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The administration of contrast media: Is there a risk of acute kidney injury?
Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?
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"tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "314" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The administration of contrast media: is there a risk of acute kidney injury?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1152 "Ancho" => 1583 "Tamanyo" => 88109 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de las tomografías computarizadas (TC) realizadas con contraste. La frecuencia de la administración de contraste intravenoso en las exploraciones de TC disminuye conforme aumenta el nivel de creatinina sérica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.D. Ferrer Puchol, P. Montesinos García, M. Forment Navarro, E. Sanz Rodrigo, E. Blanco Pérez, E. Taberner López" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.D." "apellidos" => "Ferrer Puchol" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Montesinos García" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Forment Navarro" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Sanz Rodrigo" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Blanco Pérez" ] 5 => array:2 [ "nombre" => "E." 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(B) Axial T2-weighted MRI. (C) Axial DWI/ADC MRI. (D) Axial T1-weighted gadolinium MRI. (E) IFS: macroscopic specimen. (F) Anatomical pathology. H/E 400×. 52-Year-old female patient, G2P2, studied for initial staging of an endometrial adenocarcinoma, moderate-grade (G2) endometrioid subtype. Initial MRI (A and B). Tumour formation observed with intermediate signal in T2-weighted images (thick arrow), restriction in DWI/ADC (C) and intense enhancement after administration of gadolinium (D) which occupied the anterior uterine wall. Appears to infiltrate the deep myometrium. This was classified as M2. Adjacent small intramural myoma observed (thin arrow). Intraoperative frozen section (IFS) (C): during the surgical procedure the tumour (thick arrow) was distinguished from the posterior leiomyoma (thin arrow). This was classified as M2. Anatomical pathology (D): shows a moderately differentiated G2 endometrioid adenocarcinoma, with deep myometrial invasion (M2) and proximity to the uterine serosa (thick arrow). Findings of the IFS and MRI confirmed.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.F. Sánchez, P.I. Causa Andrieu, C. Latapie, M.C. Saez Perrotta, N. Napoli, M. Perrotta, C.R.B. Chacón, A. Wernicke" "autores" => array:8 [ 0 => array:2 [ "nombre" => "M.F." "apellidos" => "Sánchez" ] 1 => array:2 [ "nombre" => "P.I." "apellidos" => "Causa Andrieu" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Latapie" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Saez Perrotta" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Napoli" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Perrotta" ] 6 => array:2 [ "nombre" => "C.R.B." "apellidos" => "Chacón" ] 7 => array:2 [ "nombre" => "A." 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(A and B) Computed tomography which reveals a blind-ending tubular structure in the lower right quadrant of the abdomen (arrows) with intravenous contrast extravasation (arrowhead). (C) The multiplanar coronal reconstruction showed the diverticulum in the right ileal region (arrow) and the vitellointestinal artery (arrowhead).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Parra-Fariñas, S. Quiroga-Gomez, S. Castro-Boix, F. Vallribera-Valls, E. Castellà-Fierro" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Parra-Fariñas" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Quiroga-Gomez" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Castro-Boix" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vallribera-Valls" ] 4 => array:2 [ "nombre" => "E." 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "314" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.D. Ferrer Puchol, P. Montesinos García, M. Forment Navarro, E. Sanz Rodrigo, E. Blanco Pérez, E. Taberner López" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Ferrer Puchol" "email" => array:2 [ 0 => "lolesferrer@ono.com" 1 => "mferrer@hospital-ribera.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Montesinos García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Forment Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Sanz Rodrigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Blanco Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "E." "apellidos" => "Taberner López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario de la Ribera, Alzira, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Analista de Sistema, Hospital Universitario de la Ribera, Alzira, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1152 "Ancho" => 1583 "Tamanyo" => 95133 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage of CT scans performed with contrast media. The frequency of administering intravenous contrast in CT examinations decreases as the serum creatinine level increases.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Intravenous contrast media are used routinely in radiology departments to improve diagnostic performance. Their administration has been reported to cause a reversible form of acute kidney injury (AKI), which arises shortly after administration, mostly without sequelae, although there is evidence that developing the condition may be associated with adverse effects, primarily cardiovascular events, as well as a prolonged hospital stay, increased hospital mortality and, in the long term, progression to chronic kidney disease (CKD).<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Contrast-induced nephropathy (CIN) is defined as the exacerbation, in the absence of other aetiologies, of kidney function following the administration of intravenous iodinated contrast, understood as an increase in baseline serum creatinine of 0.3–0.5<span class="elsevierStyleHsp" style=""></span>mg/dl (or 44.2<span class="elsevierStyleHsp" style=""></span>μl) or a relative 25–50% increase in baseline creatinine within the first 24–72<span class="elsevierStyleHsp" style=""></span>h of exposure to a contrast medium.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3–7</span></a> The incidence of CIN is variable depending on the reference population and the patient's risk factors. An incidence rate of 0.6–2.3% has been described in the population given a contrast medium,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> and it has been postulated as the third cause of AKI of iatrogenic origin.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In imaging studies required by the emergency department (ED), contrast-enhanced computed tomography (CT) is becoming an increasingly widespread diagnostic method and is performed in many critical patients in whom, according to specialist literature, the possibility of CIN is up to 14%, with twice as many adverse effects arising over the course of the first year.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3,9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A greater incidence of CIN has also been reported in patients undergoing emergency procedures versus those having elective surgery.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Many studies have been published on AKI following the administration of an intravenous contrast medium, but few include a control group of patients not exposed to contrast media.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> This is due to the fact that, historically, randomised clinical trials designed to assess the true incidence of CIN were considered unethical, since administering contrast was presumed to be a direct cause of kidney injury. As a result, the studies performed are observational and their conclusions have been limited by selection biases associated with the clinical decision on whether to administer a contrast medium or not. Recent studies, such as by Newhouse et al.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> and Bruce et al.,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> retrospectively demonstrate that the rate of AKI following CT was similar in patients administered intravenous contrast media and those who were not.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Two working groups recently used a propensity score matching analysis to control these biases, approximating randomised distribution to the use of non-randomised population matching. These studies produced contradictory results. McDonald et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> did not find any increase in the risk of kidney injury, need for emergency dialysis or mortality following the administration of contrast media. However, the Davenport et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> working group published an increase in AKI following the administration of iodinated contrast media in patients in whom impaired kidney function was already evident, with creatinine levels above 1.5<span class="elsevierStyleHsp" style=""></span>mg/dl.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A major study has recently been published that analyses a cohort of 17,934 patients who attended the ED over a five-year period requiring intravenous contrast-enhanced CT. The study concluded that the administration of an intravenous iodinated contrast medium is not associated with an increase in the onset of AKI.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Interest in this work stems from the fact that the latter publication has been reproduced in our hospital setting. Moreover, given the impact it has had in the scientific community, we analysed the patients who attended our hospital's ED over a six-year period and underwent intravenous contrast-enhanced CT, assessing whether or not they experienced a deterioration in kidney function. Our working hypothesis is that performing intravenous iodinated contrast-enhanced CT (with no previous preparation) in these patients will not interfere with the onset of AKI as much as expected.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0045" class="elsevierStylePara elsevierViewall">This is a retrospective cohort study in a hospital setting. The data were collected from January 2010 to December 2015, both inclusive (six years). We obtained the hospital's permission to collect said data through its ethics committee. The data were provided by an analyst from the Central Corporate Information Office (<span class="elsevierStyleItalic">Oficina Central de Información Corporativa, OCIC</span>).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The search criterion was: “patients who attended the hospital's ED and had a serum creatinine test upon admission and at least one further test within the first 72<span class="elsevierStyleHsp" style=""></span>hours”.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population and scope</span><p id="par0055" class="elsevierStylePara elsevierViewall">Our catchment area covers 253,330 inhabitants. Each year, the hospital's ED receives 108,170 people on average, which equates to 296.35 patients every day. A yearly average of 3968 emergency CT scans are requested, 804 of which (20.3%) require the administration of an intravenous contrast medium.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inclusion criteria</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients over 18 years of age who attended the ED between 1 January 2010 and 31 December 2015.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Exclusion criteria</span><p id="par0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Patients with serum creatinine levels <0.4<span class="elsevierStyleHsp" style=""></span>mg/dl or >4.0<span class="elsevierStyleHsp" style=""></span>mg/dl.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Patients with a history of kidney transplant or on haemodialysis treatment.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0080" class="elsevierStylePara elsevierViewall">Patients who had undergone contrast-enhanced CT or an angiographic study within six months prior to the beginning of this study.</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">The sample size was calculated using a statistics equation for population proportions, with a 95% confidence interval and 3% precision.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The primary endpoint was “administration of contrast”, which was used to create three different groups: patients who underwent CT with intravenous contrast; patients who underwent CT without intravenous contrast; and a third group who did not have any form of CT scan.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The secondary endpoints were: age, gender, admission date, discharge date, destination upon discharge, main diagnosis and previous contrast-enhanced studies.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The two most common definitions were used to assess kidney injury in the data analysis: (a) According to the Acute Kidney Injury Network (AKIN)<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> AKI is defined as a creatinine increase ≥0.3<span class="elsevierStyleHsp" style=""></span>mg/dl or 1.3 times greater than the baseline value. (b) According to the CIN definition,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">16,17</span></a> kidney injury is deemed to be a creatinine increase ≥0.5<span class="elsevierStyleHsp" style=""></span>mg/dl or 25% greater than the baseline creatinine level.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although various types of iodinated contrast were used throughout the study, all of them have a low osmolarity and the volume was adjusted to the patient's weight within a range of 50–200<span class="elsevierStyleHsp" style=""></span>ml.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">The data were collected through appointments with medical professionals, documented in each patient's electronic medical record in the Integrated Health Care System (<span class="elsevierStyleItalic">Sistema Integrado de Ayuda Asistencial, SIAS</span>). The variables were analysed using the bivariate and multivariate descriptive statistics method. The logistic regression analysis was used to assess the correlation between administering intravenous contrast and the onset of kidney injury.</p><p id="par0115" class="elsevierStylePara elsevierViewall">To reduce the selection bias inherent to the administration of contrast media, propensity score matching was used and two control groups were managed to approximate randomised distribution to the use of non-randomised population matching.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The database, descriptive analysis and measures of statistical dispersion were performed with the Microsoft Office ACCESS program and using the Galenus-Campus Ribera platform, where the investigators are registered as part of the “Big Data” project, led by the principal investigator. The processing of both data and patients was completely anonymous and in line with the Spanish Law on Personal Data Protection (LOPD). The results were analysed with the STATA 15 program.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical considerations</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study was performed in accordance with the basic principles of all medical research (Declaration of Helsinki), having been submitted for the prior consideration and approval of the hospital's Independent Ethics Committee, subject to the signature of confidentiality clauses on data consultation and variables taken from medical records for the aforementioned research purposes.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Accordingly, the study was governed by Organic Law 15/1999, of 13 December, on Personal Data Protection (LOPD), which aims to safeguard and protect the processing of personal data, and Law 41/2002, of 14 November, regulating patient autonomy and rights and obligations relating to clinical information and documentation.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0135" class="elsevierStylePara elsevierViewall">From 1 January 2010 to 31 December 2015, 632,615 patients attended the hospital's ED (daily average: 296.35), 13.4% of whom (84,626) required hospitalisation.</p><p id="par0140" class="elsevierStylePara elsevierViewall">52,411 patients—those who had a baseline and second serum creatinine reading 24–72<span class="elsevierStyleHsp" style=""></span>h later—were selected.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Having applied the exclusion criteria, a final sample of 46,637 patients was obtained (25,831 males and 20,806 females). 32,802 patients (72.48%) did not undergo CT, while 12,835 (27.52%) did. Of these, 6642 patients (14.24%) were administered intravenous contrast media and 6193 (13.28%) were not (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The demographic study revealed that the three groups analysed (contrast-enhanced CT, non-contrast-enhanced CT and no CT) were demographically similar. Whether or not a CT was performed was not influenced by gender (<span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span>), although significant differences were found for age, since the patients who underwent CT scans were younger (<span class="elsevierStyleItalic">t</span> test for age, 95% confidence interval [CI]).</p><p id="par0155" class="elsevierStylePara elsevierViewall">The mean age of the patients was 67.95 years (standard deviation [SD]: 18), p50: 73 (age range 106–18 years).</p><p id="par0160" class="elsevierStylePara elsevierViewall">The mean serum creatinine value 1 (baseline) was 1.16<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 0.61), p50: 0.97 (range: 3.99–0.40), while the mean serum creatinine value 2 (24–72<span class="elsevierStyleHsp" style=""></span>h) was 1.14<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 0.66), p50: 0.94 (range: 1.32–2.03) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comparative study of patients who underwent CT (with and without contrast media) and those who did not</span><p id="par0165" class="elsevierStylePara elsevierViewall">A bivariate study with a <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test was performed, comparing the onset of kidney injury whether or not CT was performed, according to the AKIN criteria. In total, 9.67% of the patients who did not undergo a CT scan developed kidney injury versus 8.10% of those who did. In terms of the CIN criteria, 9.91% of the patients who did not have a CT scan developed kidney injury, compared with 8.40% of those who did. These differences were statistically significant and suggested that performing a CT scan “protected” against the onset of kidney injury (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Comparative study of patients who underwent CT (with and without intravenous contrast)</span><p id="par0170" class="elsevierStylePara elsevierViewall">According to the AKIN criteria, 9.58% of patients who underwent non-contrast-enhanced CT were found to have developed kidney injury, which rose to 9.79% according to the CIN criteria. However, in patients who underwent contrast-enhanced CT, kidney injury occurred in 7.15% of the patients when the AKIN criteria were applied, and in 7.72% when the CIN criteria were applied (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">When we compared the group of patients who underwent non-contrast-enhanced CT with those who did not have any form of CT scan, no significant differences were found between them. According to the AKIN criteria, 9.25% of the patients who did not undergo CT developed kidney injury, compared with 9.11% of those who had a non-contrast-enhanced CT scan. In accordance with the CIN criteria, kidney injury arose in 9.55% of the patients who did not have a CT scan versus 9.12% of those who underwent non-contrast-enhanced CT.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Knowledge of the previous creatinine values conditioned the performance of contrast-enhanced CT, such that the mean creatinine level in patients who underwent a contrast-enhanced CT was 1.04<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 0.45). In patients who did not undergo contrast-enhanced CT, mean creatinine was 1.17<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 0.63), a statistically significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.000). Contrast-enhanced CT was performed in 14.9% of the patients with baseline creatinine values below 2<span class="elsevierStyleHsp" style=""></span>mg/dl and in 8.06% of patients with a creatinine value greater than 2<span class="elsevierStyleHsp" style=""></span>mg/dl (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.000). Therefore, the higher the baseline creatinine level, the lower the likelihood of contrast-enhanced CT being performed (<span class="elsevierStyleItalic">t</span> test with 95% CI) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">As regards the severity of the patients, 36,492 were classified as severe (those who were hospitalised or who died within the first 72<span class="elsevierStyleHsp" style=""></span>h), and the remaining 10,145 as non-severe. Kidney injury was significantly more common in the most severe patients (significant <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span>, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.26).</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Multivariate study</span><p id="par0190" class="elsevierStylePara elsevierViewall">A multivariate logistic regression study was performed that included the following variables: age, gender, contrast-enhanced CT, non-contrast-enhanced CT and no CT. The statistics program omitted non-contrast-enhanced CT due to collinearity.</p><p id="par0195" class="elsevierStylePara elsevierViewall">With respect to the AKIN criteria, patient age was statistically significant, in the sense that the greater the patient's age, the more likely they were to develop kidney injury, regardless of whether CT had been performed or not, with an odds ratio (OR) of 1.02 (positive). Gender was not significant. Performing CT protected against the onset of kidney injury with an OR of 0.90 (95% CI: 0.83–0.99) and contrast-enhanced CT had an even greater protective effect against the onset of kidney injury, with an OR of 0.84 (95% CI: 0.74–0.96).</p><p id="par0200" class="elsevierStylePara elsevierViewall">As regards the CIN criteria, patient age was also statistically significant: the greater the age, the greater the likelihood of developing kidney injury, with an OR of 1.01 (positive), regardless of whether CT had been performed with or without contrast or not at all. Again, gender was not significant and performing a CT scan significantly protected against kidney injury, with an OR of 0.89 (95% CI: 0.81–0.98). Moreover, as with the AKIN criteria, contrast-enhanced CT had an even greater protective effect against the onset of kidney injury, with an OR of 0.89 (95% CI: 0.78–1.00).</p><p id="par0205" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows these results, combining both sets of kidney injury criteria, AKIN and CIN. The values obtained show that age and previous creatinine level increase the likelihood of kidney injury, while performing CT with or without intravenous contrast reduces the likelihood of kidney injury.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">The possibility of the baseline serum creatinine level conditioning a deterioration in kidney function was explored, and the study showed that baseline creatinine did indeed condition the onset of kidney injury with an OR of 1.41, although this was irrespective of whether or not CT was performed.</p><p id="par0215" class="elsevierStylePara elsevierViewall">To eliminate selection biases, propensity score matching was applied. This was used to analyse whether age, gender and baseline creatinine (C1) had conditioned indication-based confusion. The result obtained showed that performing intravenous contrast-enhanced CT had not been conditioned by these factors and had not increased the likelihood of kidney injury, actually lowering the risk with an OR of 0.37 (CI: 0.32–0.41).</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Analysis based on the glomerular filtration rate</span><p id="par0220" class="elsevierStylePara elsevierViewall">The glomerular filtration rate (GFR) was calculated using serum creatinine levels, applying the CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> algorithm. When kidney injury occurring after contrast-enhanced CT was analysed using both sets of criteria (AKIN and CIN) and what happened with patients who had a GFR ≤30<span class="elsevierStyleHsp" style=""></span>ml/min (5415 cases) was studied, an OR of 0.66 was obtained (95% CI: 0.47–0.91), with a significant <span class="elsevierStyleItalic">p</span> value. It was therefore deduced that administering a contrast medium is not an independent variable for the onset of AKI. Conversely, having analysed the group of patients with a GFR ≤20<span class="elsevierStyleHsp" style=""></span>ml/min (2023 cases), an OR of 0.94 was obtained (95% CI: 0.52–1.70), albeit with an insignificant <span class="elsevierStyleItalic">p</span> value (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">When we analysed the GFRs (GFR1: baseline result upon admission; GFR2: result after 24–72<span class="elsevierStyleHsp" style=""></span>h) and performed a multiple regression analysis, we found that performing intravenous contrast-enhanced CT does not affect the GFR2 in either patients with a GRF1 ≤30, or in those who scored 20 or higher, with <span class="elsevierStyleItalic">p</span> values of 0.001 and 0.023, respectively, thus indicating that the GFR variations experienced were irrespective of intravenous contrast administration.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0230" class="elsevierStylePara elsevierViewall">Numerous studies have been published which compare serum creatinine levels before and after the administration of iodinated contrast to perform a CT scan. Most find an increase in the serum creatinine value after exposure to the contrast medium,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5,11</span></a> so a causal relationship is established between these two events. The concept of CIN—which is the most widely accepted definition and the one that should be used universally—stems from this relationship, the physiopathology of which is well described in the literature.</p><p id="par0235" class="elsevierStylePara elsevierViewall">Nevertheless, it should be taken into account that most of the studies describing CIN do not include a control group of patients in which iodinated contrast is not administered.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The inclusion of control groups with patients who have not received intravenous contrast media in these types of study is a significant methodological leap. Recent studies by Newhouse et al.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> and Bruce et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> show that changes in serum creatinine values in patients who did not receive intravenous iodinated contrast media are comparable to those of patients who were given contrast. Consequently, not all variations in post-contrast serum creatinine are dependent on the administration of contrast media. There are numerous factors besides the use of iodinated contrast that may affect the kidney function of patients seen in the ED, particularly in those who are hospitalised. Among the most reported factors are the administration of nephrotoxic medicines, glomerulonephritis, haemolysis, rhabdomyolysis, low cardiac output syndrome, urinary obstruction, surgery, burns, bowel obstruction and sepsis.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Therefore, the assumed causal relationship between administering intravenous contrast media and AKI is called into question or, at the very least, overestimated.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Our study, a retrospective, single-centre, cohort study in a hospital setting, which had a final sample size of 46,637 patients, found that administering intravenous iodinated contrast to perform a CT scan in patients with a serum creatinine value of between 0.4<span class="elsevierStyleHsp" style=""></span>mg/dl and 4<span class="elsevierStyleHsp" style=""></span>mg/dl is not associated with the onset of AKI in our setting.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Among the results obtained, it is worth highlighting, both in the bivariate study and the multivariate logistic regression analysis, that patients who underwent CT with intravenous iodinated contrast had a lower rate of AKI and a lower likelihood of its onset compared with patients who had a non-contrast-enhanced CT scan and those who did not undergo any form of CT, results which were statistically significant. In light of our results, not only is iodinated contrast-enhanced CT not associated with the onset of AKI, but it is also a “protective” factor against the condition, with a negative OR of less than 1, both when the two sets of criteria for kidney injury are explored separately and when they are analysed indistinctly together. This finding has also been obtained by other authors in their respective studies.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> One possible explanation could be the hydration that occurs upon administering the contrast volume itself, its osmotic diuretic effect and the subsequent hydration it causes, primarily in the most severe hospitalised patients.</p><p id="par0260" class="elsevierStylePara elsevierViewall">Conversely, age and the baseline creatinine level were proportionally associated with the onset of AKI, always irrespective of whether a CT scan with or without intravenous contrast had been performed or not.</p><p id="par0265" class="elsevierStylePara elsevierViewall">Having reviewed the literature, only three studies among those assessing the association between exposure to iodinated contrast and AKI have a control group, that is to say they compare the incidence of AKI in patients who underwent non-contrast-enhanced CT with those who underwent contrast-enhanced CT.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14,19,20</span></a> All three obtain similar results and conclusions to our own.</p><p id="par0270" class="elsevierStylePara elsevierViewall">The application of propensity score matching in the published studies to reduce selection bias provides similar results to ours, leading to the conclusion that intravenous iodinated contrast is not an independent risk factor for kidney injury.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">13,14,21</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">The only discrepancy is the study carried out by Davenport et al.,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> which concludes that using low-osmolarity contrast media results in a significant increase in kidney injury only in patients with previous creatinine levels exceeding 1.6<span class="elsevierStyleHsp" style=""></span>mg/dl. With regard to this study, we found it interesting that the authors determined the GFR, and we obtained the same results on grouping together patients who had a GFR below 30<span class="elsevierStyleHsp" style=""></span>ml/min. Nevertheless, when we analysed those with a GFR below 20<span class="elsevierStyleHsp" style=""></span>ml/min, all statistical significance was lost. Other authors also draw the conclusion that only with a GFR >30<span class="elsevierStyleHsp" style=""></span>ml/min is the administration of contrast media not an independent risk factor for the onset of kidney injury, the need for dialysis and mortality.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">To date, for ethical reasons, there has been no randomised, controlled, prospective study to conclusively determine the relationship between intravenous iodinated contrast and AKI. However, given the results obtained in our study and those in similar studies referenced above, carrying out a study of this kind seems possible.</p><p id="par0285" class="elsevierStylePara elsevierViewall">A meta-analysis was recently published analysing kidney injury after CT and which encompassed the results of 107,335 cases, finding no statistically significant differences between patients who underwent contrast-enhanced CT and those who did not receive contrast media.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Despite the fact that our study includes more patients than most other published studies, it has significant limitations, including the fact that all patients were treated in the ED of the same hospital, as well as being a retrospective observational study in which the patients’ comorbidities, other clinical approaches and the potential administration of nephrotoxic medicines were not assessed. Although we have tried to minimise the bias associated with assigning patients using propensity score matching, this decision has been limited by the exclusion of other factors that might have influenced the decision on whether or not to administer an intravenous contrast medium in the CT study.</p><p id="par0295" class="elsevierStylePara elsevierViewall">A randomised prospective study would be required to accurately determine the impact of intravenous iodinated contrast on the onset of AKI, although our results conclude that, in our setting (the ED), administering intravenous iodinated contrast is not associated with an increase in the incidence of kidney injury, at least in patients with a baseline creatinine value less than or equal to 4<span class="elsevierStyleHsp" style=""></span>mg/dl.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Authorship</span><p id="par0300" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1.</span><p id="par0305" class="elsevierStylePara elsevierViewall">Responsible for the integrity of the study: MDFP, MFN, PMG, ESR, EBP and ETL.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0310" class="elsevierStylePara elsevierViewall">Study conception: MDFP, MFN, PMG, ESR, EBP and ETL.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3.</span><p id="par0315" class="elsevierStylePara elsevierViewall">Study design: MDFP, MFN, PMG, EBP and ETL.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4.</span><p id="par0320" class="elsevierStylePara elsevierViewall">Data collection: MDFP, MFN, PMG, ESR, EBP and ETL.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">5.</span><p id="par0325" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: MDFP, MFN, PMG, ESR, EBP and ETL.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">6.</span><p id="par0330" class="elsevierStylePara elsevierViewall">Statistical processing:</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">7.</span><p id="par0335" class="elsevierStylePara elsevierViewall">Literature search: MDFP, MFN and PMG.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">8.</span><p id="par0340" class="elsevierStylePara elsevierViewall">Drafting of the paper: MDFP, MFN and PMG.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">9.</span><p id="par0345" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually significant contributions: MDFP, MFN, PMG, ESR, EBP and ETL.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">10.</span><p id="par0350" class="elsevierStylePara elsevierViewall">Approval of the final version: MDFP, MFN, PMG, ESR, EBP and ETL.</p></li></ul></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0355" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1220915" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1135468" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1220914" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1135467" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and method" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study population and scope" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Inclusion criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Exclusion criteria" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethical considerations" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Comparative study of patients who underwent CT (with and without contrast media) and those who did not" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Comparative study of patients who underwent CT (with and without intravenous contrast)" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Multivariate study" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Analysis based on the glomerular filtration rate" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Authorship" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack417495" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-24" "fechaAceptado" => "2019-01-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1135468" "palabras" => array:4 [ 0 => "Computed tomography" 1 => "Multidetector CT" 2 => "Contrast-induced nephropathy" 3 => "Nephroprotection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1135467" "palabras" => array:4 [ 0 => "Tomografía computarizada" 1 => "TC multidetector" 2 => "Nefropatía por contraste" 3 => "Nefroprotección" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72<span class="elsevierStyleHsp" style=""></span>h later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤0.4<span class="elsevierStyleHsp" style=""></span>mg/dl or ≥4.0<span class="elsevierStyleHsp" style=""></span>mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6642), those who underwent noncontrast CT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6193), and those who did not undergo CT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analysed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 0.61); C2: 1.14<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (<span class="elsevierStyleItalic">odds ratio</span> [OR: 0.90; 95% CI: 0.83–0.99] and [OR 0.89, 95% CI: 0.81–0.98], respectively). The propensity score matching study using both sets of criteria (AKIN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CIN) yielded OR 0.80 [95% CI: 0.77–0.84]. Glomerular filtration rates less than 30<span class="elsevierStyleHsp" style=""></span>ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47–0.91].</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer si la administración intravenosa de contraste yodado en la tomografía computarizada (TC) se asocia a un aumento en los niveles de creatinina y de daño renal agudo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo. Incluye todos los pacientes que acudieron al servicio de urgencias del 2010 al 2015 y que presentaban una creatinina basal (C1) y otra 24-72 horas después (C2). El Comité de Ética y de Investigación aprobó el estudio. Criterios de exclusión: paciente menor de 18 años, creatinina ≤0,4<span class="elsevierStyleHsp" style=""></span>mg/dl, ≥4,0<span class="elsevierStyleHsp" style=""></span>mg/dl y administración de contraste en los últimos 6 meses. Al servicio de urgencias acudieron una media de 105.435,6 pacientes/año. Tres grupos de pacientes: <span class="elsevierStyleItalic">1</span>) TC con contraste (6.642), <span class="elsevierStyleItalic">2</span>) TC sin contraste (6.193,3) y <span class="elsevierStyleItalic">3</span>) Sin TC (33.802). Se usaron los criterios de Acute Kidney Injury Network (AKI) y nefropatía aguda por contraste (NAC). Se realizó estudio estadístico bivariante y de regresión logística con el programa (Stata15).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 52.411 pacientes; depurando datos: 46.637. Edad media: 67,95 años. Valor de C1: media 1,16<span class="elsevierStyleHsp" style=""></span>mg/dl (DE: 0,61) y de C2: 1,14<span class="elsevierStyleHsp" style=""></span>mg/dl (DE: 0,66). Con criterios AKI y NAC: la realización de TC con contraste no se asocia a una mayor probabilidad de desarrollar nefropatía (<span class="elsevierStyleItalic">odds ratio</span> [OR]: 0,90, intervalo de confianza [IC]: 0,83-0,99 y OR 0,89, IC: 0,81-0,98, respectivamente). El estudio “propensity score matching”, usando ambos criterios (AKI<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>NAC), obtuvo una OR de 0,80 y una IC de 0,77-0,84. Pacientes con filtrado glomerular inferior a 30<span class="elsevierStyleHsp" style=""></span>ml/min no asociaron incremento del daño renal (OR: 0,66, IC: 0,47-0,91).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La administración de contraste intravenoso, en el grupo de pacientes estudiados, no está asociada a un aumento del daño renal agudo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Ferrer Puchol MD, Montesinos García P, Forment Navarro M, Sanz Rodrigo E, Blanco Pérez E, Taberner López E. Administración de medios de contraste. ¿Existe riesgo de daño renal agudo? Radiología. 2019;61:306–314.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1249 "Ancho" => 2923 "Tamanyo" => 183044 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients included in the study.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1072 "Ancho" => 1500 "Tamanyo" => 53791 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of creatinine values on admission.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1152 "Ancho" => 1583 "Tamanyo" => 95133 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage of CT scans performed with contrast media. The frequency of administering intravenous contrast in CT examinations decreases as the serum creatinine level increases.</p>" ] ] 3 => 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:2 [ "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of patients (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6642 (14.24%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6193 (13.28%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33,802 (77.48%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3889 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3491 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.451 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2753 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2702 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.351 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.71 (SD: 17.04) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.32 (SD: 10.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.05 (SD: 18.39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine 1 (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.05 (SD: 0.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.18 (SD: 0.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.18 (SD: 0.63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine 2 (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 (SD: 0.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.16 (SD: 0.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.16 (SD: 0.68) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalisation<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>deceased<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6544 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5727 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24,221 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084958.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The most severe patients were deemed those requiring hospitalisation or patients who died.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical and demographic characteristics of the patients.</p>" ] ] 4 => 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" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span>, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.000.</p>" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CT (with and without i.v. contrast) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">AKIN criterion</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Developed nephropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.67% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.10% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">CIN criterion</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Developed nephropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.91% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.40% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084960.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bivariate comparison between patients who underwent computed tomography (CT) and those who did not.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span>, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.000.</p>" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CT (with and without i.v. contrast) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">AKIN criterion</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Developed nephropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">CIN criterion</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Developed nephropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.79% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.72% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084957.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Bivariate comparison between patients who underwent computed tomography (CT) with and without contrast.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">95% CI: 95% confidence interval; CT: computed tomography.</p>" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AKIN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CIN \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>Z \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0164–1.0204 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.480 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9619–1.0853 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baseline creatinine (C1), mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.1366–1.2454 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.034 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8311–0.9926 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7707–0.9790 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084961.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Logistic regression, combining both sets of criteria for kidney injury (AKIN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CIN).</p>" ] ] 7 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">95% CI: 95% confidence interval; CT: computed tomography; GFR: glomerular filtration rate.</p>" "tablatextoimagen" => array:2 [ 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with GFR <30, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5415</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AKIN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CIN \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Z</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.723 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99–1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72–0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GFR1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.96–0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.07–1.60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.47–0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084959.png" ] ] 1 => 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with GFR <20, <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2023</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AKIN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CIN \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Z</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98–1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.579 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73–1.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GFR1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.051 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91–1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.782 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.67–1.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contrast-enhanced CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.851 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52–1.70 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084956.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Glomerular filtration rate data (CKD-EPI), combining both sets of criteria for kidney injury (AKIN<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CIN). Logistic regression analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of contrast nephropathy associated with angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Rudnick" 1 => "P.M. Palevsky" 2 => "A.M. Sheridan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "editores" => "T.W.Post" "titulo" => "UpToDate" "serieFecha" => "2018" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0120" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-induced acute kidney injury: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Chalikias" 1 => "I. Drosos" 2 => "D.N. 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Thanks a lot, Paco!</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000006100000004/v2_201907190802/S2173510719300400/v2_201907190802/en/main.assets" "Apartado" => array:4 [ "identificador" => "66551" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000006100000004/v2_201907190802/S2173510719300400/v2_201907190802/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510719300400?idApp=UINPBA00004N" ]
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