P109 (RA6443)
Incidence of Contrast-induced Nephropathy in Patients Undergoing Noncoronary Angiography
MR Clatworthy1, MR Todd1, E Jolly1, D Appleton2 and AN Chaudhry1
1
Division of Renal Medicine Department of Medicine, University of Cambridge, Box
118, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, United Kingdom
and 2Department of Radiology, University of Cambridge, Box 188, Addenbrooke's
Hospital, Hills Road, Cambridge, CB2 2QQ, United Kingdom
Radiographic contrast-induced nephropathy (CIN) is a significant cause of hospitalacquired acute renal failure and has been associated with increased in-hospital
mortality and length of stay. CIN is normally defined as an increase in creatinine of
25% or more from baseline1. Risk factors associated with the development of CIN
include high doses of contrast media, volume depletion, pre-existing renal disease,
and administration of nephrotoxins. A number of prevention strategies have been
suggested such as pre-hydration, N-acetyl cysteine, and more recently sodium
bicarbonate.
We wished to ascertain the incidence of CIN in patients undergoing non-coronary
angiography in Addenbrookes Hospital. We retrospectively reviewed the hospital
biochemistry database on patients undergoing non-coronary angiography in an annual
period between April 1st 2004 and March 31st 2005. Age, baseline creatinine and
creatinine at 12-48 hours, and contrast dose were documented.
676 non-coronary angiographic procedures (aortofemoral, renal, and upper limb
angiograms, arch aortograms, and anterograde pyelograms) were undertaken within
the studied time period. Of these, 30 (4.5%) were excluded because procedures were
duplicate entries on the procedure list, or patients were already receiving renal
replacement therapy. Baseline and post-procedure creatinine values were available on
160 patients (23.5% of total procedures). These were divided into two groups
according to previous studies1, Group 1 (baseline creatinine <97μmol/l, low risk of
CIN, n=72), and Group 2 (baseline creatinine >97μmol/l, high risk of CIN, n=88).
Group 1, 2 patients (28%) had a >25% fall in creatinine post-procedure, compared
with 9 (10.2%) in Group 2. 11 patients (15.3%) in Group 1, and 12 (13.6%) of
patients in Group 2 developed a >25% rise in creatinine following angiography. No
patient with worsening renal function required renal replacement therapy.
In summary, in the so-called high risk group of patients (Group 2), 13.6% developed
CIN, this was similar to previously reported incidence but also to that seen in the lowrisk group (Group 1). Given current accepted criteria, the actual clinical impact of
radiographic contrast on renal function seems to be relatively mild.
References
1. Merten GJ,et al. Prevention of contrast-induced nephropathy with sodium
bicarbonate: a randomised controlled trial. JAMA. 2004; 291:2328-2334