Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography

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Heras Benito, M. Garrido Blázquez, Y. Gómez Sanz, M. Bernardez Mardomingo, J. Ruiz Cacho, F.J. Rodríguez Recio, M.J. Fernández-Reyes Luis" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Heras Benito" "email" => array:1 [ 0 => "mherasb@saludcastillayleon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Garrido Blázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Y." "apellidos" => "Gómez Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Bernardez Mardomingo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Ruiz Cacho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "F.J." "apellidos" => "Rodríguez Recio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "M.J." "apellidos" => "Fernández-Reyes Luis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Enfermería, Servicio de Radiología, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de nefropatía por contraste en pacientes sometidos a tomografía computarizada: ¿qué factores la condicionan?" ] ] "textoCompleto" => "IntroductionContrast-induced nephropathy (CIN) is defined as an acute decline of the renal function in a short period of time (2–7 days) after the administration of radiological contrast agents.<a class="elsevierStyleCrossRef" href="#bib0095">1</a> It is characterized by an absolute increase of serum creatinine with respect to its basal value of at least 0.5mg/dl, or by a relative increase of 25%.<a class="elsevierStyleCrossRefs" href="#bib0100">2,3</a> Its estimated incidence has been established between 0.6% and 2.3% in the general population, and in up to 40% in high-risk patients (with prior renal decline and diabetics).<a class="elsevierStyleCrossRef" href="#bib0110">4</a> However, during the last few years there has been controversy on the existence of CIN in patients with normal renal function; and even in patients with renal failure, the risk of CIN is probably lower than we traditionally thought.<a class="elsevierStyleCrossRef" href="#bib0095">1</a> In a recent prospective study conducted by Moos et al. this is the case after studying nearly 1000 patients with an average age of 60 years old; the glomerular filtration rate (GFR) of 88.8% of these patients was ≥60ml/min/1.73m2, and only 58 of them were at risk of developing CIN, that only occurred in 2 patients, which is leads us to think that the incidence of CIN is low, even in patients who do not receive prophylactic hydration.<a class="elsevierStyleCrossRef" href="#bib0115">5</a> Another retrospective study that included 193 patients with serum creatinine levels >1.2mg/dl questioned the role of IV contrast and the overestimation of CIN.<a class="elsevierStyleCrossRef" href="#bib0120">6</a>Our goal was to analyze the incidence of CIN in a cohort of outpatients who were scheduled to one computed tomography (CT) scan with IV iodinated contrast and assess the results of nephroprotection with N-acetylcysteine.Patients and methodsThis study has been evaluated and approved by the center ethics committee.PatientsTwo hundred and twenty-six (226) patients with scheduled CT scans were studied. The selection of patients was conducted including the first five (5) patients of the day's agenda (morning shift) who accepted to participate in the study and signed the written informed consent. It was decided to select the patients like this so that the morning patients would not have to be delayed. Patients under 18, hospitalized patients, or those with intercurrent processes (clinical situations per se that can alter the normal renal function regardless of the effect of contrast), and those who did not accept to participate or signed the informed consent were excluded.MethodologyProspective observational study conducted between March 1, 2016 and July 1, 2016. The blood samples were taken from venous blood while catheterizing one peripheral route for the administration of contrast, and the levels of serum urea and creatinine were recorded. After conducting the CT scan, a note was included for the GP to conduct a new blood sample test, in venous blood, of the urea and creatinine levels within a week; this analysis was also conducted in a lab at our center. Also, once the test ended, the radiology unit recommended forcing oral hydration. The GFR was estimated using the MDRD-4 (Modification of Diet in Renal Disease) formula. The sociodemographic data (age, sex), the cardiovascular history (diabetes mellitus, blood hypertension, ischemic cardiomyopathy, heart failure) and the indication for conducting the CT scan were all collected. The number of patients who received prophylaxis with N-acetylcysteine (600mg orally every 12h) was estimated pre- and post-CT scan. When it comes to the contrast agent used, the active ingredient and the dose of contrast used were recorded.Statistical analysisThe statistical analysis was conducted using the SPSS 15.0 software package. Data were expressed as means and proportions. The comparison of the means was conducted using the Student's t test and the comparison of proportions using the chi-square test (Fisher). P values <0.05. were considered statistically significant.ResultsA total of 226 patients accepted to participate in the study, of which 23 were excluded because the follow-up blood test was not conducted by their GPs at their health center. Also, one (1) patient was excluded because he was already in a program of chronic hemodialysis. Finally, 202 patients were considered valid for the study and no traces of CIN were found in any of them.The average age of the patients included in the study (n=202) was 63.92±12 years (range 22–87), 98 of them above 65 years. One hundred and sixteen (116) (54.4%) patients were male. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the percentage of prior cardiovascular histories and chronic therapies used.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>These were the reason why the CT scan was indicated: in 164 patients (81.2%) due to oncological control; in 11 patients (5.4%) due to vascular study, and in 27 patients (13.4%) the reasons varied.On the degree of renal function pre-CT scan: the GFR estimated by MDRD4 of 176 patients was ≥60ml/min/1.73m2 (89.45±14; range 62.36–134.14) compared to the GFR of 26 patients estimated by MDRD4 that was <60ml/min/1.73m2 (45.38±11; range 9.16–58.90): 11 patients were stage 3A-patients (59–45ml/min/1.73m2) and 14 patients were 3B-patients (44–30ml/min/1.73m2). Only one female patient's GFR was <30ml/min/1.73m2.The contrast used in all patients was the same: iopamidol at an average dose of 107.03±11ml (range 70–140). The average days elapsed before and after the CT scan were 4.06±1 (1–7).Overall, the serum creatinine level pre-CT scan was 0.93±0.40mg/dl (range 0.6–5.2). Only 30 patients showed pre-CT scan serum creatinine levels >1.1mg/dl; pre-CT scan urea levels were 42.13±15 (range 13–150) and the pre-CT scan MDRD-4 was 83.77±20ml/min/1.73m2.Specific CIN prevention measures with 600mg of oral N-acetylcysteine every 12h pre- and post-CT scan were used in 13 patients only: in 4 (2.3%) patients with MDRD4≥60ml/min/1.73m2 (patients with one kidney only) and in 9 patients with impaired renal function, with MDRD4<40ml/min/1.73m2 (p=0.000). These patients, with more advanced renal failure, had received prior advice in the external nephrology office to increase the oral intake the day before the CT scan on top of the prescribed N-acetylcysteine. The only female patient whose GFR was <30ml/min/1.73m2 was hospitalized the day before conducting the CT scan in order to receive hydration with 500ml of isotonic saline solution added to the N-acetylcysteine. No significant differences were seen in the dose of contrast administered among the 13 patients who received N-acetylcysteine (105.38±8) and those who did not (108.01±11), p=0.42.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the comparison of renal parameters pre- and post-CT scan based on the application of measures of N-acetylcysteine.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>No significant changes were seen in the evolution of the analytical parameters of renal function studied when comparing age <65 versus >65, presence of heart failure, ischemic cardiomyopathy, or diabetes mellitus.No hemodialysis session was required, and no patient died.DiscussionIn our study, patients who underwent scheduled CT scans with IV iodinated contrast (iopamidol) did not show any episodes of CIN. Also, most of them had not been prepared with IV hydration, or saline solution, or oral N-acetylcysteine.CIN is a common cause of iatrogenic acute renal failure (ARF) and has a variable incidence that goes from <1% and >40%.<a class="elsevierStyleCrossRef" href="#bib0110">4</a> However, according to recent studies such an incidence rate may be overestimated even in patients with chronic renal disease or diabetes.<a class="elsevierStyleCrossRefs" href="#bib0120">6,7</a> One systematic review and one meta-analysis of controlled studies (13 non-randomized studies) that assessed the incidence rate of AFR and prognoses associated with the exposure to radiological contrast agents and included nearly 26,000 patients found that the incidence rate of AFR, dialysis and mortality was similar among patients who received contrast agents compared to a control group that was not exposed to any contrast agents.<a class="elsevierStyleCrossRef" href="#bib0130">8</a> Similarly, one recent study that used a database of nearly 8,000,000 hospitalizations, in the United States, from the year 2009 found that the rate of ARF was 5.5% in patients who had received contrast compared to 5.6% in those who had not, which led the study authors to conclude that the risk of CIN is overestimated both in the specialized medical literature and among clinicians.<a class="elsevierStyleCrossRef" href="#bib0135">9</a> Also, our findings are consistent with these recent studies: lack of CIN in the population under study, yet one of the limitations is that we studied a reduced number of patients. These findings may be explained, among other reasons, due to the fact that 1st) most patients studied had normal renal function; 2nd) they were outpatients, with clinical stability, and who underwent one scheduled CT scan, and 3rd), because the radiological contrast was administered using the lowest necessary dose and, also, because it had a good nephrotoxic profile.When it comes to the factors that may contribute to an increased incidence of CIN, those patients with an active cancer, and with signs of dehydration are more predisposed to develop CIN.<a class="elsevierStyleCrossRefs" href="#bib0140">10,11</a> Although in our initial study the main indication for the CT scan was also oncological, all patients were, however, outpatients and, therefore, clinically stable. Also, these patients had been conducting activities of daily living one day prior to the test, which leads us to think that they were in some sort of euvolemic state; after the test, the patients had been told to increase their water intake – circumstances that may justify the favorable results presented here.When it comes to other risk factors to develop CIN, it was considered that diabetic patients or patients with heart failure had a higher risk of developing CIN.<a class="elsevierStyleCrossRefs" href="#bib0150">12,13</a> However, in certain recent studies, diabetes mellitus has not been associated with a higher risk of developing CIN.<a class="elsevierStyleCrossRefs" href="#bib0125">7,8</a> In our study, patients with a history of diabetes, heart failure, or ischemic cardiomyopathy did not show any significant variations either in the analyzed renal parameters.On the other hand, when analyzing radiological contrast, it has already been discussed that certain studies found no statistically significant differences in the incidence of CIN between the administration of contrast and the non-administration.<a class="elsevierStyleCrossRefs" href="#bib0130">8,14</a> We could also argue here that the improvement in the development of contrast molecules leads to the appearance of less adverse reactions: particularly non-ionic low-osmolality molecules (600–900mOsm/kg of water) have a better nephrotoxic profile.<a class="elsevierStyleCrossRef" href="#bib0165">15</a> Iopamidol<a class="elsevierStyleCrossRef" href="#bib0165">15</a> is included in the category of “non-ionic monomers” – the only contrast agent used in this study. Besides, if we take the characteristics of the molecules into consideration on the role played by toxicity, the contrast volume is another factor that has been associated with the appearance of CIN, particularly when the amount used is higher than 140ml.<a class="elsevierStyleCrossRefs" href="#bib0100">2,16</a> In our patients, the protocols used based on the indication of CT scan required doses than were never >140ml – the average dose used was around 100ml, which is another argument that may justify the lack of CIN.Lastly, the oral or IV volume expansion prior to the exposure to radiological contrast and/or the use of N-acetylcysteine have been the general recommendations to avoid CIN basically in patients who undergo cardiac catheterization.<a class="elsevierStyleCrossRef" href="#bib0100">2</a> When it comes to patients who undergo CT scans, Traub et al. conducted one bi-center randomized, double-blind clinical trial in a cohort of 357 patients who completed the study and found no benefit in the combined used of N-acetylcysteine and one saline solution compared to the control group that received the saline solution only. In this study, the reduced CIN was significantly associated with the volume of fluid administered.<a class="elsevierStyleCrossRef" href="#bib0175">17</a> However, in one meta-analysis that included 6 randomized controlled trials with nearly 500 patients, the prophylactic administration of N-acetylcysteine in patients with serum creatinine >1.2mg/dl plus hydration did reduce the risk of CIN.<a class="elsevierStyleCrossRef" href="#bib0180">18</a> In our study, we did not implement specific measures of hydration with an IV saline solution or N-acetylcysteine in most patients and no CIN was recorded either. However, patients with a single kidney with GFR>60ml/min/1.73m2 or patients with worse renal function (GFR<40ml/min/1.73m2) who received prophylaxis with N-acetylcysteine did not show CIN either. This reduced number of patients who were premedicated with N-acetylcysteine is another limiting factor when interpreting the results.Our favorable results of lack of CIN in patients who underwent one CT scan with the administration of contrast should be interpreted with caution based on the characteristics of the population analyzed: (a) clinically stable (non-hospitalized) patients who underwent “scheduled” CT scans were studied; (b) “non- ionic” contrast with doses <140ml was used, and (c) mostly they were patients with GFR≥60ml/min/1.73m2.When it comes to the practical utility of these results, not finding CIN in “selected” patients does not mean that the CT scan with iodinated contrast can be used indiscriminately as the elective diagnostic imaging modality since the study is based on a single CT scan and the long-term effect of repeated exposure to CT scans on the renal function has not been studied, which by the way may be the goal of future studies.In sum, the incidence of CIN is not significant in the cohort studied here with glomerular filtration rates (GFR) >30ml/min/1.73m2: these favorable results may be explained by the fact that the CT scan was “scheduled” and “non-ionic” iodinated contrast in relatively low doses was administered.Authors<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Manager of the integrity of the study: MH, MG, FJR and MJF.</li><li class="elsevierStyleListItem" id="lsti0010">2.Study idea: MH, MG, FJR and MJF.</li><li class="elsevierStyleListItem" id="lsti0015">3.Study design: MH, MG, MJR and MJF.</li><li class="elsevierStyleListItem" id="lsti0020">4.Data mining: MH, YG, MB and MJF.</li><li class="elsevierStyleListItem" id="lsti0025">5.Data analysis and interpretation: MH and JR.</li><li class="elsevierStyleListItem" id="lsti0030">6.Statistical analysis: MH.</li><li class="elsevierStyleListItem" id="lsti0035">7.Reference: MH.</li><li class="elsevierStyleListItem" id="lsti0040">8.Writing: MH and MJF.</li><li class="elsevierStyleListItem" id="lsti0045">9.Critical review of the manuscript with intellectually relevant remarks: MH and MG.</li><li class="elsevierStyleListItem" id="lsti0050">10.Approval of the final version: MH, MG, YG, MB, JR, MJR and MJF.</li></ul>Conflicts of interestsThe authors declare no conflict of interests associated with this article whatsoever.This study has been approved by the clinical research ethics committee of Segovia." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1060324" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1009167" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1060323" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1009168" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Authors" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interests" ] 10 => array:2 [ "identificador" => "xack358846" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-30" "fechaAceptado" => "2018-03-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1009167" "palabras" => array:3 [ 0 => "Contrast-induced nephropathy" 1 => "Acute kidney injury" 2 => "Computed tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1009168" "palabras" => array:3 [ 0 => "Nefropatía por contraste" 1 => "Insuficiencia renal aguda" 2 => "Tomografía computarizada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography (CT) with intravenous iodinated contrast material. To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy. Patients and methodsThis prospective observational study was carried out in the months comprising March 2016 through July 2016. We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form. We recorded patients’ cardiovascular histories, chronic treatments, and indications for the CT examination. We measured blood levels of creatinine and urea before and after the CT examination. We used the Modification of Diet in Renal Disease (MDRD-4) equation to estimate the glomerular filtration rate. We analyzed the type and dose of contrast material. We recorded whether N-acetylcysteine was administered before the CT examination. We used SPSS 15.0® to compare means and proportions. Statistical significance was set at p<0.05. ResultsNo incidents of contrast-induced nephropathy were detected in any of the 202 patients included [mean age, 63.92±12 years (range 22–87); 57.4% male; 21.8% diabetic; 39.6% hypertensive; 87.1% had MDRD4≥60ml/min/1.73m2 (89.45±14, range 62.36–134.14) and 12.9% had MDRD4<60ml/min/1.73m2 (45.38±11, range 9.16–58.90)]. The most common indication for CT examinations was oncologic (81.2%). The only contrast agent administered was iopamidol; the mean dose was 107.83±11ml (range 70–140). The mean interval between pre-CT and post-CT laboratory tests was 4.06±1 days. Only 13 patients received N-acetylcysteine; 9 of these had MDRD<60ml/min/1.73m2 and 4 had MDRD4≥60ml/min/1.73m2 (p=0.000). ConclusionsThe incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30ml/min/1.73m2: these favorable results might be due to analyzing only scheduled examinations and to using relatively low doses of a “nonionic” iodinated contrast agent." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoAnalizar la incidencia de nefropatía por contraste en una cohorte de pacientes sometidos a tomografía computarizada (TC) con contraste yodado intravenoso. Valorar los resultados de la nefroprotección con N-acetilcisteína. Pacientes y métodosEstudio observacional prospectivo, entre los meses de marzo y julio de 2016. Los pacientes seleccionados tenían programada una TC. Se incluyeron los primeros 5 pacientes de cada día, que aceptaban participar y firmaban el consentimiento informado. Se registraron antecedentes cardiovasculares, tratamientos crónicos e indicación de la TC. Se determinó la creatinina y la urea en sangre pre-TC y pos-TC. El filtrado glomerular se determinó por MDRD-4 (Modification of Diet in Renal Disease). Respecto al contraste, se analizó tipo y dosis. Se registró el uso de N-acetilcisteína anterior a la TC. Estadística: SPSS 15.0® utilizando comparación de medias y proporciones. Significación: p<0,05. ResultadosNo se detectó ninguna NC en 202 pacientes estudiados. Datos globales: edad: 63,92±12 años (rango 22-87); 57,4% varones; 21,8% diabéticos; 39,6% hipertensos; 176 pacientes tenían MDRD4≥60ml/min/1,73m2 (89,45±14, rango 62,36-134,14) y 26 MDRD4<60ml/min/1,73m2 (45,38±11, rango 9,16-58,90). La principal indicación de TC fue oncológica (81,2%). El único contraste administrado fue iopamidol, en dosis de 107,83±11ml (rango 70-140). El intervalo de días entre analíticas fue de 4,06±1 días. Solo en 13 pacientes se administró N-acetilcisteína: en 9 con MDRD<60ml/min/1,73m2 y en 4 con MDRD4>60ml/min/1,73m2 (p=0,000). ConclusionesLa incidencia de NC es no significativa en la cohorte estudiada con un filtrado glomerular superior a 30ml/min/1,73m2: la realización de TC de forma “programada”, utilizando un contraste yodado “no iónico” en dosis relativamente baja, es un factor que quizás explique estos resultados favorables." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Heras Benito M, Garrido Blázquez M, Gómez Sanz Y, Bernardez Mardomingo M, Ruiz Cacho J, Rodríguez Recio FJ, et al. Incidencia de nefropatía por contraste en pacientes sometidos a tomografía computarizada: ¿qué factores la condicionan? Radiología. 2018;60:326–331." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">(%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metformin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other antidiabetic drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">angiotensin-converting-enzyme inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angiotensin II receptor blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diuretics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Calcium antagonists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alpha blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Beta blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Statins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-steroidal anti-inflammatory drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1804579.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Percentages of prior cardiovascular histories and chronic therapies used." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CT: computed tomography; MDRD: Modification of Diet in Renal Disease; p: statistical significance." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes (No.=13) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No (No.=189) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine pre-CT scan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.74±1.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.88±0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.231 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine post-CT scan (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.73±1.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89±0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea pre-CT scan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.00±31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.08±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea post-CT scan (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.07±32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.26±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.460 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDRD4 pre-CT scan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.11±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.02±18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDRD4 post-CT scan (ml/min/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.21±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.07±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1804580.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Overall evolution of analytical parameters of renal function based on the use of N-acetylcysteine." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-induced acute kidney injury: definition, epidemiology, and outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.G. 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Incidencia de nefropatía por contraste en pacientes sometidos a tomografía computarizada: ¿qué factores la condicionan?

M. Heras Benitoa,

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mherasb@saludcastillayleon.es

Corresponding author.

, M. Garrido Blázquezb, Y. Gómez Sanzc, M. Bernardez Mardomingoc, J. Ruiz Cachod, F.J. Rodríguez Reciob, M.J. Fernández-Reyes Luisa

a Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain

b Servicio de Radiología, Hospital General de Segovia, Segovia, Spain

c Enfermería, Servicio de Radiología, Hospital General de Segovia, Segovia, Spain

d Servicio de Análisis Clínicos, Hospital General de Segovia, Segovia, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Contrast-induced nephropathy &#40;CIN&#41; is defined as an acute decline of the renal function in a short period of time &#40;2&#8211;7 days&#41; after the administration of radiological contrast agents&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> It is characterized by an absolute increase of serum creatinine with respect to its basal value of at least 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; or by a relative increase of 25&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2&#44;3</span></a> Its estimated incidence has been established between 0&#46;6&#37; and 2&#46;3&#37; in the general population&#44; and in up to 40&#37; in high-risk patients &#40;with prior renal decline and diabetics&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> However&#44; during the last few years there has been controversy on the existence of CIN in patients with normal renal function&#59; and even in patients with renal failure&#44; the risk of CIN is probably lower than we traditionally thought&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> In a recent prospective study conducted by Moos et al&#46; this is the case after studying nearly 1000 patients with an average age of 60 years old&#59; the glomerular filtration rate &#40;GFR&#41; of 88&#46;8&#37; of these patients was &#8805;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; and only 58 of them were at risk of developing CIN&#44; that only occurred in 2 patients&#44; which is leads us to think that the incidence of CIN is low&#44; even in patients who do not receive prophylactic hydration&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> Another retrospective study that included 193 patients with serum creatinine levels &#62;1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl questioned the role of IV contrast and the overestimation of CIN&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our goal was to analyze the incidence of CIN in a cohort of outpatients who were scheduled to one computed tomography &#40;CT&#41; scan with IV iodinated contrast and assess the results of nephroprotection with N-acetylcysteine&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This study has been evaluated and approved by the center ethics committee&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">Two hundred and twenty-six &#40;226&#41; patients with scheduled CT scans were studied&#46; The selection of patients was conducted including the first five &#40;5&#41; patients of the day&#39;s agenda &#40;morning shift&#41; who accepted to participate in the study and signed the written informed consent&#46; It was decided to select the patients like this so that the morning patients would not have to be delayed&#46; Patients under 18&#44; hospitalized patients&#44; or those with intercurrent processes &#40;clinical situations per se that can alter the normal renal function regardless of the effect of contrast&#41;&#44; and those who did not accept to participate or signed the informed consent were excluded&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Prospective observational study conducted between March 1&#44; 2016 and July 1&#44; 2016&#46; The blood samples were taken from venous blood while catheterizing one peripheral route for the administration of contrast&#44; and the levels of serum urea and creatinine were recorded&#46; After conducting the CT scan&#44; a note was included for the GP to conduct a new blood sample test&#44; in venous blood&#44; of the urea and creatinine levels within a week&#59; this analysis was also conducted in a lab at our center&#46; Also&#44; once the test ended&#44; the radiology unit recommended forcing oral hydration&#46; The GFR was estimated using the MDRD-4 &#40;Modification of Diet in Renal Disease&#41; formula&#46; The sociodemographic data &#40;age&#44; sex&#41;&#44; the cardiovascular history &#40;diabetes mellitus&#44; blood hypertension&#44; ischemic cardiomyopathy&#44; heart failure&#41; and the indication for conducting the CT scan were all collected&#46; The number of patients who received prophylaxis with N-acetylcysteine &#40;600<span class="elsevierStyleHsp" style=""></span>mg orally every 12<span class="elsevierStyleHsp" style=""></span>h&#41; was estimated pre- and post-CT scan&#46; When it comes to the contrast agent used&#44; the active ingredient and the dose of contrast used were recorded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted using the SPSS 15&#46;0 software package&#46; Data were expressed as means and proportions&#46; The comparison of the means was conducted using the Student&#39;s <span class="elsevierStyleItalic">t</span> test and the comparison of proportions using the chi-square test &#40;Fisher&#41;&#46; <span class="elsevierStyleItalic">P</span> values &#60;0&#46;05&#46; were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 226 patients accepted to participate in the study&#44; of which 23 were excluded because the follow-up blood test was not conducted by their GPs at their health center&#46; Also&#44; one &#40;1&#41; patient was excluded because he was already in a program of chronic hemodialysis&#46; Finally&#44; 202 patients were considered valid for the study and no traces of CIN were found in any of them&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The average age of the patients included in the study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>202&#41; was 63&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 years &#40;range 22&#8211;87&#41;&#44; 98 of them above 65 years&#46; One hundred and sixteen &#40;116&#41; &#40;54&#46;4&#37;&#41; patients were male&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the percentage of prior cardiovascular histories and chronic therapies used&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">These were the reason why the CT scan was indicated&#58; in 164 patients &#40;81&#46;2&#37;&#41; due to oncological control&#59; in 11 patients &#40;5&#46;4&#37;&#41; due to vascular study&#44; and in 27 patients &#40;13&#46;4&#37;&#41; the reasons varied&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the degree of renal function pre-CT scan&#58; the GFR estimated by MDRD4 of 176 patients was &#8805;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;89&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#59; range 62&#46;36&#8211;134&#46;14&#41; compared to the GFR of 26 patients estimated by MDRD4 that was &#60;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;45&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#59; range 9&#46;16&#8211;58&#46;90&#41;&#58; 11 patients were stage 3A-patients &#40;59&#8211;45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; and 14 patients were 3B-patients &#40;44&#8211;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#46; Only one female patient&#39;s GFR was &#60;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The contrast used in all patients was the same&#58; iopamidol at an average dose of 107&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>ml &#40;range 70&#8211;140&#41;&#46; The average days elapsed before and after the CT scan were 4&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 &#40;1&#8211;7&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Overall&#44; the serum creatinine level pre-CT scan was 0&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;range 0&#46;6&#8211;5&#46;2&#41;&#46; Only 30 patients showed pre-CT scan serum creatinine levels &#62;1&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; pre-CT scan urea levels were 42&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 &#40;range 13&#8211;150&#41; and the pre-CT scan MDRD-4 was 83&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Specific CIN prevention measures with 600<span class="elsevierStyleHsp" style=""></span>mg of oral N-acetylcysteine every 12<span class="elsevierStyleHsp" style=""></span>h pre- and post-CT scan were used in 13 patients only&#58; in 4 &#40;2&#46;3&#37;&#41; patients with MDRD4<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;patients with one kidney only&#41; and in 9 patients with impaired renal function&#44; with MDRD4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; These patients&#44; with more advanced renal failure&#44; had received prior advice in the external nephrology office to increase the oral intake the day before the CT scan on top of the prescribed N-acetylcysteine&#46; The only female patient whose GFR was &#60;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> was hospitalized the day before conducting the CT scan in order to receive hydration with 500<span class="elsevierStyleHsp" style=""></span>ml of isotonic saline solution added to the N-acetylcysteine&#46; No significant differences were seen in the dose of contrast administered among the 13 patients who received N-acetylcysteine &#40;105&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#41; and those who did not &#40;108&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;42&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the comparison of renal parameters pre- and post-CT scan based on the application of measures of N-acetylcysteine&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">No significant changes were seen in the evolution of the analytical parameters of renal function studied when comparing age &#60;65 versus &#62;65&#44; presence of heart failure&#44; ischemic cardiomyopathy&#44; or diabetes mellitus&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">No hemodialysis session was required&#44; and no patient died&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In our study&#44; patients who underwent scheduled CT scans with IV iodinated contrast &#40;iopamidol&#41; did not show any episodes of CIN&#46; Also&#44; most of them had not been prepared with IV hydration&#44; or saline solution&#44; or oral N-acetylcysteine&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">CIN is a common cause of iatrogenic acute renal failure &#40;ARF&#41; and has a variable incidence that goes from &#60;1&#37; and &#62;40&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> However&#44; according to recent studies such an incidence rate may be overestimated even in patients with chronic renal disease or diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6&#44;7</span></a> One systematic review and one meta-analysis of controlled studies &#40;13 non-randomized studies&#41; that assessed the incidence rate of AFR and prognoses associated with the exposure to radiological contrast agents and included nearly 26&#44;000 patients found that the incidence rate of AFR&#44; dialysis and mortality was similar among patients who received contrast agents compared to a control group that was not exposed to any contrast agents&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Similarly&#44; one recent study that used a database of nearly 8&#44;000&#44;000 hospitalizations&#44; in the United States&#44; from the year 2009 found that the rate of ARF was 5&#46;5&#37; in patients who had received contrast compared to 5&#46;6&#37; in those who had not&#44; which led the study authors to conclude that the risk of CIN is overestimated both in the specialized medical literature and among clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Also&#44; our findings are consistent with these recent studies&#58; lack of CIN in the population under study&#44; yet one of the limitations is that we studied a reduced number of patients&#46; These findings may be explained&#44; among other reasons&#44; due to the fact that 1st&#41; most patients studied had <span class="elsevierStyleItalic">normal renal function</span>&#59; 2nd&#41; they were <span class="elsevierStyleItalic">outpatients</span>&#44; with clinical stability&#44; and who underwent one <span class="elsevierStyleItalic">scheduled</span> CT scan&#44; and 3rd&#41;&#44; because the radiological contrast was administered using the lowest necessary dose and&#44; also&#44; because it had a good nephrotoxic profile&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">When it comes to the factors that may contribute to an increased incidence of CIN&#44; those patients with an active cancer&#44; and with signs of dehydration are more predisposed to develop CIN&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">10&#44;11</span></a> Although in our initial study the main indication for the CT scan was also oncological&#44; all patients were&#44; however&#44; outpatients and&#44; therefore&#44; clinically stable&#46; Also&#44; these patients had been conducting activities of daily living one day prior to the test&#44; which leads us to think that they were in some sort of euvolemic state&#59; after the test&#44; the patients had been told to increase their water intake &#8211; circumstances that may justify the favorable results presented here&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When it comes to other risk factors to develop CIN&#44; it was considered that diabetic patients or patients with heart failure had a higher risk of developing CIN&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">12&#44;13</span></a> However&#44; in certain recent studies&#44; diabetes mellitus has not been associated with a higher risk of developing CIN&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7&#44;8</span></a> In our study&#44; patients with a history of diabetes&#44; heart failure&#44; or ischemic cardiomyopathy did not show any significant variations either in the analyzed renal parameters&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">On the other hand&#44; when analyzing radiological contrast&#44; it has already been discussed that certain studies found no statistically significant differences in the incidence of CIN between the administration of contrast and the non-administration&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;14</span></a> We could also argue here that the improvement in the development of contrast molecules leads to the appearance of less adverse reactions&#58; particularly non-ionic low-osmolality molecules &#40;600&#8211;900<span class="elsevierStyleHsp" style=""></span>mOsm&#47;kg of water&#41; have a better nephrotoxic profile&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> Iopamidol<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> is included in the category of &#8220;non-ionic monomers&#8221; &#8211; the <span class="elsevierStyleItalic">only</span> contrast agent used in this study&#46; Besides&#44; if we take the characteristics of the molecules into consideration on the role played by toxicity&#44; the contrast volume is another factor that has been associated with the appearance of CIN&#44; particularly when the amount used is higher than 140<span class="elsevierStyleHsp" style=""></span>ml&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2&#44;16</span></a> In our patients&#44; the protocols used based on the indication of CT scan required doses than were never &#62;140<span class="elsevierStyleHsp" style=""></span>ml &#8211; the average dose used was around 100<span class="elsevierStyleHsp" style=""></span>ml&#44; which is another argument that may justify the lack of CIN&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Lastly&#44; the oral or IV volume expansion prior to the exposure to radiological contrast and&#47;or the use of N-acetylcysteine have been the general recommendations to avoid CIN basically in patients who undergo cardiac catheterization&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> When it comes to patients who undergo CT scans&#44; Traub et al&#46; conducted one bi-center randomized&#44; double-blind clinical trial in a cohort of 357 patients who completed the study and found no benefit in the combined used of N-acetylcysteine and one saline solution compared to the control group that received the saline solution only&#46; In this study&#44; the reduced CIN was significantly associated with the volume of fluid administered&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> However&#44; in one meta-analysis that included 6 randomized controlled trials with nearly 500 patients&#44; the prophylactic administration of N-acetylcysteine in patients with serum creatinine &#62;1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl plus hydration did reduce the risk of CIN&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> In our study&#44; we did not implement specific measures of hydration with an IV saline solution or N-acetylcysteine in most patients and no CIN was recorded either&#46; However&#44; patients with a single kidney with GFR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> or patients with worse renal function &#40;GFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; who received prophylaxis with N-acetylcysteine did not show CIN either&#46; This reduced number of patients who were premedicated with N-acetylcysteine is another limiting factor when interpreting the results&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our favorable results of lack of CIN in patients who underwent one CT scan with the administration of contrast should be interpreted with caution based on the characteristics of the population analyzed&#58; &#40;a&#41; clinically <span class="elsevierStyleItalic">stable</span> &#40;non-hospitalized&#41; patients who underwent &#8220;scheduled&#8221; CT scans were studied&#59; &#40;b&#41; &#8220;non- ionic&#8221; contrast with doses &#60;140<span class="elsevierStyleHsp" style=""></span>ml was used&#44; and &#40;c&#41; mostly they were patients with GFR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When it comes to the practical utility of these results&#44; not finding CIN in &#8220;selected&#8221; patients does not mean that the CT scan with iodinated contrast can be used indiscriminately as the elective diagnostic imaging modality since the study is based on a single CT scan and the long-term effect of repeated exposure to CT scans on the renal function has not been studied&#44; which by the way may be the goal of future studies&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In sum&#44; the incidence of CIN is not significant in the cohort studied here with glomerular filtration rates &#40;GFR&#41; &#62;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#58; these favorable results may be explained by the fact that the CT scan was &#8220;scheduled&#8221; and &#8220;non-ionic&#8221; iodinated contrast in relatively low doses was administered&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors</span><p id="par0130" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; MH&#44; MG&#44; FJR and MJF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Study idea&#58; MH&#44; MG&#44; FJR and MJF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Study design&#58; MH&#44; MG&#44; MJR and MJF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Data mining&#58; MH&#44; YG&#44; MB and MJF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; MH and JR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; MH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Reference&#58; MH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Writing&#58; MH and MJF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks&#58; MH and MG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Approval of the final version&#58; MH&#44; MG&#44; YG&#44; MB&#44; JR&#44; MJR and MJF&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interests</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">This study has been approved by the clinical research ethics committee of Segovia&#46;</p></span></span>"
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            0 => "Contrast-induced nephropathy"
            1 => "Acute kidney injury"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography &#40;CT&#41; with intravenous iodinated contrast material&#46; To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This prospective observational study was carried out in the months comprising March 2016 through July 2016&#46; We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form&#46; We recorded patients&#8217; cardiovascular histories&#44; chronic treatments&#44; and indications for the CT examination&#46; We measured blood levels of creatinine and urea before and after the CT examination&#46; We used the Modification of Diet in Renal Disease &#40;MDRD-4&#41; equation to estimate the glomerular filtration rate&#46; We analyzed the type and dose of contrast material&#46; We recorded whether N-acetylcysteine was administered before the CT examination&#46; We used SPSS 15&#46;0<span class="elsevierStyleSup">&#174;</span> to compare means and proportions&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No incidents of contrast-induced nephropathy were detected in any of the 202 patients included &#91;mean age&#44; 63&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 years &#40;range 22&#8211;87&#41;&#59; 57&#46;4&#37; male&#59; 21&#46;8&#37; diabetic&#59; 39&#46;6&#37; hypertensive&#59; 87&#46;1&#37; had MDRD4<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;89&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44; range 62&#46;36&#8211;134&#46;14&#41; and 12&#46;9&#37; had MDRD4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;45&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44; range 9&#46;16&#8211;58&#46;90&#41;&#93;&#46; The most common indication for CT examinations was oncologic &#40;81&#46;2&#37;&#41;&#46; The only contrast agent administered was iopamidol&#59; the mean dose was 107&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>ml &#40;range 70&#8211;140&#41;&#46; The mean interval between pre-CT and post-CT laboratory tests was 4&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 days&#46; Only 13 patients received N-acetylcysteine&#59; 9 of these had MDRD<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and 4 had MDRD4<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#58; these favorable results might be due to analyzing only scheduled examinations and to using relatively low doses of a &#8220;nonionic&#8221; iodinated contrast agent&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la incidencia de nefropat&#237;a por contraste en una cohorte de pacientes sometidos a tomograf&#237;a computarizada &#40;TC&#41; con contraste yodado intravenoso&#46; Valorar los resultados de la nefroprotecci&#243;n con N-acetilciste&#237;na&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional prospectivo&#44; entre los meses de marzo y julio de 2016&#46; Los pacientes seleccionados ten&#237;an programada una TC&#46; Se incluyeron los primeros 5 pacientes de cada d&#237;a&#44; que aceptaban participar y firmaban el consentimiento informado&#46; Se registraron antecedentes cardiovasculares&#44; tratamientos cr&#243;nicos e indicaci&#243;n de la TC&#46; Se determin&#243; la creatinina y la urea en sangre pre-TC y pos-TC&#46; El filtrado glomerular se determin&#243; por MDRD-4 &#40;<span class="elsevierStyleItalic">Modification of Diet in Renal Disease</span>&#41;&#46; Respecto al contraste&#44; se analiz&#243; tipo y dosis&#46; Se registr&#243; el uso de N-acetilciste&#237;na anterior a la TC&#46; Estad&#237;stica&#58; SPSS 15&#46;0<span class="elsevierStyleSup">&#174;</span> utilizando comparaci&#243;n de medias y proporciones&#46; Significaci&#243;n&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No se detect&#243; ninguna NC en 202 pacientes estudiados&#46; Datos globales&#58; edad&#58; 63&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 a&#241;os &#40;rango 22-87&#41;&#59; 57&#44;4&#37; varones&#59; 21&#44;8&#37; diab&#233;ticos&#59; 39&#44;6&#37; hipertensos&#59; 176 pacientes ten&#237;an MDRD4<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;89&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44; rango 62&#44;36-134&#44;14&#41; y 26 MDRD4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;45&#44;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44; rango 9&#44;16-58&#44;90&#41;&#46; La principal indicaci&#243;n de TC fue oncol&#243;gica &#40;81&#44;2&#37;&#41;&#46; El &#250;nico contraste administrado fue iopamidol&#44; en dosis de 107&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>ml &#40;rango 70-140&#41;&#46; El intervalo de d&#237;as entre anal&#237;ticas fue de 4&#44;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 d&#237;as&#46; Solo en 13 pacientes se administr&#243; N-acetilciste&#237;na&#58; en 9 con MDRD<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> y en 4 con MDRD4<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La incidencia de NC es no significativa en la cohorte estudiada con un filtrado glomerular superior a 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#58; la realizaci&#243;n de TC de forma &#8220;programada&#8221;&#44; utilizando un contraste yodado &#8220;no i&#243;nico&#8221; en dosis relativamente baja&#44; es un factor que quiz&#225;s explique estos resultados favorables&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Heras Benito M&#44; Garrido Bl&#225;zquez M&#44; G&#243;mez Sanz Y&#44; Bernardez Mardomingo M&#44; Ruiz Cacho J&#44; Rodr&#237;guez Recio FJ&#44; et al&#46; Incidencia de nefropat&#237;a por contraste en pacientes sometidos a tomograf&#237;a computarizada&#58; &#191;qu&#233; factores la condicionan&#63; Radiolog&#237;a&#46; 2018&#59;60&#58;326&#8211;331&#46;</p>"
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                      "titulo" => "Contrast-induced acute kidney injury&#58; definition&#44; epidemiology&#44; and outcome"
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                      "titulo" => "Prevenci&#243;n de la nefropat&#237;a por contraste"
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                      "titulo" => "Patients at risk for contrast-induced nephropathy and mid-term effects after contrast-administration&#58; a prospective cohort study"
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2018.03.007

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