title: Nephrotoxic Polypharmacy and Risk of Contrast Medium-Induced Nephropathy in Hospitalized Patients Undergoing Contrast-Enhanced CT.
abstract: OBJECTIVE
  For unknown reasons, there is discordance among previous reports with regard to the association of contrast medium (CM) with nephropathy and the incidence of nephropathy after contrast-enhanced CT. This study aimed to determine the frequency of and possible factors related to CM-induced nephropathy in hospitalized patients, with an emphasis on detailing coprescriptions with nephrotoxic potential.
  
  
  METHODS
  Of 1378 inpatients who underwent CT, 208 (15.1%) met the inclusion criteria: receipt of IV iodinated CM and baseline serum creatinine level obtained within 45 days before and within 2 weeks after CT. Patient demographics, clinical characteristics, comorbidity, nephrotoxic comedications (nine classes of drugs), and type of CM administered were retrospectively reviewed. Relationships between CM-induced nephropathy (serum creatinine level increase ≥ 25% or ≥ 0.5 mg/dL after CT) and risk factors were assessed by stepwise multivariate logistic regression.
  
  
  RESULTS
  The cohort of 208 subjects had a high number of comorbidities (mean [± SD], 5.8 ± 3.5 diagnoses) and a high rate of receiving nephrotoxic comedications (45.2%). CM-induced nephropathy was detected in 27 (13.0%) patients. Concurrent use of four nephrotoxic agents (odds ratio [OR], 26.250; 95% CI, 3.673-233.993) was the most influential factor associated with CM-induced nephropathy; other predictors included preexisting renal disease (OR, 8.218; 95% CI, 1.622-42.357), baseline serum creatinine level less than 0.7 or greater than or equal to 1.3 mg/dL (OR, 3.463; 95% CI, 1.341-9.025), and hemoglobin level less than 9.3 g/dL (OR, 3.141; 95% CI, 1.087-8.946).
  
  
  CONCLUSIONS
  Among the known risk factors, such as preexisting renal disease, high serum creatinine level, and low hemoglobin level, a statistically significant association was identified between CM-induced nephropathy and concurrent receipt of four nephrotoxic medications. Relevant preventive measures are warranted for individuals at risk, especially hospitalized patients receiving multiple nephrotoxic medications who require contrast-enhanced CT.
authors.affiliation: 1 Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.|2 School of Pharmacy, National Taiwan University, Taipei, Taiwan.|3 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yunn-Fang
authors.initials: YF
authors.lastname: Ho
authors.affiliation: 1 Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.
authors.forename: Kun-Lin
authors.initials: KL
authors.lastname: Hsieh
authors.affiliation: 2 School of Pharmacy, National Taiwan University, Taipei, Taiwan.
authors.forename: Fan-Lu
authors.initials: FL
authors.lastname: Kung
authors.affiliation: 1 Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.|2 School of Pharmacy, National Taiwan University, Taipei, Taiwan.
authors.forename: Fe-Lin Lin
authors.initials: FL
authors.lastname: Wu
authors.affiliation: 2 School of Pharmacy, National Taiwan University, Taipei, Taiwan.|3 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Hsieh
authors.affiliation: 3 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hua
authors.initials: H
authors.lastname: Chou
authors.affiliation: 4 Department of Radiology, College of Medicine, National Taiwan University, Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan.|5 Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shyh-Jye
authors.initials: SJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media; D003404:Creatinine
keywords: incidence; iodinated contrast medium; nephropathy; renal insufficiency; risk factors