Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

AIM:To evaluate the incidence of contrast-induced nephropathy(CIN)in cirrhotic patients and to identify risk factors for the development of CIN.METHODS:We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography(CT)with intravenous contrast at the University of Rochester between the years 2000-2005.We retrospectively examined factors associated with a high risk for CIN,defined as a decrease in creatinine clearance of 25%or greater within one week after receiving contrast.RESULTS:Twenty-five percent of our patients developed CIN,and 74%of these patients had ascites seen on CT.Of the 75%of patients who did not develop CIN,only 46%had ascites.The presence of ascites was a significant risk factor for the development of CIN(P=0.0009,OR 3.38,95%CI 1.55-7.34)in multivariate analysis.Patient age,serum sodium,Model for End-stage Liver Disease score,diuretic use,and the presence of diabetes were not found to be significant risk factors for the development of CIN.Of the patients who developed CIN,11%developed chronic renal insufficiency,defined as a creatinine clearance less than baseline for 6 wk.CONCLUSION:Our results suggest that in hospitalized cirrhotic patients,especially those with ascites,the risk of CIN is substantial.