Administración de medios de contraste. ¿Existe riesgo de daño renal agudo? / The administration of contrast media: is there a risk of acute kidney injury?

Objetivo: Conocer si la administración intravenosa de contraste yodado en la tomografía computarizada (TC) se asocia a un aumento en los niveles de creatinina y de daño renal agudo. Material y métodos: Estudio de cohortes retrospectivo. Incluye todos los pacientes que acudieron al servicio de urgencias del 2010 al 2015 y que presentaban una creatinina basal (C1) y otra 24-72 horas después (C2). El Comité de Ética y de Investigación aprobó el estudio. Criterios de exclusión: paciente menor de 18 años, creatinina ≤ 0,4mg/dl, ≥4,0mg/dl y administración de contraste en los últimos 6 meses. Al servicio de urgencias acudieron una media de 105.435,6 pacientes/año. Tres grupos de pacientes: 1) TC con contraste (6.642), 2) TC sin contraste (6.193,3) y 3) Sin TC (33.802). Se usaron los criterios de Acute Kidney Injury Network (AKI) y nefropatía aguda por contraste (NAC). Se realizó estudio estadístico bivariante y de regresión logística con el programa (Stata15). Resultados: Se analizaron 52.411 pacientes; depurando datos: 46.637. Edad media: 67,95 años. Valor de C1: media 1,16mg/dl (DE: 0,61) y de C2: 1,14mg/dl (DE: 0,66). Con criterios AKI y NAC: la realización de TC con contraste no se asocia a una mayor probabilidad de desarrollar nefropatía (odds ratio [OR]: 0,90, intervalo de confianza [IC]: 0,83-0,99 y OR 0,89, IC: 0,81-0,98, respectivamente). El estudio "propensity score matching", usando ambos criterios (AKI+NAC), obtuvo una OR de 0,80 y una IC de 0,77-0,84. Pacientes con filtrado glomerular inferior a 30ml/min no asociaron incremento del daño renal (OR: 0,66, IC: 0,47-0,91). Conclusión: La administración de contraste intravenoso, en el grupo de pacientes estudiados, no está asociada a un aumento del daño renal agudo

Objective: To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. Material and methods: This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. Results: We analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83-0.99] and [OR 0.89, 95% CI: 0.81-0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77-0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47-0.91]. Conclusion: The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury

The administration of contrast media: is there a risk of acute kidney injury? / Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?

OBJECTIVE: To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. MATERIAL AND METHODS: This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. RESULTS: We analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83-0.99] and [OR 0.89, 95% CI: 0.81-0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77-0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47-0.91]. CONCLUSION: The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.