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11.04.2019 | Contrast Media | Ausgabe 7/2019

European Radiology 7/2019

Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study

Zeitschrift:
European Radiology > Ausgabe 7/2019
Autoren:
Pasqualina Castaldo, Giovanni M. Frascà, Fabiana Brigante, Luigi Ferrante, Simona Magi, Marianna Pavani, Edlira Skrami, Gian Marco Giuseppetti, Gabriele Polonara, Salvatore Amoroso
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00330-019-06147-2) contains supplementary material, which is available to authorized users.

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Abstract

Objectives

To estimate the incidence of contrast-induced acute kidney injury (CI-AKI) after intravenous (iv) iodinated contrast material (ICM) exposure.

Methods

This prospective cohort study included all consecutive patients who underwent radiological investigations using low-osmolar iopamidol 370 mg/ml in a regional hospital over a period of 36 months, without any exclusion criteria. The estimated glomerular filtration rate (eGFR) was evaluated using the MRDR equation before (2–10 days) and after (24–36 h) radiological investigations. CI-AKI was defined as a ≥ 25% decrease in eGFR from baseline. CI-AKI incidence was estimated using a binomial distribution. The association between CI-AKI and demographic and clinical characteristics was modeled using logistic regression.

Results

The study included 1541 patients with a median age of 68 (1st–3rd quartiles 58–76) years with various comorbidities, 30% of whom had pre-existing CKD. Patients affected by stage III or IV chronic kidney disease (CKD) received an infusion of 0.9% normal saline (1.0–1.5 ml/kg/h) before and after iso-osmolar iodixanol administration. CI-AKI was observed in 33 patients (2.1%, 95% CI 1.5–3.0). The logistic regression analysis showed that antibiotic and statin therapies were significantly associated with CI-AKI. The probability of developing CI-AKI decreased by 80% in patients taking statins (OR = 0.20, 95% CI 0.03; 0.68) and increased approximately three times in patients with antibiotic therapy compared with those who did not take statins and antibiotics (OR = 2.92, 95% CI 1.21; 6.36).

Conclusions

Our data suggest that low-osmolar iopamidol carries a low incidence of nephrotoxicity, even in subjects with various comorbid conditions or reduced renal function.

Key Points

• IV administration of ICM carries a low incidence of nephrotoxicity, which was transient in observed patients.
• Statin therapy is negatively associated with AKI in patients exposed to ICM.
• Pre-existing impairment of renal function is not associated with AKI in patients exposed to ICM.

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