Incidence and outcomes of contrast-induced nephropathy after computed tomography in patients with CKD: a quality improvement report.
BACKGROUND
Although there has been considerable investigation of the general characteristics of contrast-induced nephropathy (CIN), it has not been studied adequately in a computed tomography (CT) population. We assessed the incidence and outcomes of CIN after contrast-enhanced CT in patients with chronic kidney disease pretreated with saline and N-acetylcysteine (NAC).


METHODS
Quality improvement report.


METHODS
520 patients registered in a CIN prevention program.


METHODS
We initiated the CIN prevention program in January 2007. In this program, patients with chronic kidney disease undergoing contrast-enhanced CT in an outpatient setting were automatically referred to nephrologists, and patients received saline and NAC before and after CT. The development of CIN was assessed 48-96 hours after CT.


RESULTS
Incidence of CIN and time to renal replacement therapy.


METHODS
Baseline serum creatinine, hemoglobin, and serum albumin levels; type and volume of contrast agents; and post-CT serum creatinine level.


RESULTS
Overall, CIN occurred in 13 (2.5%) patients. Incidences of CIN were 0.0%, 2.9%, and 12.1% in patients with an estimated glomerular filtration rate of 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively. The risk of CIN was increased in patients with severely decreased kidney function and diabetes. The development of CIN consequently increased the risk of renal replacement therapy (P < 0.001 by log-rank), and the risk was significantly accentuated in patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2).


CONCLUSIONS
A single-center study and comparison with previous studies.


CONCLUSIONS
The incidence of CIN was relatively low in patients treated with saline and NAC. The development of CIN predisposed to poor kidney survival in the long term.
Kim
Sun Moon
SM
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Cha
Ran-hui
RH
Lee
Jung Pyo
JP
Kim
Dong Ki
DK
Oh
Kook-Hwan
KH
Joo
Kwon Wook
KW
Lim
Chun Soo
CS
Kim
Suhnggwon
S
Kim
Yon Su
YS
D000111:Acetylcysteine / Q000627:therapeutic use; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011785:Quality Assurance, Health Care; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology* / Q000517:prevention & control; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000379:methods
D003287:Contrast Media; D012965:Sodium Chloride; D000111:Acetylcysteine