Incidences of Contrast-Induced Nephropathy, and associated factors in patients with chronic kidney disease at Burapha University Hospital
Keywords:
Contrast induced nephropathy, Chronic kidney disease, Estimated glomerular filtration rate, Contrast mediaAbstract
Background: An acute kidney injury, following the administration of contrast media, affects
diagnosis and therapy in patients with chronic kidney disease.
Objective: To determine the incidence of Contrast-Induced Nephropathy (CIN), and its associated
factors in patients with chronic kidney disease.
Materials and Methods: A descriptive, cross-sectional study was conducted at Burapha
University Hospital between September of 2018 and September, 2019. The data was collected
from medical records throughout the hospital’s computer directory. Once the incidence
of disease was calculated, statistical calculations were done using logistic regression and
multivariate logistic regression analysis.
Result: The incidence of CIN occured in 23 out of 205 patients, accounting for a rate of 11.2%.
Factors that increased the risk of CIN included a glomerular filtration rate less than 15 ml/
min/1.73m2
. In this way, the risk of CIN increased to 21.01 times (95% CI: 3.34, 131.97, p = 0.001).
By contrast, a GFR in the range of 30 - 59 ml/min/1.73m2
, and with a ratio of contrast media
to body weight ≥ 2.5 ml/kg, will increase the risk of CIN to 4.8 times (95% CI: 1.12, 20.61, p =
0.035), as compared to the group that received the amount of contrast media to body weight
< 2.5 ml/kg.
Conclusion: In patients with chronic kidney disease, the incidence of CIN was 11.2%. An
estimated glomerular filtration rate less than 15 ml/min/1.73m2
, with the administration of
contrast media to body weight ≥ 2.5 ml/kg, increases the risk of CIN.
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Radiocontrast-induced nephropathy in
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Kidney Int. 1992; 41:1408.
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radiocontrast-induced renal artery
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of contrast-induced nephropathy:
experimental and clinical observations
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Pathophysiology of contrast mediuminduced nephropathy. Kidney Int. 2005;
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Lights and shadows on the pathogenesis
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Davenport MS. Influence of Clinical Factors
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From IV Iodinated Low-Osmolality Contrast
Material in Patients With a Low Estimated
Glomerular Filtration Rate. AJR Am J
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17989201.
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Cózar R, Méndez I, Banerjee D, et al. The
reno-protective effect of hydration with
sodium bicarbonate plus N-acetylcysteine
in patients undergoing emergency
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1283.
21. Kooiman J, Sijpkens YW, van Buren M,
Groeneveld JH, Ramai SR, van der Molen AJ,
et al. Randomised trial of no hydration vs.
sodium bicarbonate hydration in patients
with chronic kidney disease undergoing
acute computed tomography-pulmonary
angiography. J Thromb Haemost. 2014;
12: 1658.
22. Timal RJ, Kooiman J, Sijpkens YWJ, de Vries
JPM, Verberk-Jonkers IJAM, Brulez HFH, et
al. Effect of No Prehydration vs Sodium
Bicarbonate Prehydration Prior to ContrastEnhanced Computed Tomography in the
Prevention of Postcontrast Acute Kidney
Injury in Adults With Chronic Kidney
Disease: The Kompas Randomized Clinical
Trial. JAMA Intern Med. 2020; 180: 533.
23. Brar SS, Hiremath S, Dangas G, Mehran R,
Brar SK, Leon MB, et al. Sodium bicarbonate
for the prevention of contrast inducedacute kidney injury: a systematic review
and meta-analysis. Clin J Am Soc Nephrol.
2009; 4: 1584.
24. Nijssen EC, Rennenberg RJ, Nelemans PJ,
Essers BA, Janssen MM, Vermeeren MA,
et al. Prophylactic hydration to protect
renal function from intravascular iodinated
contrast material in patients at high risk of
contrast-induced nephropathy (AMACING):
a prospective, randomised, phase 3,
controlled, open-label, non-inferiority trial.
Lancet. 2017; 389: 1312.
25. Manske CL, Sprafka JM, Strony JT, Wang Y.
Contrast nephropathy in azotemic diabetic
patients undergoing coronary angiography.
Am J Med. 1990; 89: 615.
26. Marenzi G, Assanelli E, Campodonico
J, Lauri G, Marana I, De Metrio M, et
al. Contrast volume during primary
percutaneous coronary intervention and
subsequent contrastinduced nephropathy
and mortality. Ann Intern Med. 2009; 150:
170–7.
27. Andò G, de Gregorio C, Morabito G, Trio
O, Saporito F, Oreto G. Renal functionadjusted contrast volume redefines
the baseline estimation of contrastinduced acute kidney injury risk in patients
undergoing primary percutaneous coronary
intervention. Circ Cardiovasc Interv. 2014;
7: 465-72
Kidney Int. 1989; 36: 730–40.
2. Rudnick MR, Goldfarb S, Tumlin J. Contrastinduced nephropathy: is the picture any
clearer? Clin J Am Soc Nephrol. 2008; 3:
261–2.
3. Weisberg LS, Kurnik PB, Kurnik BR.
Radiocontrast-induced nephropathy in
humans: role of renal vasoconstriction.
Kidney Int. 1992; 41:1408.
4. Cantley LG, Spokes K, Clark B, McMahon
EG, Carter J, Epstein FH, et al. Role
of endothelin and prostaglandins in
radiocontrast-induced renal artery
constriction. Kidney Int 1993; 44:1217.
5. Russo D, Minutolo R, Cianciaruso B, Memoli
B, Conte G, De Nicola L, et al. Early effects
of contrast media on renal hemodynamics
and tubular function in chronic renal
failure. J Am Soc Nephrol. 1995; 6: 1451.
6. Rudnick MR, Goldfarb S. Pathogenesis
of contrast-induced nephropathy:
experimental and clinical observations
with an emphasis on the role of osmolality.
Rev Cardiovasc Med. 2003; 4 Suppl 5: S28.
7. Persson PB, Hansell P, Liss P.
Pathophysiology of contrast mediuminduced nephropathy. Kidney Int. 2005;
68:14.
8. Detrenis S, Meschi M, Musini S, Savazzi G.
Lights and shadows on the pathogenesis
of contrast-induced nephropathy: state
of the art. Nephrol Dial Transplant. 2005;
20: 1542.
9. Weisbord S.D., Chen H., Stone R.A., Kip
K.E., Fine M.J., Saul M.I., et al. Associations
of increases in serum creatinine with
mortality and length of hospital stay after
coronary angiography. J Am Soc Nephrol.
2006; 17: 2871–7.
10. McCullough PA, Wolyn R, Rocher LL, Levin
RN, O’Neill WW. Acute renal failure after
coronary intervention: incidence, risk
factors, and relationship to mortality. Am
J Med. 1997; 103: 368–75.
11. Kidney Disease Improving Global Outcomes
(KDIGO). Clinical practice guideline for
acute kidney injury. Kidney Int Suppl. 2012;
2: 1-138.
12. American College of Radiology. Committee
on Drugs and Contrast Media. ACR Manual
on Contrast Media, Version 10.3. 2017.
2017. https://www.acr.org/Quality-Safety/
Resources/Contrast-Manual (Accessed on
July 10, 2017).
13. Davenport MS, Khalatbari S, Dillman JR,
Cohan RH, Caoili EM, Ellis JH , et al. Use
of Intravenous Iodinated Contrast Media
in Patients with Kidney Disease: Consensus
Statements from the American College
of Radiology and the National Kidney
Foundation. Radiology. 2020; 294: 660.
14. American College of Radiology. Committee
on Drugs and Contrast Media. ACR Manual
on Contrast Media, Version 10.3. 2017.
2017. https://www.acr.org/Quality-Safety/
Resources/Contrast-Manual (Accessed on
July 10, 2017).
15. McDonald JS, McDonald RJ, Carter RE,
Katzberg RW, Kallmes DF, Williamson
EE. Risk of intravenous contrast materialmediated acute kidney injury: a propensity
score-matched study stratified by baselineestimated glomerular filtration rate.
Radiology 2014; 271: 65-73.
16. Ellis JH, Khalatbari S, Yosef M, Cohan RH,
Davenport MS. Influence of Clinical Factors
on Risk of Contrast-Induced Nephrotoxicity
From IV Iodinated Low-Osmolality Contrast
Material in Patients With a Low Estimated
Glomerular Filtration Rate. AJR Am J
Roentgenol. 2019; 213: W188.
17. Weisbord SD, Palevsky PM. Prevention
of contrast-induced nephropathy with
volume expansion. Clin J Am Soc Nephrol.
2008 Jan; 3: 273-80. doi: 10.2215/
CJN.02580607. Epub 2007 Nov 7. PMID:
17989201.
18. Merten GJ, Burgess WP, Gray LV,
Holleman JH, Roush TS, Kowalchuk GJ,
et al. Prevention of contrast-induced
nephropathy with sodium bicarbonate: a
randomized controlled trial. JAMA. 2004;
291: 2328.
19. Briguori C, Airoldi F, D›Andrea D, Bonizzoni
E, Morici N, Focaccio A, et al. Renal
Insufficiency Following Contrast Media
Administration Trial (REMEDIAL): a
randomized comparison of 3 preventive
strategies. Circulation. 2007; 115: 1211.
20. Recio-Mayoral A, Chaparro M, Prado B,
Cózar R, Méndez I, Banerjee D, et al. The
reno-protective effect of hydration with
sodium bicarbonate plus N-acetylcysteine
in patients undergoing emergency
percutaneous coronary intervention: the
RENO Study. J Am Coll Cardiol. 2007; 49:
1283.
21. Kooiman J, Sijpkens YW, van Buren M,
Groeneveld JH, Ramai SR, van der Molen AJ,
et al. Randomised trial of no hydration vs.
sodium bicarbonate hydration in patients
with chronic kidney disease undergoing
acute computed tomography-pulmonary
angiography. J Thromb Haemost. 2014;
12: 1658.
22. Timal RJ, Kooiman J, Sijpkens YWJ, de Vries
JPM, Verberk-Jonkers IJAM, Brulez HFH, et
al. Effect of No Prehydration vs Sodium
Bicarbonate Prehydration Prior to ContrastEnhanced Computed Tomography in the
Prevention of Postcontrast Acute Kidney
Injury in Adults With Chronic Kidney
Disease: The Kompas Randomized Clinical
Trial. JAMA Intern Med. 2020; 180: 533.
23. Brar SS, Hiremath S, Dangas G, Mehran R,
Brar SK, Leon MB, et al. Sodium bicarbonate
for the prevention of contrast inducedacute kidney injury: a systematic review
and meta-analysis. Clin J Am Soc Nephrol.
2009; 4: 1584.
24. Nijssen EC, Rennenberg RJ, Nelemans PJ,
Essers BA, Janssen MM, Vermeeren MA,
et al. Prophylactic hydration to protect
renal function from intravascular iodinated
contrast material in patients at high risk of
contrast-induced nephropathy (AMACING):
a prospective, randomised, phase 3,
controlled, open-label, non-inferiority trial.
Lancet. 2017; 389: 1312.
25. Manske CL, Sprafka JM, Strony JT, Wang Y.
Contrast nephropathy in azotemic diabetic
patients undergoing coronary angiography.
Am J Med. 1990; 89: 615.
26. Marenzi G, Assanelli E, Campodonico
J, Lauri G, Marana I, De Metrio M, et
al. Contrast volume during primary
percutaneous coronary intervention and
subsequent contrastinduced nephropathy
and mortality. Ann Intern Med. 2009; 150:
170–7.
27. Andò G, de Gregorio C, Morabito G, Trio
O, Saporito F, Oreto G. Renal functionadjusted contrast volume redefines
the baseline estimation of contrastinduced acute kidney injury risk in patients
undergoing primary percutaneous coronary
intervention. Circ Cardiovasc Interv. 2014;
7: 465-72
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Published
29-12-2021
How to Cite
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Witoon R, Patpituk T. Incidences of Contrast-Induced Nephropathy, and associated factors in patients with chronic kidney disease at Burapha University Hospital. ฺBu J Med [internet]. 2021 Dec. 29 [cited 2026 Jan. 22];8(2):55-71. available from: https://he01.tci-thaijo.org/index.php/BJmed/article/view/254053
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