Background: During computed tomography (CT), contrast is commonly used to identify structural and functional defects of various organs. Contrast-induced nephropathy (CIN) is a known complication of intravenous iodinated contrast, which appears as a common cause of hospital-acquired renal failure. Objective : To evaluate the contrast-induced nephropathy following contrast-enhanced computed tomography. Method: This prospective observational study was carried out at the Department of Nephrology, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from November 2022 to September 2023, involving one hundred (100) patients who underwent contrast-enhanced computed tomography (CECT). A detailed case history was recorded, and a thorough clinical examination was carried out along with relevant investigations at baseline, after 48 - 72 hours, and on the 7 th day following CECT was done. Results: The mean age of the study participants was (49.9 ± 14.4) years, ranging from 18 to 70 years, with a slightly higher number of male participants (n = 60). The most performed contrast studies were CECT abdomen (58%), followed by chest (32%) and others (10%). Out of 100 study participants, 10 (10%) developed CIN. Our study found that advanced age and type of contrast had a significant association with the development of CIN (p < 0.05). Baseline serum creatinine was found to be a significant predictor of CIN (p = 0.013; OR = 73.86). Conclusion: Contrast-induced nephropathy (CIN) is not uncommon. Advanced age and the type of contrast have a significant association with CIN. Baseline renal status has a strong association with increased risk of CIN. Proper prophylactic measures could avoid or minimize progressive renal injury.
KeywordsAcute Kidney Injury (AKI)Contrast-Enhanced Computed Tomography (CECT)Contrast-Induced Nephropathy (CIN)Contrast Media (CM)Type of Contrast
Meinel, F.G., De Cecco, C.N., Schoepf, U.J. and Katzberg, R. (2014) Contrast-Induced Acute Kidney Injury: Definition, Epidemiology, and Outcome. BioMed Research International , 2014, Article ID: 859328. https://doi.org/10.1155/2014/859328
Bhatt, S., Rajpal, N., Rathi, V. and Avasthi, R. (2016) Contrast Induced Nephropathy with Intravenous Iodinated Contrast Media in Routine Diagnostic Imaging: An Initial Experience in a Tertiary Care Hospital. Radiology Research and Practice , 2016, Article ID: 8792984. https://doi.org/10.1155/2016/8792984
Luk, L., Steinman, J. and Newhouse, J.H. (2017) Intravenous Contrast-Induced Nephropathy—The Rise and Fall of a Threatening Idea. Advances in Chronic Kidney Disease , 24, 169-175. https://doi.org/10.1053/j.ackd.2017.03.001
Katsiki, N., Tsioufis, C., Hahalis, G. and Athyros, V.G. (2017) Contrast-Induced Acute Kidney Injury: Beware of the Risk after Coronary Angiography. Expert Review of Cardiovascular Therapy , 16, 73. https://doi.org/10.1080/14779072.2018.1421070
Heyman, S.N. (2005) Regional Alterations in Renal Haemodynamics and Oxygenation: A Role in Contrast Medium-Induced Nephropathy. Nephrology Dialysis Transplantation , 20, i6-i11. https://doi.org/10.1093/ndt/gfh1069
McDonald, R.J., McDonald, J.S., Bida, J.P., Carter, R.E., Fleming, C.J., Misra, S., et al . (2013) Intravenous Contrast Material-Induced Nephropathy: Causal or Coincident Phenomenon? Radiology , 267, 106-118. https://doi.org/10.1148/radiol.12121823
Obed, M., Gabriel, M.M., Dumann, E., Vollmer Barbosa, C., Weißenborn, K. and Schmidt, B.M.W. (2022) Risk of Acute Kidney Injury after Contrast-Enhanced Computerized Tomography: A Systematic Review and Meta-Analysis of 21 Propensity Score-Matched Cohort Studies. European Radiology , 32, 8432-8442. https://doi.org/10.1007/s00330-022-08916-y
Mehran, R. and Nikolsky, E. (2006) Contrast-Induced Nephropathy: Definition, Epidemiology, and Patients at Risk. Kidney International , 69, S11-S15. https://doi.org/10.1038/sj.ki.5000368
Au, T.H., Bruckner, A., Mohiuddin, S.M. and Hilleman, D.E. (2014) The Prevention of Contrast-Induced Nephropathy. Annals of Pharmacotherapy , 48, 1332-1342. https://doi.org/10.1177/1060028014541996
Eng, J., Wilson, R.F., Subramaniam, R.M., Zhang, A., Suarez-Cuervo, C., Turban, S., et al . (2016) Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis. Annals of Internal Medicine , 164, 417-424. https://doi.org/10.7326/m15-1402
Gruberg, L., Mehran, R., Dangas, G., Mintz, G.S., Waksman, R., Kent, K.M., et al . (2001) Acute Renal Failure Requiring Dialysis after Percutaneous Coronary Interventions. Catheterization and Cardiovascular Interventions , 52, 409-416. https://doi.org/10.1002/ccd.1093
Mitchell, A.M., Jones, A.E., Tumlin, J.A. and Kline, J.A. (2010) Incidence of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Outpatient Setting. Clinical Journal of the American Society of Nephrology , 5, 4-9. https://doi.org/10.2215/cjn.05200709
Mula-Abed, W.S., Al Rasadi, K. and Al Riyami, D. (2012) Estimated Glomerular Filtration Rate (EGFR): A Serum Creatinine-Based Test for the Detection of Chronic Kidney Disease and Its Impact on Clinical Practice. Oman Medical Journal , 27, 108-113. https://doi.org/10.5001/omj.2012.23
Selistre, L.d.S., Souza, V.C.d., Dubourg, L., Wagner, M.B., Hoefel Filho, J.R. and Saitovitch, D. (2015) Contrast-Induced Nephropathy after Computed Tomography. Jornal Brasileiro de Nefrologia , 37, 27-31. https://doi.org/10.5935/0101-2800.20150005
Moriya, H., Mochida, Y., Ishioka, K., Oka, M., Maesato, K., Yamano, M., Suzuki, H., Ohtake, T., Hidaka, S. and Kobayashi, S. (2022) Impact of Contrast-Induced Nephropathy on Long-Term Renal Function after Coronary Angiography and Contrast-Enhanced Computed Tomography. Cardiology and Cardiovascular Medicine , 6, 473-479.
Alhozali, H., Toonsi, F.A., Alsubhi, J.M., Eissa, G.A., Almaghrabi, S.J., Alharbi, S.H., et al . (2024) Assessing the Risk of Contrast Induced-Acute Kidney Injury (CI-AKI) after Enhanced CT Scan: Single-Centre Experience. Journal of Contemporary Medical Sciences , 10, 277-287. https://doi.org/10.22317/jcms.v10i4.1510
Khodabandeh, H., Izadpanah Ghahremani, A., Zolfi gol, A., Jafari, N., Soleimantabar, H., Shahabi Rabori, V., et al . (2023) Contrast-Associated Acute Kidney Injury Following Intravenous Contrast Media Computed Tomography; New Concept and Future Directions: A Systematic Review Study on Emergencies Patients. Journal of Renal Injury Prevention , 13, e32234. https://doi.org/10.34172/jrip.2023.32234
Ong, M., Koh, J.J., Kothan, S. and Lai, C. (2022) The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review. Life , 12, Article 826. https://doi.org/10.3390/life12060826
Kene, M., Arasu, V., Mahapatra, A., Huang, J. and Reed, M. (2021) Acute Kidney Injury after CT in Emergency Patients with Chronic Kidney Disease: A Propensity Score-Matched Analysis. Western Journal of Emergency Medicine , 22, 614-622. https://doi.org/10.5811/westjem.2021.1.50246
Akman, C. and Bakirdogen, S. (2020) The Impact of Serum Creatinine, Albumin, Age, and Gender on the Development of Contrast-Induced Nephropathy in Patients Exposed to Contrast Agent Upon Admission to the Emergency Department. Cureus , 12, e11051. https://doi.org/10.7759/cureus.11051
McGillicuddy, E.A., Schuster, K.M., Kaplan, L.J., Maung, A.A., Lui, F.Y., Maerz, L.L., et al . (2010) Contrast-Induced Nephropathy in Elderly Trauma Patients. Journal of Trauma : Injury , Infection & Critical Care , 68, 294-297. https://doi.org/10.1097/ta.0b013e3181cf7e40
Hopyan, J.J., Gladstone, D.J., Mallia, G., Schiff, J., Fox, A.J., Symons, S.P., et al . (2008) Renal Safety of CT Angiography and Perfusion Imaging in the Emergency Evaluation of Acute Stroke. American Journal of Neuroradiology , 29, 1826-1830. https://doi.org/10.3174/ajnr.a1257
Yadollahi Fars, Y., Moghadasi, R. and Shayanpour, S. (2023) Contrast-Induced Nephropathy; An Update on Pathophysiology. Journal of Renal Endocrinology , 9, e25099. https://doi.org/10.34172/jre.2023.25099
Li, Q. and Pan, S. (2022) Contrast-Associated Acute Kidney Injury: Advances and Challenges. International Journal of General Medicine , 15, 1537-1546. https://doi.org/10.2147/ijgm.s341072
Evola, S., Lunetta, M., Macaione, F., Fonte, G., Milana, G., Corrado, E., et al . (2012) Risk Factors for Contrast Induced Nephropathy: A Study among Italian Patients. Indian Heart Journal , 64, 484-491. https://doi.org/10.1016/j.ihj.2012.07.007
Cheruvu, B., Henning, K., Mulligan, J., Klippenstein, D., Lawrence, D., Gurtoo, L., et al . (2007) Iodixanol: Risk of Subsequent Contrast Nephropathy in Cancer Patients with Underlying Renal Insufficiency Undergoing Diagnostic Computed Tomography Examinations. Journal of Computer Assisted Tomography , 31, 493-498. https://doi.org/10.1097/rct.0b013e31802e29d9
Cernigliaro, J.G., Haley, W.E., Adolphson, D.P., Jepperson, M.A., Crook, J.E., Thomas, C.S., et al . (2016) Contrast-Induced Nephropathy in Outpatients with Preexisting Renal Impairment: A Comparison between Intravenous Iohexol and Iodixanol. Clinical Imaging , 40, 902-906. https://doi.org/10.1016/j.clinimag.2016.04.008
Lenhard, D.C., Pietsch, H., Sieber, M.A., Ernst, R., Lengsfeld, P., Ellinghaus, P., et al . (2012) The Osmolality of Nonionic, Iodinated Contrast Agents as an Important Factor for Renal Safety. Investigative Radiology , 47, 503-510. https://doi.org/10.1097/rli.0b013e318258502b
Maioli, M., Toso, A., Leoncini, M., Gallopin, M., Musilli, N. and Bellandi, F. (2012) Persistent Renal Damage after Contrast-Induced Acute Kidney Injury: Incidence, Evolution, Risk Factors, and Prognosis. Circulation , 125, 3099-3107. https://doi.org/10.1161/circulationaha.111.085290