title: Contrast-induced acute kidney injury after computed tomography prior to transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To identify independent predictors of contrast medium-induced acute kidney injury (CI-AKI) after enhanced multidetector-row computed tomography (MDCT) prior to transcatheter aortic valve implantation (TAVI) in high-risk patients.
  
  
  METHODS
  The present single-centre study analysed retrospectively 361 patients who were assessed using MDCT prior to TAVI. CI-AKI was defined as an increase in serum creatinine (SCr) of ≥ 25% or ≥ 0.5 mg/dl in at least one sample over baseline (24 h before MDCT) and at 24, 48, and 72 h after MDCT.
  
  
  RESULTS
  A total of 38 patients (10.5%) experienced CI-AKI. As compared to patients without CI-AKI, they presented more frequently with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), (81.6% versus 64.4%, p = 0.045) and tended to receive higher volumes of iodinated contrast media (ICM; 55.3% versus 39%, p = 0.057). There was a significant interaction between baseline eGFR and the amount of intravenous ICM administered (pfor interaction = <0.001) identifying the amount of ICM >90 ml as independent predictive factor of CI-AKI only in patients with baseline eGFR <60 ml/min/1.73m(2) (OR 2.615; 95% CI: 1.21-5.64).
  
  
  CONCLUSIONS
  One in ten elderly patients with aortic stenosis undergoing MDCT to plan a TAVI procedure experienced CI-AKI after intravenous ICM injection. Intravenous administration of <90 ml of ICM reduces this risk in patients with or without pre-existing impaired renal function. However, in the majority of patients renal function recovers before the TAVI procedure.
authors.affiliation: Cardiology Department, Munich University Clinic, Germany. Electronic address: david.jochheim@med.uni-muenchen.de.
authors.forename: D
authors.initials: D
authors.lastname: Jochheim
authors.affiliation: Radiology Department, Munich University Clinic, Germany.
authors.forename: V-S
authors.initials: VS
authors.lastname: Schneider
authors.affiliation: Radiology Department, Munich University Clinic, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schwarz
authors.affiliation: Cardiology Department, Munich University Clinic, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kupatt
authors.affiliation: Cardiology Department, Munich University Clinic, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Lange
authors.affiliation: Radiology Department, Munich University Clinic, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reiser
authors.affiliation: Cardiology Department, Munich University Clinic, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Massberg
authors.affiliation: Cardiology Department, Munich University Clinic, Germany.
authors.forename: J-L
authors.initials: JL
authors.lastname: Gutiérrez-Chico
authors.affiliation: Cardiology Department, Munich University Clinic, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Mehilli
authors.affiliation: Radiology Department, Munich University Clinic, Germany.
authors.forename: H-C
authors.initials: HC
authors.lastname: Becker
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol