Will Contrast-Induced Nephropathy Kill You?

It has been said that what does not kill you, only makes you stronger. Well that is not always the case for a much used medical tool called radiocontrast agents.

Contrast-induced nephropathy (CIN) is a form of acute renal failure precipitated by exposure to these radiocontrast agents. In other words, it is hospital-acquired. The question is: will it kill you?

Aside from causing a spike in health care costs due to frequent or prolonged stays in hospitals by patients, contrast-induced nephropathy is also greatly associated with increased major adverse cardiac events and mortality rates in hospitals, as well as long-term mortality, and the risk of having to go on dialysis. Let us zero in on this mortality issue.

A study conducted by McCullough and company point out a direct relationship between mortality rates and the existence of Contrast Induced Nephropathy in the patient. This does, however, not fully establish whether or not nephropathy has a direct cause-and-effect relationship with death. Take, for example, how cardiac patients who already have renal ischemia succumb to death while undergoing coronary treatments. It is quite hard to pinpoint the exact cause of death between the cardiac condition and the nephropathy itself.

Other deductions can be made, though, one of them being that mortality is higher among patients who have other conditions that are accompanied by nephropathy. In turn, most of  the patients afflicted with nephropathy have had preexisting conditions of renal insufficiency and other risk factors. It is, according to studies by Rudnick and Berns, the greatest risk factor, accounting for 60% of patients with CIN.

Preexisting renal insufficiency has been known as the main cause of mortality in cases of contrast-induced nephropathy (CIN), or hospital-acquired acute renal failure precipitated by exposure to radiocontrast agents.  Exposure to contrast media is deemed unavoidable, especially in various other treatments, such as diagnostic cardiac catherizations, coronary angioplasty, and other radiological procedures.

Patients suffering from diabetes are also considered at high risks of acquiring contrast-induced nephropathy; however, it is notable that in these cases, most of them already have both preexisting and coexisting renal insufficiency. Therefore, mortality cannot be fully ascribed to the diabetes or to nephropathy independently. The evidence of this connection is mounting, in a study conducted by Solomon, (the CARE study)  clearly shows that when a patient gets CIN the rate of death, stroke and dialysis go up. This study shows the causal relationship between CIN and these serious events.

So will CIN kill you? Perhaps not directly, but it is still a factor that would ‘speed up the process’, so to speak.

A company that is working in this field is PLC Systems who presented at OneMedForum SF 2012 in January.

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