Contrast media: nephrotoxicity was rare with contrast media studies.

Clinical bottom line (level 2b)

  1. About 3% of patients undergoing contrast-media studies developed nephrotoxicity.
  2. Patients were at an increased risk for nephrotoxicity if they had:
    • angiocardiography (NNF = 15 for 48 hours)
    • preexisting renal insufficiency (NNF = 17 for 48 hours)
    • insulin-dependent diabetes mellitus (NNF = 17 for 48 hours)
    • received furosemide (NNF = 19 for 48 hours)
Moore et al: Radiology 1992; 182: 649-655
Expires October 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university medical centre radiology department, USA

929 patients (aged ?, ?% male) hospitalised patients having angiocardiography (n=430) or contrast-enhanced body computed tomography (n=499). All patients had to be over 18 years old. Patients having CT also had to meet one or more of:
  • 60 years old or more
  • presence of diabetes, multiple myeloma, nephrotic syndrome, hepatitis, cirrhosis or haemoglobinopathy (except sickle cell disease)
  • serum creatinine level, 130 µ mol/ L to <310 µ mol/ L


Excluded if
  • previous reaction to contrast media
  • sickle cell disease
  • contrast medium administered in the 72 hours before, or expected to be administered in next 48 hours


    • Patients were randomly assigned to low-osmolality or high osmolality contrast media.

    Logistic regression was used for multivariate analysis of risk factors.

    100% followed for 48 hours after radiologic procedure
    Outcomes studied:
  • nephrotoxicity increase in serum creatinine of more than both 33% and 40 µ mol/ L above the baseline, within 48 hours of the radiologic procedure, and judged attributable to the contrast medium by a blinded panel

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    nephrotoxicity 48 hours after radiologic procedure 26/929 2.8%
    (1.74% to 3.86%)

    prognostic factor for
    nephrotoxicity     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    angiocardiography 48 hours after radiologic procedure 3.44
    (1.25 to 6.79)     		15
    (6 to 143)
    pre-existing renal insufficiency 48 hours after radiologic procedure 3.06
    (1.29 to 5.41)     		17
    (8 to 120)
    insulin-dependent diabetes mellitus 48 hours after radiologic procedure 3.06
    (1.19 to 7.80)     		17
    (5 to 190)
    received furosemide 48 hours after radiologic procedure 2.92
    (1.25 to 6.79)     		19
    (6 to 140)

    • Thirteen patients (3%) in each treatment group developed nephrotoxicity.
    • After adjusting for the above factors, the type of contrast medium was not associated with the development of nephrotoxicity.
    • A trend toward interaction between contrast medium type and preexisting renal insufficiency was found.

    Comments

    1. The results were taken from a randomised controlled trial, and should be treated with some caution.

    Citation

    1. Moore RD, Steinberg EP, Powe NR, et al: Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial. Radiology 1992; 182: 649-655
    Contributor: Clare Wotton and Musab Hayatli, October 2000
    Reviewer:

    Clinical Question.
    Patient low- or high-osmolality contrast media
    Intervention or Exposure risk factors
    Outcome nephrotoxicity