title: Contrast-induced acute kidney injury in cirrhotic patients. A retrospective analysis.
abstract: BACKGROUND
  The nephrotoxic potential of intravenous iodinated contrast (IC) is controversial. Cirrhotic patients are often submitted to imaging procedures involving IC and small changes in renal function may have detrimental effects.
  
  
  METHODS
  Retrospective analysis of hospitalized patients with elective imaging by either contrast-enhanced CT or MRI. Contrast induced acute kidney injury (CI-AKI) was diagnosed if there was either an increase of SCr by 25% or by 44 μmol/L or a decrease of estimated glomerular filtration rate by 25% by day 3.
  
  
  RESULTS
  Between 2004 and 2012 152 patients (female: 30.3%, age: 60 ± 10.8 years, MELD 13 ± 6) were included in this study of which 84 (55.3%) had received IC and 68 (44,7%), who served as controls, MRI with gadolinium based contrast (non-IC). Baseline parameters were well matched except for age (61.7 vs. 56.9) years in the IC vs. non-IC groups, p = 0.005). 15 patients (17.9%) receiving IC and 4 patients (5.9%) not receiving IC (p = 0.026) reached the composite end-point for CI-AKI. In multivariable regression analysis INR [B = 0.252 (95% CI: 0.108-0.397), p = 0.001]; IC [B = 0.136 (95% CI: 0.023-0.248), p = 0.019] and serum sodium [B = 0.011 (95% CI: 0.001-0.023); p = 0.080] were independently associated with changes of SCr. In conclusion IC may cause renal dysfunction in cirrhotic patients. Patients subjected to imaging using IC should be closely monitored.
authors.affiliation: Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München.
authors.forename: Wajima
authors.initials: W
authors.lastname: Safi
authors.affiliation: Nuklearmedizinische Klinik. Klinikum rechts der Isar der Technischen Universität München.
authors.forename: Isabel
authors.initials: I
authors.lastname: Rauscher
authors.affiliation: Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München.
authors.forename: Andreas
authors.initials: A
authors.lastname: Umgelter
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D061605:Administration, Intravenous; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D019934:International Normalized Ratio; D007479:Iopamidol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D009942:Organometallic Compounds; C057937:iomeprol; C090600:gadobutrol; D003404:Creatinine; D007479:Iopamidol