Nephrotoxicity due to iodine contrasts in computerized tomography studies of diabetic outpatients on metformin
Keywords:
Contrast-induced nephropathy. Computed tomography. Iodinated contrast. Metformin.Abstract
Background. To determine the incidence of contrast-induced nephropathy (CIN) among diabetic patients treated with Metformin who underwent computerized tomography (CT) scan with iodinated contrast media.
Methods. Prospective study of diabetic patients enrolled in a lactic acidosis prevention protocol in whom clinical and analytical follow up after CT scan with intravenous contrast was performed.
Results. In this study, 98 cases were collected. The incidence of CIN in diabetic patients without prior renal failure was 0%. In patients with previous renal failure the incidence of CIN was 4.7%.
Conclusions. The risk of CIN in diabetic patients with no renal failure undergoing intravenous contrast administration is minimal. Recommendations to stop Metformin to avoid lactic acidosis in patients undergoing intravenous contrast administration may be restricted to patients with abnormal renal function.
Downloads
References
1. BARTELS ED, BAUN GC, GAMMELTOFT A, GJORUP PA. Acute anuria following intravenous pyelography in a patient with myelomatosis. Acta Med Scand 1954; 150: 297-302.
https://doi.org/10.1111/j.0954-6820.1954.tb18632.x
2. ARANA E, CATALÁ-LÓPEZ F. Nefropatía inducida por contraste en pacientes de riesgo con insuficiencia renal explorados con tomografía computarizada: revisión sistemática y metaanálisis de ensayos clínicos aleatorizados. Med Clin (Barc) 2010; 135: 343-350.
https://doi.org/10.1016/j.medcli.2010.01.035
3. PARFREY PS, GRIFFITHS SM, BARRETT BJ, PAUL M, GENGE M, WITHERS J et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. New Engl J Med1989; 320: 143-149.
https://doi.org/10.1056/NEJM198901193200303
4. MC CULLOGH PA, STACUL F, BECKER CR. Contrast-Induced Nephropathy (CIN) Consensus Working Panel: executive summary. Rev Cardiovasc Med. 2006; 7: 177-197.
5. STACUL F, VAN DER MOLEN A, REIMER P, WEBB J, THOMSEN H, MORCOS S et al. Contrast induced nephropahy: update ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011; 21: 2527-2541.
https://doi.org/10.1007/s00330-011-2225-0
6. MACÍAS-ROBLES M.D, MACÍAS-BOBES C, YANO-ESCUDERO R, FERNÁNDEZ-DIÉGUEZ O, ÁLVAREZ-LECUE O. Acidosis láctica por metformina desencadenada por una insuficiencia renal aguda. An Sist Sanit Navar 2011; 34: 115-118.
https://doi.org/10.4321/S1137-66272011000100014
7. GOERGEN S, RUMBOLD G, COMPTON G, HARRIS C. Systematic Review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin. Radiology 2010; 254: 261-269.
https://doi.org/10.1148/radiol.09090690
8. Renal adverse reactions to iodinated contrast media (2008) Contrast mdia safety guidelines of the Contrast Media Safety Committee of the European Society of Urogenital Radiology, version 8.0. http://www.esur.org/Contrast-media.51.0.html#c269 (consultado feb 2013).
9. REDDAN D, LAVILLE M, GAROVIC V. Contrast-induced nephropathy and its prevention: what do we really know from evidence-based findings? J Nephrol 2009; 22: 333-351.
10. KATZBERG R, LAMBA R. Contrast-induced nephrotpathy after intravenous administration: fact or fiction? Radiol Clin N Am 2009; 47: 789-800.
https://doi.org/10.1016/j.rcl.2009.06.002
11. CRAMER BC, PARFREY PS, HUTCHINSON TA, BARAN D, MELANSON DM, ETHIER RE et al. Renal function following infusion of radiologic contrast material: a prospective controlled study. Arch Intern Med 1985; 145: 87-89.
https://doi.org/10.1001/archinte.1985.00360010115018
12. WEISBORD S, MOR M, RESNICK A, HARTWIG K, PALEVSKY P, FINE M. Incidence and outcomes of contrast-induced AKI following computed tomography. Clin J Am Soc Nephrol 2008; 3: 1274-1281.
Published
How to Cite
Issue
Section
License
Copyright (c) 2013 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
