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Medicine (Baltimore). 2016 Apr;95(16):e3388. doi: 10.1097/MD.0000000000003388.

Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study.

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From the Department of Emergency Medicine (M-SH), Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan; Department of Emergency Medicine (M-SH), Taipei Veterans General Hospital; Institute of Occupational Medicine and Industrial Hygiene (M-SH), National Taiwan University College of Public Health; School of Medicine (M-SH, C-SC, C-KH), National Yang-Ming University, Taipei; Department of Dermatology (C-SC), Taichung Veterans General Hospital; Institute of Biomedical Sciences (C-SC, M-LS), National Chung Hsing University; Management Office for Health Data (J-HC); College of Medicine (J-HC); Graduate Institute of Integrated Medicine (J-HC, W-CC), College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University; Sex Hormone Research Center (W-CC), Departments of Obstetrics and Gynecology, Urology, and Medical Research; Department of Medical Research (W-CC), Obstetrics and Gynecology, Dermatology, and Urology; Kidney Institute and Division of Nephrology (H-JL), Department of internal medicine; Department of Health Services Administration (VC-RH), China Medical University; Department of Emergency Medicine (S-YH), Taichung Veterans General Hospital; Institute of Medicine (S-YH), Chung Shan Medical University; and Department of Nursing (S-YH), College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.


The aim of the study was to investigate the long-term association between contrast medium exposure during computed tomography (CT) and the subsequent development of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD). We conducted a population-based cohort study using Taiwan's National Health Insurance Research Database. A total of 7100 patients with nonadvanced CKD who underwent contrast medium-enhanced CT were identified and served as the study cohort. To avoid selection bias, we used the propensity score to match 7100 nonadvanced CKD patients, who underwent noncontrast medium-enhanced CT to serve as the comparison cohort. The age, sex, index year, and frequency of undergoing CTs were also matched between the study and comparison cohorts. Participants were followed until a new diagnosis of ESRD or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. Contrast medium exposure was not identified as a risk factor for developing ESRD in nonadvanced CKD patients after confounders adjustment (adjusted HR = 0.91; 95% CI, 0.66-1.26; P = 0.580). We further divided the patients who underwent CTs with contrast medium use into ≤1 exposure per year on average, >1 and <2 exposure per year on average, and ≥2 exposure per year on average. After adjusting for confounders, we identified a much higher risk for developing ESRD in the 2 groups of >1 and <2 exposure per year on average and ≥2 exposure per year on average (adjusted HR = 8.13; 95% CI, 5.57-11.87 and adjusted HR = 12.08; 95% CI, 7.39-19.75, respectively) compared with the patients who underwent CTs without contrast medium use. This long-term follow-up study demonstrated that contrast medium exposure was not associated with an increased risk of ESRD development in nonadvanced CKD patients.

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