P0584A COMPARATIVE STUDY ON THE INCIDENCE OF CONTRAST INDUCED NEPHROPATHY FOLLOWING INTRA-ARTERIAL VERSUS INTRAVENOUS CONTRAST ADMINISTRATION

Abstract

Abstract BACKGROUND Contrast-induced nephropathy (CIN) / Contrast induced-acute kidney injury (CI-AKI), defined as a relative increase of ≥25% or an absolute increase of ≥0.5 mg/dL in S.Cr levels assessed at 48 hours post procedure, is a well described following an administration of Intra-arterial (IA) iodinated contrast agent, but its occurrence after Intravenous (IV) contrast is being questioned. AIMS To compare the incidence of CIN following IV and IA contrast procedures and to identify its risk factors. METHOD This is a prospective, single center study of 774 patients (449 males and 325 females with mean age of 48.85 ± 14.05 years) who underwent contrast studies with nonionic, low-osmolar iodinated contrast agent (Iomeprol) via IV and IA routes were included in the study. We recorded baseline characteristics along with laboratory parameters; underlying renal injury risk factors; contrast administration volume, type, and route of administration; incidence of CIN and requirement of renal replacement therapy (RRT). Univariate and multivariate models were used to determine predictors of CIN. RESULTS The total incidence of CIN was 14.85% (115 patients). Baseline eGFR was lower for patients undergoing intra-arterial contrast procedures (66.02 ± 23.70 ml/min/1.73m2 vs 71.31±24.07 ml/min/1.73m2, p=0.002). Simple logistic regression showed a statistically significant difference in the rate of CIN in patients who received IV vs. IA iomeprol (6.2% vs 25.1%). The total risk of RRT was 1.7% with the incidence being more in the IA group than the IV group (3.1% vs 0.5%, p=0.005). Advanced age, dehydration and hypotension, CCF, anemia, proteinuria, diabetes mellitus, preexisting renal disease (i.e. baseline serum creatinine>1.5mg/dl), baseline eGFR<60ml/min/1.73m2), use of nephrotoxic antibiotics and route of contrast correlated significantly with CIN. Proteinuria ≥1 g/day and hypoalbuminemia was significantly higher in the intra-arterial group than the intravenous group (p=0.001). CONCLUSION We found that administration of both IV and IA iodinated contrast agents is associated with a risk of CIN with a significant higher risk of CIN as well as RRT following IA contrast. Proteinuria may be a new risk factor for the development of CIN.