title: Incidence and risk factors for radiocontrast-induced nephropathy in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization.
abstract: BACKGROUND
  Transcatheter arterial chemoembolization (TACE) is an effective treatment for unresectable hepatocellular carcinoma (HCC); however, large volumes of radiocontrast agents are used for TACE and may induce renal dysfunction. Most patients with HCC have coexisting liver cirrhosis (LC) at the time of diagnosis. Advanced cirrhosis is characterized by peripheral vasodilatation associated with decreased renal perfusion due to the activation of vasoconstrictor systems. We retrospectively investigated patients with HCC who had undergone TACE to determine the incidence and risk factors for radiocontrast-induced nephropathy (RCIN).
  
  
  METHODS
  A total of 101 patients with HCC who underwent a combined 221 TACE treatment sessions were included. Follow-up serum creatinine levels within 96 h after TACE were confirmed in these patients. RCIN was defined as an increase of at least 25% in baseline serum creatinine levels between 48 and 96 h after TACE.
  
  
  RESULTS
  RCIN developed in 20 (9%) of the 221 treatment sessions after TACE. A univariate analysis showed that the Child-Pugh score (6.0 ± 1.3 vs. 6.7 ± 1.9, P = 0.005), ascites (14.4 vs. 40%, P = 0.008), contrast medium volume (257.3 ± 66.8 vs. 275.0 ± 44.0 ml, P = 0.009), total bilirubin (1.3 ± 1.7 vs. 3.4 ± 8.0 mg/dl, P < 0.001), basal serum creatinine levels (0.9 ± 0.3 vs. 1.0 ± 0.5 mg/dl, P < 0.001) and glomerular filtration rate using the modification of diet in renal disease formula (90.5 ± 21.8 vs. 88.4 ± 29.6 ml/min, P = 0.015) were significantly associated with the development of RCIN. A multivariate analysis revealed that the Child-Pugh score was associated with RCIN [odds ratio (OR) 1.5; P = 0.015]. Overall, in-hospital mortality after TACE was 4.07% (with RCIN, 30%; without RCIN, 1.5%; P < 0.001). The multivariate analysis also showed that the Child-Pugh score and the occurrence of RCIN were associated with in-hospital mortality after TACE (OR 2.8; P = 0.001; OR 26.7, P = 0.002, respectively).
  
  
  CONCLUSIONS
  RCIN after TACE was closely associated with the severity of LC. Effective preventive measures remain to be determined in patients with HCC and advanced LC who are undergoing TACE.
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.
authors.forename: Hyun Seop
authors.initials: HS
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.
authors.forename: Yeojin
authors.initials: Y
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.|Institute of Health Science, Gyeongsang National University, Jinju, South Korea.
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea.|Institute of Health Science, Gyeongsang National University, Jinju, South Korea.
authors.forename: Se-Ho
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, College of Medicine, Gyeongsang National University, 92 Chilamdong, Jinju, South Korea. drpdj@korea.com.|Institute of Health Science, Gyeongsang National University, Jinju, South Korea. drpdj@korea.com.
authors.forename: Dong Jun
authors.initials: DJ
authors.lastname: Park
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D003404:Creatinine