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J Am Soc Nephrol. 2017 Feb;28(2):653-659. doi: 10.1681/ASN.2016010021. Epub 2016 Sep 29.

Estimating the Risk of Radiocontrast-Associated Nephropathy.

Author information

1
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California ewilhelm@stanford.edu.
2
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.

Abstract

Estimates of the incidence of radiocontrast-associated nephropathy vary widely and suffer from misclassification of the cause of AKI and confounding. Using the Nationwide Inpatient Sample, we created multiple estimates of the risk of radiocontrast-associated nephropathy among adult patients hospitalized in the United States in 2009. First, we stratified patients according to the presence or absence of 12 relatively common diagnoses associated with AKI and evaluated the rate of AKI between strata. Next, we created a logistic regression model, controlling for comorbidity and acuity of illness, to estimate the risk of AKI associated with radiocontrast administration within each stratum. Finally, we performed an analysis stratified by the degree of preexisting comorbidity. In general, patients who received radiocontrast did not develop AKI at a clinically significant higher rate. Adjusted only for the complex survey design, patients to whom radiocontrast was and was not administered developed AKI at rates of 5.5% and 5.6%, respectively. After controlling for comorbidity and acuity of illness, radiocontrast administration associated with an odds ratio for AKI of 0.93 (95% confidence interval, 0.88 to 0.97). In conclusion, the risk of radiocontrast-associated nephropathy may be overstated in the literature and overestimated by clinicians. More accurate AKI risk estimates may improve clinical decision-making when attempting to balance the potential benefits of radiocontrast-enhanced imaging and the risk of AKI.

KEYWORDS:

acute renal failure; nephrotoxicity; outcomes

Comment in

PMID:
27688297
PMCID:
PMC5280012
DOI:
10.1681/ASN.2016010021
[Indexed for MEDLINE]
Free PMC Article

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