Do Clinicians Overestimate Risk of Radiocontrast-Associated Nephropathy?

The risk of radiocontrast-associated nephropathy may be overstated in the literature and overestimated by clinicians, according to a new study.

“There is little agreement in the medical literature regarding the incidence of contrast-associated nephropathy,” the researchers said. “Published rates range from <1% to >30%. In fact, at least two prospective studies failed to show any increase in the rate of acute kidney injury (AKI) in patients receiving radiocontrast when compared to materially similar patients who did not receive radiocontrast.”
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In this study, the researchers sought to estimate the burden of AKI among patients receiving radiocontrast compared with patients with similar comorbidities and severity of illness who did not receive radiocontrast during their hospitalization.

Using the Nationwide Inpatient Sample, investigators created multiple estimates of the risk of radiocontrast-associated nephropathy among adult patients hospitalized in the United States in 2009. First, they stratified patients according to the presence or absence of 12 relatively common diagnoses associated with AKI and evaluated the rate of AKI between strata. Next, they created a logistic regression model, controlling for comorbidity and acuity of illness, to estimate the risk of AKI associated with radiocontrast administration within each strata. Finally, they performed an analysis stratified by the degree of preexisting comorbidity.

In general, patients who received radiocontrast did not develop AKI at a clinically significant higher rate. Adjusted only for the complex survey design, patients to whom radiocontrast was and was not administered developed AKI at rates of 5.5% and 5.6%, respectively. After controlling for comorbidity and acuity of illness, radiocontrast administration was associated with an odds ratio for AKI of 0.93.

“More accurate AKI risk estimates may improve clinical decision-making when attempting to balance the potential benefits of radiocontrast-enhanced imaging and the risk of AKI,” the researchers concluded.

—Mike Bederka

Reference:

Wilhelm-Leen E, Montez-Rath ME, Chertow G, et al. Estimating the risk of radiocontrast-induced (associated) nephropathy [published online September 29, 2016]. J Am Soc Nephrol. doi:10.1681/ASN.2016010021.