Yeungnam Univ J Med.  2015 Dec;32(2):90-97. 10.12701/yujm.2015.32.2.90.

Nephropathy related to computed tomography in emergency department patients with serum creatinine <1.5 mg/dL

• kim JH
• Park SY
• Kim CG

• KMID: 2319906
• DOI: http://doi.org/10.12701/yujm.2015.32.2.90

Abstract

BACKGROUND
Contrast-induced nephropathy (CIN) can cause serious adverse effects. To reduce the occurrence of CIN related computed tomography (CT) in emergency patients, we assessed the respective roles of serum creatinine (SCr) alone and estimated glomerular filtration rate (eGFR) as an early predictor for CIN related CT.
METHODS
For patients with SCr <1.5 mg/dL who underwent CT in emergency department (ED) between September 2012 and October 2013, we assessed the prevalence of CIN and its adverse effects. The Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG) formula was used for the calculation of eGFR. Practical calculation was performed by electronic medical record (EMR) system for MDRD and internet calculating service for CG. And we investigated the prevalence of CIN in eGFR <60 mL/min/1.73 m2 before CT.
RESULTS
A total of 1,555 patients were enrolled. The prevalence of CIN after CT was 4.6% and it showed correlation with renal deterioration, increased in-hospital mortality, and prolonged hospitalization. Despite baseline SCr <1.5 mg/dL, among enrolled patients, 11.3% as MDRD equation and 29.5% as CG formula were <60 mL/min/1.73 m2 and in this condition, the prevalence of CIN was significantly high (odds ratio was 2.87 [1.64-5.02] as MDRD equation and 2.03 [1.26-3.29] as CG formula).
CONCLUSION
Just SCr <1.5mg/dL was not appropriate to recognize preexisting renal insufficiency, but eGFR using MDRD equation was useful in predicting the risk of CIN related CT in ED. Using EMR, calculation of eGFR can be easier and more convenient.

Keyword

Contrast-induced nephropathy; Estimated glomerular filtration rate; Emergency department; Electronic medical record; Computed tomography

MeSH Terms

Creatinine*
Diet
Electronic Health Records
Emergencies*
Emergency Service, Hospital*
Glomerular Filtration Rate
Hospital Mortality
Hospitalization
Humans
Internet
Prevalence
Renal Insufficiency
Creatinine