Abstract
Background Contrast-induced nephropathy (CIN) is a major cause of acute kidney injury in chronic kidney disease. Many cancer patients have risk factors for CIN and frequently undergo contrast-enhanced computed tomography (CECT). We aimed to develop a risk prediction model for CIN in cancer patients undergoing CECT. Methods Between 2009 and 2017, 2,240 cancer patients with estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 who underwent CECT with CIN preventive measures were included in a development cohort. Primary outcome was development of CIN, defined as 25% increase in serum creatinine within 2-6 days after contrast exposure. A prediction model was developed using logistic regression analysis. The model was evaluated for prognostic utility in an independent cohort (N = 555). Results Overall incidence of CIN was 2.5% (55/2,240). In multivariable analysis, eGFR, diabetes mellitus, and serum albumin level were identified as independent predictors of CIN. A prediction model including eGFR, serum albumin level, and diabetes mellitus was developed, and risk scores ranged from 0 to 6 points. The model demonstrated fair discriminative power (C statistic = 0.733, 95% confidence interval [CI] 0.656-0.810) and good calibration (calibration slope 0.867, 95% Cl 0.719-1.015). In the validation cohort, the model also demonstrated fair discriminative power (C statistic = 0.749, 95% CI 0.648-0.849) and good calibration (calibration slope 0.974, 95% CI 0.634-1.315). Conclusions The proposed model has good predictive ability for risk of CIN in cancer patients with chronic kidney disease. This model can aid in risk stratification for CIN in patients undergoing CECT.
Highlights
Iodinated contrast media are extensively used for diagnosis or therapy, and intravascular injection can cause acute kidney injury (AKI)
diabetes mellitus (DM) was more common in patients with Contrast-induced nephropathy (CIN) (70.9%) than in those without CIN (44.2%, P < 0.001)
Validation cohort patients with CIN were younger, more frequently had DM, and less frequently used statins compared with patients without CIN, without statistical significance
Summary
Iodinated contrast media are extensively used for diagnosis or therapy, and intravascular injection can cause acute kidney injury (AKI). Chronic kidney disease (CKD) and diabetes mellitus (DM), well-known risk factors for CIN, are common comorbidities in cancer patients [5, 6]. Many cancer patients have risk factors for CIN and frequently undergo contrast-enhanced computed tomography (CECT). We aimed to develop a risk prediction model for CIN in cancer patients undergoing CECT. A prediction model including eGFR, serum albumin level, and diabetes mellitus was developed, and risk scores ranged from 0 to 6 points. The proposed model has good predictive ability for risk of CIN in cancer patients with chronic kidney disease. This model can aid in risk stratification for CIN in patients undergoing CECT
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