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Critical Care

, 16:R67

First Online: 25 April 2012Received: 05 December 2011Revised: 24 February 2012Accepted: 25 April 2012

Abstract

IntroductionComputerized tomography is frequently employed in the critically ill, often using intravenous radiocontrast material. Many of these patients have clinical features that are considered risk factors for contrast induced nephropathy, but are simultaneously at risk for renal injury from other factors related to their acute illnesses. The attributable risk for renal dysfunction from radiocontrast exposure has not been well quantified in this population.

MethodsA prospective matched cohort study was conducted of patients scanned with or without radiocontrast enhancement while receiving intensive care in a Veterans Affairs Medical Center. Patients were matched for pre-scan measured creatinine clearance, diabetes, mechanical ventilation, and vasopressor use. Measured clearance was followed for three days after scanning. Evolution of nephropathy, as determined by change in measured clearance, was compared within matched pairs.

ResultsFifty-three pairs of patients satisfied matching criteria. Unmatched characteristics were similar among the pairs, including serum creatinine variability during the week preceding scanning 67 ± 85% among contrast recipients, 63 ± 62% among others and clinical risk factors for renal failure. In 29 pairs, pre-scan measured clearances were less than 60 mL-minute-1.73 m. Following scanning, measured clearance declined by at least 33% in 14 contrast and 19 non-contrast patients 95% confidence interval for contrast associated difference in nephropathy rates -27% to 9%, while a 50% reduction in clearance persisted three days after scanning in three contrast and nine non-contrast patients 95% confidence interval for difference in rates -25% to 2%.

ConclusionsAmong established intensive care unit patients declines in glomerular filtration following contrast-enhanced scanning are common, but these changes are far more likely to be attributable to factors other than the contrast exposure itself. The upper bound for the incidence of contrast induced renal injury lasting even three days was 2% in the population studied.

AbbreviationsAKIacute kidney injury

CGCockcroft-Gault

CIconfidence interval

CINcontrast induced nephropathy

CTcomputerized tomography

GFRglomerular filtration rate

IQRinterquartile range

mCrClmeasured creatinine clearance

MDRDModified Diet in Renal Disease

RCMradiographic contrast material

SDstandard deviation.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11317 contains supplementary material, which is available to authorized users.

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Autor: Cynthia M Cely - Roland MH Schein - Andrew A Quartin

Fuente: https://link.springer.com/







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