Incidence of contrast material-induced nephropathy after neuroendovascular procedures

摘要

Purpose: To report the incidence and risk factors for contrast material (CM)-induced nephropathy (CIN) in patients with no history of chronic kidney disease and estimated glomerular filtration rate that exceeded 30 mL/min/1.73 m2 after a relatively high dose of CM (≥250 mL) during neuroendovascular procedures.Materials and Methods: An institutional review board-approved retrospective chart review was performed for all patients who received a dose of CM 250 mL or greater while they underwent a neuroendovascular procedure between January 2011 and February 2013. The control group consisted of comparable patients who received a CM dose of 75-249 mL during the same period. Patients with pre-existing estimated glomerular filtration rate of 30 mL/min/1.73 m2 or less or documented history of chronic kidney disease were excluded. CIN was defined as an increase in serum creatinine 50% above the baseline or an absolute increase of 0.3 mg/dL at either 24 or 48 hours after the procedure. Statistical analysis was performed with the Student t test, χ2 analysis, and mixed-model analysis of variance.Results: Clinical characteristics between the control and highdose group were similar for age (95% confidence interval [CI]: 23.69, 5.48; P = .70), sex (95% CI: 0.28, 0.43; P = .62), and ethnicity (95% CI: 0.42, 0.58; P = .47). The average volume of CM administered was 172 mL in the control group and 326 mL in the high-dose cohort (95% CI: 131.78, 175.05; P < .001). Of the 79 cases in the high-dose cohort, 36 (46%) received a CM dose between 250 and 299 mL, 29 (37%) received 300-399 mL, nine (11%) received 400-499 mL, and five (6%) received greater than 500 mL. By 48 hours, a statistically significant decrease in serum creatinine was seen in two of the four high-dose CM dose categories: 250-299 mL (decrease of 24%; [95% CI: 0.04, 0.36]; P = .003) and greater than 500 mL (decrease of 14% [95% CI: 20.33, 0.57]; P = .007). There were four cases (5%) of CIN: three (4%) at 24 hours and one (1%) at 48 hours. The comorbid rate of diabetes (25% vs 15% [95% CI: 20.01, 0.04]; P < .001) was found to be higher among those who developed CIN compared with those who did not within the high-dose cohort. No cases of CIN occurred in the control group.Conclusion: Risk of developing CIN is relatively low in patients who undergo neuroendovascular procedures with CM doses of 250 mL or greater.