Prevalence, risk factors, and short-term outcome of contrast-induced nephropathy among patients with chronic kidney disease: A cross-sectional study from Sri Lanka

Abstract

Contrast-induced nephropathy (CIN) is a significant complication following the administration of radiocontrast media, defined as acute deterioration of renal function within 24 to 48 hours post-procedure. It represents the third most common cause of hospital-acquired acute kidney injury, accounting for approximately 11% of cases. CIN increases short-term morbidity and mortality while accelerating the progression of chronic kidney disease (CKD). This study investigated the prevalence, risk factors, and short-term outcomes of CIN among CKD patients undergoing contrast studies at 2 tertiary care centers in Sri Lanka. This descriptive cross-sectional study was conducted at the nephrology units of Colombo North Teaching Hospital and Teaching Hospital Kurunegala from August 2018 to September 2023. The study included 405 CKD patients over 18 years referred for pre-procedural nephrology consultation before undergoing contrast-enhanced imaging. All patients received intravenous normal saline hydration (1 mL/kg/h) 12 hours before and after contrast administration, with temporary discontinuation of nephrotoxic medications. Data was collected via an interviewer-administered questionnaire. CIN was defined per KDIGO guidelines as a rise in serum creatinine >25% or 0.5 mg/dL from baseline. The mean age of patients was 62.6 years (SD = 12.4), with 310 (76.5%) being male. Comorbidities included diabetes mellitus (48.9%), hypertension (44.2%), coronary artery disease (13.3%), and chronic liver disease (6.2%). CIN occurred in 45 patients (11.1%), with diabetes mellitus identified as a significant risk factor (P = .0044). Arterial contrast administration had a higher risk (17.7%) than venous administration (10.7%). Seven patients (1.7%) required acute hemodialysis, and 1 patient died. Age, gender, and CKD stage did not significantly influence CIN development. CIN remains a common complication in CKD patients undergoing contrast studies, with diabetes mellitus being a significant independent risk factor. Pre-procedural risk assessment and appropriate prophylactic measures are essential to minimize CIN incidence and associated complications.