Assessing the nephrotoxicity of intravenous iodinated contrast agents in patients with chronic renal failure in the absence of interfering acute disease

Abstract

Background The existence of contrast-induced nephropathy is widely accepted. Recent studies suggest its incidence has been overestimated. Purpose To determine the effect of intravenous iodinated contrast agents on renal function in patients with chronic renal failure without acute disease that can interfere with the assessment of renal function. Material and Methods We prospectively analyzed changes in serum creatinine levels after intravenous administration of iodinated contrast agents in all patients with chronic renal failure (creatinine clearance < 60 mL/min by the CKD-EPI Equation) without acute disease referred for computed tomography (CT) follow-up of aortic aneurysm. Between March 2010 and December 2016, a total of 108 patients met the inclusion criteria. The first 35 patients randomly underwent both contrast-enhanced and unenhanced CT examinations six months apart; the 73 following patients underwent only contrast-enhanced CT examinations. Serum creatinine levels were recorded immediately before and 48–72 h after CT examinations. Contrast-induced nephropathy was defined as an increase of ≥25% in serum creatinine from baseline levels. Results In the first 35 patients, mean changes in creatinine levels after unenhanced and enhanced CT examinations were similar. From the total of 108 patients who underwent contrast-enhanced CT, serum creatinine increased > 25% with respect to baseline in only two patients, in one case after contrast-enhanced CT examination and in the other after unenhanced CT examination; in a third patient, serum creatinine decreased >25% after contrast-enhanced CT examination. Conclusion No relevant contrast-induced nephrotoxicity was detected in this group of patients with chronic renal failure without acute disease.