CONCLUSIONS
The data suggest that the majority of patients with a serum creatinine level of at least 2.0 mg/dL (177 micromol/L) will be identified by screening for risk factors. Careful patient screening, especially for renal disease, at the time of scheduling could result in considerable savings in terms of radiology man-hours expended and laboratory costs.
Radiology Section, Emory Clinic, 1364 Clifton Rd NE, Atlanta, GA 30322, USA. rtippin@emory.edu
R B
RB
Tippins
W E
WE
Torres
B R
BR
Baumgartner
D A
DA
Baumgarten
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000503:physiopathology; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D005665:Furosemide / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000187:drug effects; D016014:Linear Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
D003287:Contrast Media; D004232:Diuretics; D005665:Furosemide; D003404:Creatinine