title: Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity.
abstract: OBJECTIVE
  Most studies of contrast-induced nephropathy lack controls to distinguish it from nephropathy from other causes. We assessed the frequency and magnitude of serum creatinine changes in patients not receiving iodinated contrast material to compare with creatinine changes in publications regarding contrast nephropathy.
  
  
  METHODS
  From the electronic medical records of an academic medical center, adults with creatinine determinations on five consecutive days who had not received contrast material during the previous 10 days were identified. The first creatinine level was compared with those on subsequent days. We calculated the frequency with which these levels exceeded thresholds used to identify contrast nephropathy in previous publications.
  
  
  RESULTS
  Among 32,161 patients, more than half showed a change of at least 25% and more than two fifths, a change of at least 0.4 mg/dL. Among patients with baseline creatinine levels of 0.6-1.2 mg/dL, increases of at least 25%, 33%, and 50% occurred in 27%, 19%, and 11% of patients, respectively. Increases of 0.4, 0.6, and 1.0 mg/dL occurred in 13%, 7%, and 3% of patients. Among patients with baseline creatinine levels greater than 2.0 mg/dL, increases of at least 25%, 33%, and 50% occurred in 16%, 12%, and 7%. Increases of 0.4, 0.6, and 1.0 mg/dL occurred in 33%, 26%, and 18%. These increases were not different from the incidences of contrast nephropathy previously published.
  
  
  CONCLUSIONS
  The creatinine level increases in patients who are not receiving contrast material as often as it does in published series of patients who are receiving contrast material. The role of contrast material in nephropathy may have been overestimated.
authors.affiliation: Department of Radiology, Columbia University Medical Center, 630 W 168th St., New York, NY 10032, USA. jhn2@columbia.edu
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Newhouse
authors.forename: David
authors.initials: D
authors.lastname: Kho
authors.forename: Qasim A
authors.initials: QA
authors.lastname: Rao
authors.forename: Justin
authors.initials: J
authors.lastname: Starren
mesh_terms: D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000139:chemically induced; D008297:Male; D012189:Retrospective Studies; D014283:Triiodobenzoic Acids / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine