CONTRAST-INDUCED NEPHROPATHY: A PROSPECTIVE STUDY IN 66 CRITICALLY ILL PATIENTS.

Rachid Seddiki1, Nadir Zemraoui2, Mohamed Bahi1, Youssef Qamouss1, Mohamed Boughalem1
Page No. 19-27

44,2 μmol/l (or 0,5 mg/dl) or a relative increase of 25% from the base of creatinine occurring 48 to
72 hours after intravenous administration of iodinated contrast media. It remains a common cause
of acute renal failure in intensive care at the origin of specific morbidity and mortality. Prevention
is therefore required, especially in patients with risk factors for kidney failure and uses a variety of
protocols. Materials and Methods: This is a randomized longitudinal observational study over a
period of six months from July 2014 to December 2014. Inclusion criteria were the need to conduct
an examination with injection of iodinated contrast material with occurrence of acute renal failure
or worsening of pre-existing renal insufficiency. Exclusion criteria were all patients with dialysis
formal indication.The authors evaluate a renal protection protocol in 66 intensive care patients.
This population was randomized into 2 groups: Group P1 which benefited from an hydro
electrolytic and metabolic equilibration and P2 group who participated in addition to that a urine
alkalinization before, during and after injection of iodinated contrast media. The alkalizing
protocol uses sodium bicarbonate 1.4%: 3 ml / kg administered one hour before the injection of the
iodinated contrast media and 1 ml/kg /h for 6 h after. Results: The mean age was 53.51 ± 14.28
years, ranging from 19 to 87 years. The sex ratio is 0.53. Hypovolemia and shock states were renal
failure risk factors most frequently encountered (56.1 and 36.4% respectively). The diabetes
represents 16.7% and a pre-existing renal disease was observed in 12.12%. The mean initial
creatinine was 138 ± 36.6 mmol / l with a range from 62 to 333 mmol /l.7 patients from the P1
group (21.8%) and 4 patients from the the P2 group (11.7%) have developed an acute renal failure
during the 4 days of the monitoring of serum creatinine. The use of dialysis was required in a
patient or 3.12% for P1, vs 0% for P2. This work highlights accordance with literature data the
nephroprotective role of alkalizing urine pre per and post procedure. In multivariate analyze some
independent factors predictive of the occurrence of acute renal failure induced by iodinated
contrast media were identified. There is a creatinine clearance <60 ml/min/1.73 m2 (OR = 1, 07 p
<0.08), intra-arterial injection (OR = 1.07 p <0.15), a quantity of iodinated contrast media.> 120
ml (OR = 1.62 p <0.15) and SAPS II> 30 (OR = 1.07 p <0.08). Conclusion: Radiocontrast-induced
nephropathy is unanimously recognized as a major cause of hospital acute renal failure. Theintensivist plays an important role in the implementation of preventive measures to address the risk
factors related to the patient. The radiologist should a reasonable iodinated contrast media use.
Key words: Iodinated contrast media - Acute kidney injury - Intensive care unit - Risk factors -
Sodium bicarbonate.