title: Contrast-Induced Nephropathy After Computed Tomography in Stable CKD Patients With Proper Prophylaxis: 8-Year Experience of Outpatient Prophylaxis Program.
abstract: Conflicting data have been reported on the clinical significance of contrast-induced nephropathy after CT scan (CT-CIN). In addition, the epidemiologic characteristics and clinical outcomes of CT-CIN following proper prophylactic intervention remain elusive.We examined the incidence, risk factors, and outcomes of CT-CIN in stable chronic kidney disease (CKD) patients using data collected from our outpatient CT-CIN prophylaxis program conducted between 2007 and 2014. The program recruited patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m using an electronic health record-based pop-up alert system and provided an identical protocol of CIN prophylaxis to all patients.A total of 1666 subjects were included in this study, and 61 of the 1666 subjects (3.7%) developed CT-CIN. Multivariate analysis showed that baseline eGFR, diabetes mellitus, and low serum albumin were significant risk factors for CT-CIN. The generalized additive model analysis revealed a nonlinear relationship between the baseline eGFR and the risk of CT-CIN. In this analysis, the risk of CT-CIN began to increase below an eGFR threshold of 36.8 mL/min/1.73 m. To assess the outcomes of CT-CIN, patients with and without CT-CIN were compared after propensity score-based 1:2 matching. CT-CIN did not increase the mortality rate of patients. However, patients with CT-CIN were significantly more likely to start dialysis within 6 months of follow-up, but not after those initial 6 months.CT-CIN developed in only a small number of stable CKD patients who received proper prophylactic intervention, and the risk of CT-CIN was increased in patients with more advanced CKD. Despite the low incidence, CT-CIN conferred a non-negligible risk for the initiation of dialysis in the acute period, even after prophylaxis.
authors.affiliation: From the Department of Internal Medicine, Seoul National University College of Medicine, Seoul (SP, EK, SP, HAJ, HL, K-HO, KWJ, YSK, DKK); Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do (M-HK); Department of Internal Medicine, Chungbuk National University Hospital, Chungcheongbuk-do (SMK); Department of Internal Medicine, Seoul National University Boramae Medical Center (JPL); and Kidney Research Institute, Seoul National University, Seoul, Korea (KWJ, YSK, DKK).
authors.forename: Sehoon
authors.initials: S
authors.lastname: Park
authors.forename: Myoung-Hee
authors.initials: MH
authors.lastname: Kim
authors.forename: Eunjeong
authors.initials: E
authors.lastname: Kang
authors.forename: Seokwoo
authors.initials: S
authors.lastname: Park
authors.forename: Hyung Ah
authors.initials: HA
authors.lastname: Jo
authors.forename: Hajeong
authors.initials: H
authors.lastname: Lee
authors.forename: Sun Moon
authors.initials: SM
authors.lastname: Kim
authors.forename: Jung Pyo
authors.initials: JP
authors.lastname: Lee
authors.forename: Kook-Hwan
authors.initials: KH
authors.lastname: Oh
authors.forename: Kwon Wook
authors.initials: KW
authors.lastname: Joo
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D057216:Propensity Score; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000000981:diagnostic imaging; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000379:methods
chemical_list: D003287:Contrast Media; D003404:Creatinine