What is the incidence of contrast-induced nephropathy (CIN) in the US?

Updated: Dec 18, 2018
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Despite numerous studies, the actual incidence of contrast induced nephropathy is not clear. The number varies, depending on the following:

  • The definition used for CIN
  • The contrast agent characteristics, including the type, amount, duration, and route of administration
  • Preexisting risk factors
  • Length of follow-up (including the day of measurement of postcontrast serum creatinine)

In patients without risk factors, the incidence may be as low as 2%. In those with risk factors, such as diabetes, the rate rises to 9%, and to as high as 90% in patients with diabetic nephropathy. Therefore, the number and the type of preexisting risk factors directly influence the incidence of renal insufficiency. Incidence rates are also procedure dependent, with reports in the literature ranging from 1.6-2.3% for diagnostic interventions to 14.5% overall in patients undergoing coronary intervention. [22]

Although the risk for CIN with CT scans has been a long-standing concern, a retrospective study by Hinson et al of 17,934 emergency department visits from 2009 to 2014 found that IV contrast was not associated with an increased frequency of AKI. Whether patients underwent contrast-enhanced, unenhanced, or no CT, there were no significant differences in the incidence of AKI, dialysis, or mortality, regardless of baseline renal function. [7]

The main strengths of this study were the large number of patients and the use of two controls. However, this was a single-center study and it excluded patients with serum creatinine levels >4.0 mg/dL as well as those with renal transplants.

In another study, of 13,126 patients who underwent percutaneous vascular interventions, the incidence of CIN was noted to be 3%. Of the 400 patients who developed CIN, 26 (6.5%) required dialysis. [23]


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