Radiographic Contrast-Induced Nephropathy and Patient Mortality–Reply–I

Abstract

We appreciate the comments by Onuigbo and agree that nephrotoxicity is often multifactorial and may be accentuated by the presence of other medical factors or toxic agents. Furthermore, the need for identifying the highest-risk patients and avoiding, if possible, procedures that require contrast medium is perhaps the safest plan of care at this time. Ultrasonography, noncontrast computed tomography, magnetic resonance imaging, or other evaluation techniques should be considered for these patients if the clinical question requiring imaging can be answered with less risk to the patient than that posed by contrast administration. Bouzas-Mosquera et al point out that confounding variables may preclude judgment on the association of route of contrast administration and adverse clinical outcomes. Although we agree that any retrospective study could have unknown confounding factors or unidentified variables, we were aware of this potential in our study design and carefully matched and adjusted for multiple comorbidities known to be associated with CIN. The other studies cited by Bouzas-Mosquera et al were smaller and did not focus on definitive clinical end points. Overall, we hope that our study will spark more research on the utility and danger of intravenous contrast administration because this topic is largely neglected in the literature on CIN. Radiographic Contrast-Induced Nephropathy and Patient Mortality–1Mayo Clinic ProceedingsVol. 83Issue 12PreviewTo the Editor: We read with great interest the article by From et al1 who evaluated the risk of mortality after contrast-induced nephropathy (CIN). In agreement with previous studies,2–4 the authors found that CIN was associated with a higher adjusted mortality rate. The more surprising result is that this risk was found to be higher in patients in whom contrast medium was given intravenously than in those in whom it was administered intra-arterially. Because previous data suggest that contrast media may be more nephrotoxic when given intra-arterially,5 it is not straightforward to ascribe such differences in mortality to the route of administration of contrast media alone. Full-Text PDF