TOC  |   Renal  


Contrast-induced Nephropathy

Contrast-induced Nephropathy | Strategy (figure)  

REF:  JAMA Volume 295(23), 21 June 2006, p 2765–2779

Two risk scores for contrast-induced nephropathy developed from large interventional cardiology databases may be the most generalizable to this patient population.

Bartholomew et al 16 (n = 20 479) identified 8 variables that were associated with contrast-induced nephropathy

  1. creatinine clearance <60 mL/min [1.0 mL/s],
  2. use of an intra-aortic ballon pump,
  3. urgent coronary procedure,
  4. diabetes,
  5. CHF,
  6. hypertension,
  7. peripheral vascular disease,
  8. contrast volume

and created 4 risk categories based on their analysis.

They defined contrast-induced nephropathy as a greater than 1 mg/dL [88.4 µmol/L] rise in SCr with no specified time frame for post SCr measurement. By this definition, contrast-induced nephropathy occurred in 2% of patients.

Patients in the highest risk group had a 28% risk of developing contrast nephropathy and a 17% risk of death.

Mehran and colleagues (n = 8357) identified 3 additional characteristics that were associated with increased risk:

  1. older age,
  2. the presence of hypotension, and
  3. anemia.

They used a less stringent definition of contrast-induced nephropathy (change in SCr >=25% or >=0.5 mg/dL [44.2 µmol/L] at 48 hours), which may partially account for the higher reported incidence of contrast-induced nephropathy (13.1%).

Management to reduce contrast-induced nephropathy