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Porta C, Bamias A, Danesh FR, Dębska-Ślizień A, Gallieni M, Gertz MA, Kielstein JT, Tesarova P, Wong G, Cheung M, Wheeler DC, Winkelmayer WC, Małyszko J. KDIGO Controversies Conference on onco-nephrology: understanding kidney impairment and solid-organ malignancies, and managing kidney cancer. Kidney Int 2020; 98:1108-1119. [PMID: 33126977 DOI: 10.1016/j.kint.2020.06.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
The association between kidney disease and cancer is multifaceted and complex. Persons with chronic kidney disease (CKD) have an increased incidence of cancer, and both cancer and cancer treatments can cause impaired kidney function. Renal issues in the setting of malignancy can worsen patient outcomes and diminish the adequacy of anticancer treatments. In addition, the oncology treatment landscape is changing rapidly, and data on tolerability of novel therapies in patients with CKD are often lacking. Caring for oncology patients has become more specialized and interdisciplinary, currently requiring collaboration among specialists in nephrology, medical oncology, critical care, clinical pharmacology/pharmacy, and palliative care, in addition to surgeons and urologists. To identify key management issues in nephrology relevant to patients with malignancy, KDIGO (Kidney Disease: Improving Global Outcomes) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology in December 2018. This report covers issues related to kidney impairment and solid organ malignancies as well as management and treatment of kidney cancer. Knowledge gaps, areas of controversy, and research priorities are described.
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Affiliation(s)
- Camillo Porta
- Department of Internal Medicine and Therapeutics, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
| | - Aristotelis Bamias
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Greece
| | - Farhad R Danesh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alicja Dębska-Ślizień
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan T Kielstein
- Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Petra Tesarova
- Department of Oncology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | | | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK; George Institute for Global Health, Sydney, Australia
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Poland.
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Gökyer A, Küçükarda A, Köstek O, Hacıoğlu MB, Uzunoğlu S, Kula O, Kurt N, Üstündağ S, Erdoğan B, Çiçin İ. Contrast nephropathy in cancer patients receiving anti-VEGF therapy: a prospective study. Int J Clin Oncol 2020; 25:1757-1762. [PMID: 32591963 DOI: 10.1007/s10147-020-01729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Contrast nephropathy risk has been increasing in cancer patients. Nephrotoxic side effects of anti-vascular endothelial growth factor/receptor (anti-VEGF/R) drugs used in oncologic treatment are also prominent. The purpose of this study was to identify the possible association among anti-VEGF/R drugs use and development of the contrast-induced nephropathy (CIN) in patients with cancers. METHODS A total of 92 patients were included in this prospective cross-sectional study. Patients whose glomerular filtration rate (GFR) of < 50 ml/min, hemoglobin of < 10 g/dl, and eastern cooperative oncology group (ECOG) score of ≥ 2 and had received nephrotoxic drugs were not included in the study. Blood samples were collected baseline at pre computed tomography (CT) and day 2, day 3 and day 7 later CT imaging. CIN was defined as either an increased serum creatinine value of 0.5 mg/dl or increased 25% to baseline. CIN frequency between groups receivingand not receiving anti-VEGF/R was compared using the chi-squared test. CIN frequency between bevacizumab and other anti-VEGF/R was also analyzed. RESULTS There were 39 patients in the anti-VEGF/R (+) group and 53 patients in the anti-VEGF/R (-) group. Eleven patients (28%) in the anti-VEGF/R (+) group and 3 patients (5.6%) in the anti-VEGF/R (-) group had CIN (p = 0.006). In the anti-VEGF/R (+) group, 23 patients received bevacizumab (combined with FOLFOX/FOLFIRI), while 16 patients received other anti-VEGF/R (sunitinib, axitinib, regorafenib, aflibercept) effective treatments. CIN ratio in patients who received bevacizumab or other anti-VEGFR therapy was similar (p = 0 = 50). Of the patients, one patient had acute kidney injury leading to death. CONCLUSION CIN was significantly more frequent in cancer patients who receiving anti-VEGF/R drugs than those not receiving anti-VEGF/R drugs.
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Affiliation(s)
- Ali Gökyer
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey.
| | - Ahmet Küçükarda
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Osman Köstek
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Muhammet Bekir Hacıoğlu
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Sernaz Uzunoğlu
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Osman Kula
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Nazmi Kurt
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Sedat Üstündağ
- Division of Nephrology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, Turkey
| | - Bülent Erdoğan
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - İrfan Çiçin
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey
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3
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Werner S, Bez C, Hinterleitner C, Horger M. Incidence of contrast-induced acute kidney injury (CI-AKI) in high-risk oncology patients undergoing contrast-enhanced CT with a reduced dose of the iso-osmolar iodinated contrast medium iodixanol. PLoS One 2020; 15:e0233433. [PMID: 32437415 PMCID: PMC7241755 DOI: 10.1371/journal.pone.0233433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives To determine the incidence of post-contrast acute kidney injury (PC-AKI) and presumed contrast-induced acute kidney injury (CI-AKI) following contrast-enhanced CT (CECT) with intravenous application of a reduced dose of the iso-osmolar contrast agent iodixanol in cancer patients with chronic kidney disease. Methods 198 oncology patients with a baseline estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 undergoing a total of 237 CECTs using a reduced dose of 60ml iodixanol were retrospectively analyzed. Statistical analysis was performed for the entire cohort and subgroups. The effect of additional risk factors on the occurrence of PC-AKI was evaluated. Results The overall PC-AKI incidence was 6.3%. Excluding patients with concurrent medical conditions known to directly and independently impact kidney function and patients with AKI preceding the CT-scan resulted in a presumed CI-AKI incidence of 3.8%. No permanent post-contrast worsening of renal function and no AKI treatment were required. Subgroups considering baseline eGFR yielded PC-AKI incidences of 4.6% (eGFR 45-60ml/min/1.73m2, n = 130), 7.4% (eGFR 30-45ml/min/1.73m2, n = 95) and 16.7% (eGFR <30ml/min/1.73m2, n = 12). Additional patient related risk factors did not show any significant effect on the occurrence of PC-AKI. Conclusions Low incidences of PC-AKI/CI-AKI suggest that a reduced dose of an iso-osmolar contrast agent is safe in high-risk oncological patients with impaired renal function.
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Affiliation(s)
- Sebastian Werner
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
- * E-mail:
| | - Christian Bez
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Clemens Hinterleitner
- Department of Internal Medicine II–Haematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
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4
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Terrenato I, Sperati F, Musicco F, Pozzi AF, di Turi A, Caterino M, de Lutio di Castelguidone E, Setola SV, Bellomi M, Neumaier CE, Conti L, Cigliana G, Merola R, Antenucci A, Orlandi G, Giordano A, Barba M, Canitano S. Iodixanol versus iopromide in cancer patients: Evidence from a randomized clinical trial. J Cell Physiol 2017; 233:2572-2580. [PMID: 28777459 DOI: 10.1002/jcp.26132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 01/10/2023]
Abstract
To assess the safety profile of iso-osmolar contrast medium (CM) versus low osmolar CM in cancer patients with an estimated glomerular filtration rate (eGFR) >60 ml/min. In this multicenter, blind trial of patients seeking a chest-abdomen-pelvis contrast enhanced computed tomography (CT) with iodated CM, participants were centrally randomized to iodixanol or iopromide. Contrast induced nephropathy (CIN) at 24 and/or 72 hr were our primary outcomes. We further considered irreversible CIN, average eGFR percentage variation (%Δ), and adverse events (AEs). Overall, 607 patients were enrolled. Among them, 497 eligible patients were randomized to iodixanol (N: 247) or iopromide (N: 250). No differences emerged by descriptive characteristics. Seven and 3 CIN at 24 hr (p = 0.34) and 8 and 2 CIN at 72 hr (p = 0.11) occurred in the iopromide and iodixanol group, respectively. Within the subgroup of individual patients who developed CIN (N: 17), the event rate was higher in the iopromide arm (p = 0.045). No cases of permanent CIN or significant differences in terms of AEs or GFR %Δ were observed. Our results suggest a more favorable safety profile of iodixanol versus iopromide. Adequately sized trials with similar design are warranted to confirm our findings and clarify the underlying biological mechanisms.
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Affiliation(s)
- Irene Terrenato
- Biostatistic Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Biostatistic Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Felice Musicco
- Service of Pharmacovigilance, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Annunziata di Turi
- Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Caterino
- Department of Diagnostic Imaging, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Sergio V Setola
- Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Massimo Bellomi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Carlo E Neumaier
- Diagnostic Imaging and Senology, IRCCS-A.O.U., San Martino-IST, Genoa, Italy
| | - Laura Conti
- Departement of Clinical Patology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Cigliana
- Departement of Clinical Patology, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Merola
- Departement of Clinical Patology, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Antenucci
- Departement of Clinical Patology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Orlandi
- Departement of Clinical Patology, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Department of Medicine, Surgery and Neuroscience, University of Siena and Istituto Toscano Tumori (ITT), Siena, Italy.,Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | - Maddalena Barba
- Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.,Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Canitano
- Department of Diagnostic Imaging, Regina Elena National Cancer Institute, Rome, Italy
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Małyszko J, Kozlowski L, Kozłowska K, Małyszko M, Małyszko J. Cancer and the kidney: dangereoux liasons or price paid for the progress in medicine? Oncotarget 2017; 8:66601-66619. [PMID: 29029541 PMCID: PMC5630441 DOI: 10.18632/oncotarget.18094] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/23/2017] [Indexed: 01/10/2023] Open
Abstract
A long time ago, the links between renal disease and malignancy were observed, however, quite recently, their importance was recognized and 'new' subspecialty in nephrology, namely 'onconephrology' was established. In the XXI century, patients with malignancy make up the most growing number of the subjects seen for nephrology consult and/or critical care nephrology services. A plethora of renal problems may be found in patients with malignancy. They may influence not only their short-term outcomes but also the adequate therapy of the underlying oncological problem. Thus, all these kidney-related issues pose an important challenge for both specialities: oncology and nephrology. In the review a spectrum of acute and chronic renal injury caused by the malignancy is presented as well as the associations between renal disease and cancer. Assessment of kidney function and its importance in patients with malignancy is also discussed as medical oncologists should check the appropriate dose of chemotherapeutic drugs in relation to the actual renal function before prescribing them to the patients. Moreover, effects of kidney function on outcomes in oncology is presented. In addition, nephrology services should better understand both the biology of malignancy with its treatment to become a valuable part treating team to yield the best possible outcome. It is important for nephrology services to be acknowledged and to take an active participation in care of oncology patients.
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Affiliation(s)
- Jolanta Małyszko
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Leszek Kozlowski
- Department of Oncological Surgery, Ministry of Interior Affairs, Bialystok, Poland
| | - Klaudia Kozłowska
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Maciej Małyszko
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Małyszko
- First Department of Nephrology and Transplantology with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Hong SI, Ahn S, Lee YS, Kim WY, Lim KS, Lee JH, Lee JL. Contrast-induced nephropathy in patients with active cancer undergoing contrast-enhanced computed tomography. Support Care Cancer 2015; 24:1011-7. [PMID: 26238629 DOI: 10.1007/s00520-015-2875-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/27/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE This study was performed to measure the incidence and identify potential predictors of contrast-induced nephropathy (CIN) in cancer patients without chronic kidney disease and with normal or near-normal baseline serum creatinine measures who underwent contrast-enhanced computed tomography (CECT). Severity of CIN was reported based on the RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal disease) classification of acute kidney injury. METHODS A retrospective analysis was performed on 820 cancer patients who presented at our emergency department from October 2014 to March 2015. CIN was defined as an increase in creatinine concentration of ≥0.5 mg/dL or ≥25 % above baseline that occurred 48 to 72 h after CECT. RESULTS The incidence of CIN was 8.0%. Serial CT examination [odds ratio (OR) 4.09; 95% confidence interval (CI) 1.34-12.56], hypotension before the CT scan (OR 3.95; 95% CI 1.77-8.83), liver cirrhosis (OR 2.82; 95% CI 1.06-7.55), BUN/creatinine >20 (OR 2.54; 95% CI 1.44-4.46), and peritoneal carcinomatosis (OR 1.75; 95% CI 1.01-3.00) were independently associated with CIN. Of 66 CIN patients, 44 met any of the severity criteria of the RIFLE classification. Five of these patients died during hospitalization but only one death was related to renal failure. CONCLUSIONS Even when the baseline serum creatinine is ≤1.5 mg/dL, a significant portion of cancer patients are still at risk of CIN. Consecutive CECT examinations, hypotension before CT, liver cirrhosis, dehydration, and peritoneal carcinomatosis seem to predispose patients to CIN.
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Affiliation(s)
- Seok-In Hong
- Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Shin Ahn
- Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
| | - Yoon-Seon Lee
- Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Kyung Soo Lim
- Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Jae Ho Lee
- Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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Thomsen HS, Stacul F, Webb JAW. Contrast Medium-Induced Nephropathy. MEDICAL RADIOLOGY 2014. [DOI: 10.1007/174_2013_902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Song W, Zhang T, Pu J, Shen L, He B. Incidence and risk of developing contrast-induced acute kidney injury following intravascular contrast administration in elderly patients. Clin Interv Aging 2013; 9:85-93. [PMID: 24403826 PMCID: PMC3883550 DOI: 10.2147/cia.s55157] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this meta-analysis was to evaluate the epidemiology of contrast-induced acute kidney injury (CI-AKI) in the elderly. Methods A literature review was undertaken to determine the incidence of CI-AKI in individuals receiving intravascular contrast medium in the hospital setting. Results Twenty-two studies with 186,455 patients were identified. The pooled incidence of CI-AKI was 13.6% in 67,831 patients older than 65 years of age (95% confidence interval [CI] 10.1–18.2, I2=0.496). The pooled odds ratio of CI-AKI in the elderly was 2.55 (95% CI 1.85–3.52, I2=0.34). The high incidence of CI-AKI in the elderly was consistent across different administration route subgroups (intracoronary contrast medium group, 15.5% [95% CI 10.3–22.6]; intravenous contrast medium group, 12.4% [95% CI 8.0–18.8]). Conclusion Elderly patients are at greater risk for developing CI-AKI.
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Affiliation(s)
- Wei Song
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Tuo Zhang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Linghong Shen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Cicin I, Erdogan B, Gulsen E, Uzunoglu S, Sut N, Turkmen E, Kodaz H, Ustundag S. Incidence of contrast-induced nephropathy in hospitalised patients with cancer. Eur Radiol 2013; 24:184-90. [PMID: 24220752 DOI: 10.1007/s00330-013-2996-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/26/2013] [Accepted: 07/30/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine the frequency of and possible factors related to contrast-induced nephropathy (CIN) in hospitalised patients with cancer. METHODS Ninety adult patients were enrolled. Patients with risk factors for acute renal failure were excluded. Blood samples were examined the day before contrast-enhanced computed tomography (CT) and serially for 3 days thereafter. CIN was defined as an increase in serum creatinine (Cr) of 0.5 mg/dl or more, or elevation of Cr to 25 % over baseline. Relationships between CIN and possible risk factors were investigated. RESULTS CIN was detected in 18/90 (20 %) patients. CIN developed in 25.5 % patients who underwent chemotherapy and in 11 % patients who did not (P = 0.1). CIN more frequently developed in patients who had undergone CT within 45 days after the last chemotherapy (P = 0.005); it was also an independent risk factor (P = 0.017). CIN was significantly more after treatment with bevacizumab/irinotecan (P = 0.021) and in patients with hypertension (P = 0.044). CONCLUSIONS The incidence of CIN after CT in hospitalised oncological patients was 20 %. CIN developed 4.5-times more frequently in patients with cancer who had undergone recent chemotherapy. Hypertension and the combination of bevacizumab/irinotecan may be additional risk factors for CIN development. KEY POINTS • Contrast-induced nephropathy (CIN) is a concern for oncological patients undergoing CT. • CIN occurs more often when CT is performed <45 days after chemotherapy. • Hypertension and treatment with bevacizumab appear to be additional risk factors.
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Affiliation(s)
- Irfan Cicin
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
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10
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Kooiman J, Pasha SM, Zondag W, Sijpkens YWJ, van der Molen AJ, Huisman MV, Dekkers OM. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol 2011; 81:2554-61. [PMID: 22177326 DOI: 10.1016/j.ejrad.2011.11.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 11/16/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Contrast induced nephropathy (CIN) is defined as a decrease in renal function following administration of contrast media. The aim of this meta-analysis was to asses the overall risk of CIN, chronic loss of kidney function and the need for renal replacement therapy (RRT) after intravenous contrast enhanced CT-scan. Secondly, we aimed to identify subgroups at increased risk for CIN. MATERIALS AND METHODS A literature search in Pubmed, Medline, Embase and Cochrane databases was performed. Data extraction was carried out independently by two reviewers. Meta-analysis and meta-regression were performed using an exact likelihood approach. RESULTS Forty studies evaluating the incidence of CIN after CT were included. The pooled incidence of CIN was 6.4% (95% CI 5.0-8.1). The risk of RRT after CIN was low, 0.06% (95% CI 0.01-0.4). The decline in renal function persisted in 1.1% of patients (95% CI 0.6-2.1%). Patients with chronic kidney disease (odds ratio 2.26, p<0.001) or diabetes mellitus (odds ratio 3.10, p<0.001) were at increased risk for the development of CIN. CONCLUSION CIN occurred in 6% of patients after contrast enhanced CT. In 1% of all patients undergoing contrast enhanced CT the decline in renal function persisted.
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Affiliation(s)
- Judith Kooiman
- Department of Thrombosis and Haemostasis, LUMC, Leiden, The Netherlands.
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11
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Incidence of contrast-induced nephropathy in patients with multiple myeloma undergoing contrast-enhanced CT. AJR Am J Roentgenol 2011; 196:1094-101. [PMID: 21512075 DOI: 10.2214/ajr.10.5152] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the incidence of contrast-induced nephropathy (CIN) and the effects of associated risk factors in patients with multiple myeloma undergoing contrast-enhanced CT (CECT) with IV administration of nonionic iodinated contrast agent. MATERIALS AND METHODS This retrospective review of medical records identified patients with a diagnosis of myeloma who underwent a CECT examination of the chest, abdomen, or pelvis between January 1, 2005, and December 1, 2008. Analysis for CIN, as defined by an increase in creatinine level after the CECT examination of 25% or more, or of 0.5 mg/dL, compared with the level before the CECT examination, both within 48 hours and within 7 days, was performed. Statistical correlations between the development of CIN and creatinine level before CECT examination, patient location, type and amount of contrast agent, blood urea nitrogen-creatinine ratio, history of diabetes, hypercalcemia, Bence Jones proteinuria, β(2)-microglobulin level, albumin level, International Myeloma Staging System stage, and history of myeloma provided at the time the CT examination was ordered were calculated. RESULTS Forty-six patients who completed 80 unique examinations were included; their average creatinine level before CECT examination was 0.97 mg/dL. There was no significant difference in the average creatinine levels before CT examination between patients without and those with CIN. Four (5%) and 12 (15%) patients developed CIN within 48 hours and 7 days, respectively. Only serum β(2)-microglobulin level showed a statistically significant (p = 0.03) correlation with the development of CIN. CONCLUSION The incidence of CIN in patients with multiple myeloma with a normal creatinine level is low and correlates with β(2)-microglobulin levels. The administration of contrast agent in this patient population is safe but should be based on the potential benefit of the examination and the expected low risk of developing CIN.
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Abstract
OBJECTIVE The incidence of creatinine increases after intravenous contrast (postcontrast creatinine increases, PCCI) is controversial, ranging from 0% to >25%. We sought to determine what factors influenced these divergent estimates of PCCI incidence. Where possible, the association of PCCI with long-term adverse outcomes was also studied. MATERIALS AND METHODS Both observational studies and prospective randomized trials were reviewed. Definitions of clinically significant PCCI, incidence of PCCI, and its association with baseline kidney function, the setting in which intravenous contrast was administered, and the short- and long-term consequences of PCCI were extracted. RESULTS Baseline renal function impairment and inpatient versus outpatient status are the major risk factors for PCCI. PCCI is possibly associated with clinically significant short- and long-term adverse events. CONCLUSIONS PCCI occurs despite a number of potential confounding issues. The incidence is increased as kidney function at baseline is diminished and for inpatients. There is limited data on long-term outcomes following PCCI in this setting.
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Klein LW, Sheldon MW, Brinker J, Mixon TA, Skelding K, Strunk AO, Tommaso CL, Weiner B, Bailey SR, Uretsky B, Kern M, Laskey W. The use of radiographic contrast media during PCI: a focused review: a position statement of the Society of Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2010; 74:728-46. [PMID: 19830793 DOI: 10.1002/ccd.22113] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Lloyd W Klein
- Rush Medical College & Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois 60657, USA.
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Martin DR, Semelka RC, Chapman A, Peters H, Finn PJ, Kalb B, Thomsen H. Nephrogenic systemic fibrosis versus contrast-induced nephropathy: Risks and benefits of contrast-enhanced MR and CT in renally impaired patients. J Magn Reson Imaging 2009; 30:1350-6. [PMID: 19937934 DOI: 10.1002/jmri.21968] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Diego R Martin
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
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Altun E, Semelka RC, Cakit C. Nephrogenic systemic fibrosis and management of high-risk patients. Acad Radiol 2009; 16:897-905. [PMID: 19375360 DOI: 10.1016/j.acra.2009.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 12/31/2008] [Accepted: 01/02/2009] [Indexed: 01/01/2023]
Abstract
The purpose of this work is to provide current information on the rapidly evolving subject of nephrogenic systemic fibrosis (NSF), to establish the radiologic approach to the management of high-risk patients for NSF, and to assess the probabilistic risk of NSF compared to contrast induced nephropathy (CIN), as encountered with iodinated contrast media used in computed tomographic (CT) imaging. NSF is a disease process of considerable concern following gadolinium-containing contrast agents (GCCA) exposure in patients with diminished renal function. To minimize the possibility of NSF development in high-risk patients, GGCAs should not be used when they are not necessary, or the GCCAs, that have not at present been associated with NSF development, should be used at the lowest possible diagnostic dose, when they are necessary. Contrast-induced nephropathy is also a great risk in this patient population following the adminstration of iodinated contrast media (CM). In patients with diminished renal function who are not on regular dialysis, the risk of CIN following the administration of iodinated CM is higher than the risk of NSF following the administration of the most stable GCCAs. Risk benefit analysis should be performed prior to the administration of all CM, and the best combination of safety and diagnostic accuracy should be sought. Concern of NSF or CIN should not prevent the use of contrast agents in magnetic resonance imaging or computed tomography when they are deemed essential.
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Affiliation(s)
- Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA.
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The PREDICT study: a randomized double-blind comparison of contrast-induced nephropathy after low- or isoosmolar contrast agent exposure. AJR Am J Roentgenol 2008; 191:151-7. [PMID: 18562739 DOI: 10.2214/ajr.07.3370] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of the PREDICT (patients with renal impairment and diabetes undergoing computed tomography) study was to compare the incidence of contrast-induced nephropathy (CIN) after administration of low-osmolar (iopamidol 370, 796 mOsm/kg) or isoosmolar (iodixanol 320, 290 mOsm/kg) contrast medium in patients with diabetes and chronic kidney disease undergoing CT. SUBJECTS AND METHODS Two hundred sixty-three patients with moderate to severe chronic kidney disease (estimated glomerular filtration rate [GFR] = 20-59 mL/min/1.73 m(2)) and diabetes mellitus were randomized to receive at least 65 mL of iopamidol 370 or iodixanol 320 for a CT procedure. Serum creatinine levels were measured at baseline and 48-72 hours after contrast administration. CIN was defined as an increase in the serum creatinine level after contrast administration of >or= 25% from the baseline level. The incidence of CIN in the total study population and the incidence of CIN in patients at increased risk for CIN were compared using Fisher's exact test. RESULTS Two hundred forty-eight patients were included in the CIN analysis: 125 receiving iopamidol 370 and 123 receiving iodixanol 320. Study population demographics were comparable, as was baseline renal function (estimated GFR = 47.6 mL/min/1.73 m(2) for the iopamidol 370 group vs 49.9 mL/min/1.73 m(2) for the iodixanol 320 group; p = 0.16). Increases in the serum creatinine value of >or= 25% occurred in seven patients (5.6%) receiving iopamidol 370 and in six patients (4.9%) receiving iodixanol 320 (95% CI, -4.8% to 6.3%; p = 1.0). The mean serum creatinine change from the baseline level was 0.04 mg/dL in both groups (analysis of covariance, p = 0.80). In patients with a baseline serum creatinine value of >or= 2.0 mg/dL, baseline estimated GFR of <or= 40 mL/min/1.73 m(2), or those receiving > 140 mL of contrast medium, the incidence of CIN was low and comparable between the two study groups (p = 1.0 in all instances). CONCLUSION The incidence of CIN in patients with diabetes and chronic kidney disease receiving IV contrast medium was not significantly different after CT using iopamidol 370 or iodixanol 320.
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