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LETTER TO THE EDITOR
Year : 2021  |  Volume : 3  |  Issue : 1  |  Page : 8

Contrast-Induced Nephropathy: Beware of Confounders!


1 ICU Department, Brugmann University Hospital, Brussels, Belgium
2 Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Genk, Belgium

Date of Submission11-Jan-2020
Date of Acceptance30-Mar-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Prof. Patrick M Honore
CHU Brugmann – Brugmann University Hospital, 4, Place Arthur Van Gehuchten, 1020 Brussels
Belgium
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DOI: 10.4103/jtccm.jtccm_4_21

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How to cite this article:
Redant S, Bels DD, Attou R, Boer W, Honore PM. Contrast-Induced Nephropathy: Beware of Confounders!. J Transl Crit Care Med 2021;3:8

How to cite this URL:
Redant S, Bels DD, Attou R, Boer W, Honore PM. Contrast-Induced Nephropathy: Beware of Confounders!. J Transl Crit Care Med [serial online] 2021 [cited 2021 Dec 2];3:8. Available from: http://www.tccmjournal.com/text.asp?2021/3/1/8/327278



We have read with great enthusiasm the interesting publication of Goto et al.[1] about contrast-induced nephropathy (CIN) during the first day of sepsis. They performed a retrospective study on patients at risk of acute kidney injury (AKI, stage 2 and 3) with sepsis. They find that the rate of deterioration of renal function is identical between the groups that received contrast products and those who did not receive contrast products.[1] Their results are very interesting for our daily management of acute sepsis. However, we would like to add additional information. We have no idea of the amount but also the type of contrast. The type of contrast product with its osmolarity plays an important role that could be taken into account.[2] Not to speak about the amount obviously! As half of the patients were shocked in both the groups, what was the cumulative amount of fluid administered during the first 24 to 48 h between the two groups as this may change the rate of CIN. Indeed, hydration plays a role in the appearance of CIN.[3],[4] It would be also important to compare the doses and troughs of vancomycin as well as the doses of aminoglycoside administered to one group versus the other. Similarly, patients who received contrast agents had a significantly lower creatinine 1.38 (1.01–1.96) versus 1.91 mg/dl ((1.33–2.98) with P < 0.01 and the number of Stage 3 was significantly lower too in the contrast group: 24% versus 49.8% P < 0.01. The estimated glomerular filtration rate (GFR) was <30 ml in 5% of the patients who received the contrast product versus 15.6% in the patients without contrast medium. Indeed, according to Rudnick et al.,[5] the risk of developing CIN is significantly increased, especially in patients with a GFR <30 ml.[5] The difference was significant (P = 0.05). Altogether, the kidneys exposed to the contrast medium were healthier, which may be a confounding factor. Some other confounding factors may have been present as well (contrast type and dose, hydration strategy, dose and troughs of nephrotoxic antibiotics…) We are well aware of the difficulties of retrospective studies, but these data may be interesting to collect in future prospective trials.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Goto Y, Koyama K, Katayama S, Tonai K, Shima J, Koinuma T, et al. Influence of contrast media on renal function and outcomes in patients with sepsis-associated acute kidney injury: A propensity-matched cohort study. Crit Care 2019;23:249.  Back to cited text no. 1
    
2.
Zhao F, Lei R, Yang SK, Luo M, Cheng W, Xiao YQ, et al. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: A systematic review and meta-analysis. Cancer Imaging. 2019;19:38.  Back to cited text no. 2
    
3.
Wang Z, Song Y, Geru A, Li Y. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Int Heart J 2019;60:1077-82.  Back to cited text no. 3
    
4.
Weisbord SD, Palevsky PM. Prevention of contrast-associated acute kidney injury: What should we do? Am J Kidney Dis 2016;68:518-21.  Back to cited text no. 4
    
5.
Rudnick MR, Leonberg-Yoo AK, Litt HI, Cohen RM, Hilton S, Reese PP. The controversy of contrast-induced nephropathy with intravenous contrast: What is the risk? Am J Kidney Dis 2020;75:105-13.  Back to cited text no. 5
    




 

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