A primer in radiocontrast-induced nephropathy

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Abstract
Despite recent medical progress in supportive medical therapy, the frequency of hospital-acquired acute renal failure has increased in recent years from ∼5% to 6.4% [1,2]. Even more distressing is the fact that mortality associated with acute renal failure has remained high, i.e. on average ∼60% in more recent reports [1–11]. Radiocontrast-induced nephropathy (RCIN) is the third most common cause of hospital-acquired acute renal failure. When RCIN is defined as an increase in serum creatinine level of at least 25% to at least 2 mg/dl within 2 days, most disturbingly RCIN continues to be associated with death by an odds ratio of 5.5 even when adjustments are made for comorbid factors, e.g. age, liver disease and physiological severity score [10]. It appears that renal failure increases the risk of death from pre-existing nonrenal conditions, but also that major nonrenal morbidity will develop in patients with RCIN [10]. RCIN not only reduces survival, but is also costly. In a recent clinical trial, the mean cost of treating adverse reactions to contrast media, which occurred in 193 patients, was $459 [12]. The mean cost of treating adverse reactions increased to $2064 in patients with a history of renal failure, i.e. serum creatinine >1.2 mg/dl. Among the 12 patients with adverse reactions causing excessive cost, 75% had either pre-existing renal failure or developed RCIN [12]. The mean cost of treating RCIN was $1950, which is probably even an underestimate [12].