Abstract
BackgroundIntravenously administered iodine-containing contrast medium (CM) is associated with the development of contrast-induced nephropathy (CIN). Data on the effectiveness of sodium bicarbonate therapy in the prevention of CIN are controversial. Furthermore, the incidence of and risk factors for CIN in intensive care unit (ICU) patients are poorly defined. We investigated the effectiveness of sodium bicarbonate prophylaxis and the incidence of and risk factors for CIN in a heterogeneous ICU population.MethodsThis retrospective cohort study included patients admitted to the ICU in 2009–2011 who received CM for computed tomography (CT).ResultsTwo hundred eleven CT scans with CM, performed in 170 patients, were included in the study. Contrast prophylaxis with sodium bicarbonate was administered in 48 of the 211 cases. CIN developed in 19 of the 48 cases receiving prophylaxis and in 39 of 163 cases not receiving prophylaxis (p = 0.03). In 115 CTs performed in patients with a glomerular filtration rate (GFR) >60 mL/min, prophylaxis was administered 15 times (13 %) and no prophylaxis was administered 100 times (87 %). CIN developed in 12 and 13 % of these cases, respectively (NS). In 96 CTs in patients with a GFR <60 mL/min, 17 of 33 (51.5 %) cases receiving prophylaxis developed CIN and 27 of 63 (42.9 %) cases not receiving prophylaxis developed CIN (NS). Prophylactic sodium bicarbonate therapy did not prevent CIN in our patients, irrespective of pre-existing renal failure. Pre-existing renal impairment (odds ratio 4.41), an elevated Acute Physiology and Chronic Health Evaluation (APACHE) IV score (odds ratio 1.02), and higher haemoglobin levels (odds ratio 0.64) were significant and independent risk factors associated with the development of CIN.ConclusionsProphylactic isotonic sodium bicarbonate was not associated with a decreased incidence of CIN in ICU patients. Current sodium bicarbonate prophylaxis guidelines cannot be generalized to a heterogeneous ICU population. Pre-existing renal impairment was associated with the highest CIN risk.
Highlights
Administered iodine-containing contrast medium (CM) is associated with the development of contrast-induced nephropathy (CIN)
The definition of CIN includes an exposure to a contrast agent, an absolute and/or relative increase in serum creatinine compared to baseline values following exposure to a contrast agent, a temporal relationship between the rise in sCr and CM exposure, and the exclusion of reasonable alternative explanations for renal impairment [4]
7 procedures were excluded owing to missing sCr data following the computed tomography (CT) scan
Summary
Administered iodine-containing contrast medium (CM) is associated with the development of contrast-induced nephropathy (CIN). The incidence of and risk factors for CIN in intensive care unit (ICU) patients are poorly defined. We investigated the effectiveness of sodium bicarbonate prophylaxis and the incidence of and risk factors for CIN in a heterogeneous ICU population. Depending on the nature and degree of a patient’s comorbidities, the intravenous (IV) administration of iodinated contrast media (CM) is associated with the development of contrast-induced nephropathy (CIN). The incidence of CIN varies between 1 and 50 % depending on patient population, baseline risk factors, and the criteria by which it is defined [1,2,3]. Most research has been conducted in an outpatient cardiology setting, and studies regarding CIN in intensive care unit (ICU) populations are scarce and inconsistent. In previous studies in the ICU population, the incidence of CIN has varied from 14 to 23 %, depending on the definition of CIN used [6,7,8]
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