Is Intravenous Contrast-Enhanced Computed Tomography Dangerous in Patients with Elevated Serum Creatinine?

ABSTRACT

PURPOSE: Although computed tomography (CT) with contrast media (CM) is often performed in patients with renal failure, caution has been exercised due to the supposed risk of contrast-induced nephropathy (CIN). The aim of this study was to examine to true impact of CT with CM on patients with elevated serum creatinine (sCr) levels. METHODS: A total of 216 patients with renal insufficiency who underwent intravenous (IV) contrast CT, with available sCr measurements before and after CT, between January 2008 and March 2012 were included. Patient demographic, biochemical, physiological, and CM data, fluid and drug administration, causes and prognostic factors of CIN, and previously described risk factors were analyzed. RESULTS: The most significant risk factor of CIN in patients with elevated sCr was an acute disease causing pre-renal acute kidney injury (AKI) (p=0.01, odds ratio 4.2), typically related to severe sepsis and septic shock (p<0.001). The factors of fatality related to sCr at day 14 were acute diseases causing pre-renal AKI (p<0.001, p=0.001 respectively). Iodine amounts, chronic kidney disease, prophylactic treatments, and other supposed risk factors did not greatly affect the risk of CIN. CONCLUSION: Although risk factors of CIN are not fully understood, CIN in patients with elevated sCr may be the result of acute progressing diseases, such as AKI in severe sepsis. CIN following IV contrast CT may therefore be less serious than previously thought. We suggest that CT can be performed when needed, even in patients with elevated sCr.