title: [Contrast-induced nephropathy and mortality after contrast-based investigation].
abstract: OBJECTIVE
  To evaluate the Dutch CBO guideline 'Preventive measures for iodine-based contrast investigations' in daily practice, and to assess one-year mortality post contrast exposure in patients at high risk of contrast-induced nephropathy (CIN).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Between July 2011 and May 2013, 497 patients at high risk of CIN were prepared for elective iodine-based contrast investigations according to the Dutch CBO guideline. This group was followed up until May 2014 or, if applicable, until death. CIN incidence and reversibility, and mortality, were assessed.
  
  
  RESULTS
  CIN occurred in 20 patients (4%). The incidence was highest in the group of patients with an estimated glomerular filtration rate (eGFR) < 30 ml/min per 1.73 m2 (9/84 patients). CIN was reversible within two months in 19 patients. None of the patients with CIN died during that period. One-year mortality post contrast exposure was 22.5% (median survival: 203 days).
  
  
  CONCLUSIONS
  This cohort study shows a low incidence of CIN, which is largely reversible. Almost a quarter of the cohort died within a year post contrast exposure, not as the result of CIN but probably due to comorbidities. Adherence to the current CBO guideline exposes patients with a reduced life expectancy to excessive preventive measures, while the occurrence of CIN is rare. These data warrant reconsideration of the current CBO guideline.
authors.affiliation: Maasstad Ziekenhuis, afd. Interne Geneeskunde en Dialyse, Rotterdam.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gundlach
authors.forename: J A M Judith
authors.initials: JA
authors.lastname: van Beek-Peeters
authors.forename: Jeroen
authors.initials: J
authors.lastname: Ruissen
authors.forename: Iris J A M
authors.initials: IJ
authors.lastname: Verberk-Jonkers
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003287:Contrast Media / Q000009:adverse effects* / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007455:Iodine / Q000009:adverse effects / Q000378:metabolism; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D007455:Iodine