Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200161
Jornal Vascular Brasileiro
Review Article

Avaliação dos níveis de creatinina em pacientes submetidos à tomografia contrastada: uma metanálise

Creatinine level variation in patients subjected to contrast‑enhanced tomography: a meta-analysis

André Brusamolin Moro; João Gabriel Nakka Strauch; Anderson Dillmann Groto; Jeferson Freitas Toregeani

Downloads: 3
Views: 261

Resumo

Resumo: A variação do valor encontrado nos exames de creatinina em pacientes submetidos à tomografia computadorizada (TC) contrastada tem sido utilizada como método prático para a avaliação de possíveis lesões renais causadas pelo uso do contraste. Entre os critérios, considera-se o aumento absoluto de creatinina sérica ≥ 0,5 mg/dL ou relativo em ≥ 25% para possíveis distúrbios renais, como a nefropatia induzida por contraste (NIC). Nosso objetivo foi analisar a incidência de NIC através de uma metanálise envolvendo nove artigos relacionados à incidência de lesão renal por contraste, sendo calculado o odds ratio (OR) e o intervalo de confiança (IC95%) por meio do programa RStudio. A incidência de NIC em pacientes submetidos a TC foi de 11,29%, sendo o OR de 1,38 (IC95% 0,88–2,16). Contrastes não iônicos apresentam maior segurança em seu uso que outros tipos de contraste, e o volume maior que 115 mL pode estar relacionado a NIC. A doença renal prévia apresentou significado estatístico em agravar a NIC.

Palavras-chave

nefropatias, meios de contraste, tomografia

Abstract

Variation in the creatinine levels of patients who have undergone contrast-enhanced computed tomography (CT) has been adopted as a practical method for assessment of possible kidney damage caused by the contrast. Criteria employed include an absolute increase in serum creatinine ≥ 0.5 mg/dL or a relative increase ≥ 25% as indicative of possible renal disorders, such as contrast-induced nephropathy (CIN). Our objective was to analyze the incidence of CIN by means of a meta-analysis of nine articles related to incidence of kidney damage caused by contrast, calculating odds ratios (OR) and confidence intervals (95%CI) using RStudio. The overall incidence of CIN in patients who had CT scans was 11.29%, with an OR of 1.38 (95%CI 0.88–2.16). Non-ionic contrasts are safer than other types of contrast, and volumes exceeding 115 mL may be associated with CIN. Preexisting kidney disease had a statistically significant relationship with worse CIN rates.

Keywords

kidney diseases; contrast media; tomography

References

1 Radiology Key [site na Internet]. Contrast media. 2016. [citado Julho 6, 2020]. https://radiologykey.com/contrast-media/

2 Radiology Key [site na Internet]. Intravascular contrast media. 2016. [citado Julho 6, 2020]. https://radiologykey.com/intravascular-contrast-media/

3 Pasternak JJ, Williamson EE. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist. Mayo Clin Proc. 2012;87(4):390-402. http://dx.doi.org/10.1016/j.mayocp.2012.01.012. PMid:22469351.

4 Gomi T, Hasegawa M. Radiological contrast agents and radiopharmaceuticals. Side Eff Drugs Annu. 2014;36:695-706. http://dx.doi.org/10.1016/B978-0-444-63407-8.00046-0.

5 ACR Committee on Drugs and Contrast Media [site na Internet]. ACR Manual on Contrast Media Version. Virgínia: American College of Radiology; 2020. [citado Junho 5, 2020]. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf

6 Moniruzzaman. Contrast Induced Nephropathy - CIN. KYAMC J. 2013;4(1):315. http://dx.doi.org/10.3329/kyamcj.v4i1.32250.

7 Heras Benito M, Garrido Blázquez M, Gómez Sanz Y, et al. Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography. Radiologia (Engl Ed). 2018;60(4):324-9. http://dx.doi.org/10.1016/j.rxeng.2018.03.007. PMid:29779857.

8 Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: Pathogenesis, risk factors, and prevention. BioMed Res Int. 2014;2014:741018. http://dx.doi.org/10.1155/2014/741018. PMid:24895606.

9 Aoki BB, Fram D, Taminato M, Batista RES, Belasco A, Barbosa DA. Acute kidney injury after contrast-enhanced examination among elderly. Rev Lat Am Enfermagem. 2014;22(4):637-44. http://dx.doi.org/10.1590/0104-1169.3440.2462. PMid:25296148.

10 Antunes LF, Baptista A, Moreira J, Anacleto G, Gonçalves Ó, Matos A. Insuficiência renal induzida por contraste: estudo prospectivo. Angiol Cir Vasc. 2013;9(2):59-63. http://dx.doi.org/10.1016/S1646-706X(13)70017-X.

11 Palli E, Makris D, Papanikolaou J, et al. The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study. Crit Care. 2017;21(1):269. http://dx.doi.org/10.1186/s13054-017-1862-3. PMid:29089038.

12 Silva HM, Duarte TTP, Magro MCS. Influence of variation of the serum creatinine on outcomes of patient with acute kidney injury. Rev da Rede Enferm do Nord. 2018. http://dx.doi.org/10.15253/2175-6783.20181933348.

13 Luk L, Steinman J, Newhouse JH. Intravenous Contrast-Induced Nephropathy—The Rise and Fall of a Threatening Idea. Adv Chronic Kidney Dis. 2017;24(3):169-75. http://dx.doi.org/10.1053/j.ackd.2017.03.001. PMid:28501080.

14 Selistre LS, Souza VC, Dubourg L, Wagner MB, Hoefel JR Fo, Saitovitch D. Contrast-induced nephropathy after computed tomography. J Bras Nefrol. 2015;37(1):27-31. http://dx.doi.org/10.5935/0101-2800.20150005. PMid:25923747.

15 Ehrmann S, Aronson D, Hinson JS. Contrast-associated acute kidney injury is a myth. Yes. Intensive Care Med. 2018;44(1):104-6. http://dx.doi.org/10.1007/s00134-017-4950-6. PMid:29242967.

16 McDonald RJ, McDonald JS, Bida JP, et al. Intravenous contrast material-induced nephropathy: causal or coincident phenomenon? Radiology. 2013;267(1):106-18. http://dx.doi.org/10.1148/radiol.12121823. PMid:23360742.

17 Ferrer Puchol MD, Montesinos García P, Forment Navarro M, Sanz Rodrigo E, Blanco Pérez E, Taberner López E. The administration of contrast media: is there a risk of acute kidney injury? Radiol (English Ed.). 2019;61(4):306-14. http://dx.doi.org/10.1016/j.rxeng.2019.04.001.

18 Murakami R, Hayashi H, Sugizaki KI, et al. Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-Enhanced MDCT. Eur Radiol. 2012;22(10):2147-52. http://dx.doi.org/10.1007/s00330-012-2473-7. PMid:22549107.

19 Heller M, Krieger P, Finefrock D, Nguyen T, Akhtar S. Contrast CT scans in the emergency department do not increase risk of adverse renal outcomes. West J Emerg Med. 2016;17(4):404-8. http://dx.doi.org/10.5811/westjem.2016.4.28994. PMid:27429690.

20 Peer S, Choh NA, Gojwari TA. Incidence of contrast-induced nephropathy a prospective study. J Renal Inj Prev. 2017;6(3):192-8. http://dx.doi.org/10.15171/jrip.2017.37.

21 Hemmett J, Er L, Chiu HHL, Cheung C, Djurdjev O, Levin A. Time to revisit the problem of CIN? The low incidence of acute kidney injury with and without contrast in hospitalized patients: an observational cohort study. Can J Kidney Health Dis. 2015;2:38. http://dx.doi.org/10.1186/s40697-015-0073-6. PMid:26462259.

22 McDonald JS, McDonald RJ, Williamson EE, Kallmes DF, Kashani K. Post-contrast acute kidney injury in intensive care unit patients: a propensity score-adjusted study. Intensive Care Med. 2017;43(6):774-84. http://dx.doi.org/10.1007/s00134-017-4699-y. PMid:28213620.

23 Sonhaye L, Kolou B, Tchaou M, et al. Intravenous contrast medium administration for computed tomography scan in emergency: a possible cause of contrast-induced nephropathy. Radiol Res Pract. 2015;2015:805786. http://dx.doi.org/10.1155/2015/805786. PMid:26576300.

24 Hinson JS, Ehmann MR, Fine DM, et al. Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med. 2017;69(5):577-586.e4. http://dx.doi.org/10.1016/j.annemergmed.2016.11.021. PMid:28131489.

25 Moos SI, Van Vemde DNH, Stoker J, Bipat S. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis. Eur J Radiol. 2013;82(9):e387-99. http://dx.doi.org/10.1016/j.ejrad.2013.04.029. PMid:23711425.

26 Garfinkle MA, Stewart S, Basi R. Incidence of CT contrast agent-induced nephropathy: Toward a more accurate estimation. AJR Am J Roentgenol. 2015;204(6):1146-51. http://dx.doi.org/10.2214/AJR.14.13761. PMid:26001222.

27 Lee Y-C, Hsieh C-C, Chang T-T, Li C-Y. Contrast-induced acute kidney injury among patients with chronic kidney disease undergoing imaging studies: a meta-analysis. AJR Am J Roentgenol. 2019;213(4):728-35. http://dx.doi.org/10.2214/AJR.19.21309. PMid:31386574.

28 Diogo LP, Bahlis LF, Carvalhal GF. Computerized tomography contrast induced nephropathy (CIN) among adult inpatients. J Bras Nefrol. 2014;36(4):446-50. http://dx.doi.org/10.5935/0101-2800.20140064. PMid:25517272.

29 Silver SA, Shah PM, Chertow GM, Harel S, Wald R, Harel Z. Risk prediction models for contrast induced nephropathy: systematic review. BMJ. 2015;351:h4395. http://dx.doi.org/10.1136/bmj.h4395. PMid:26316642.

30 Corbett M, Duarte A, Llewellyn A, et al. Point-of-care creatinine tests to assess kidney function for outpatients requiring contrast-enhanced CT imaging: systematic reviews and economic evaluation. Health Technol Assess. 2020;24(39):1-247. http://dx.doi.org/10.3310/hta24390. PMid:32840478.
 


Submitted date:
10/21/2020

Accepted date:
04/16/2021

60ddc075a953951dc1354d12 jvb Articles

J Vasc Bras

Share this page
Page Sections