Incidence and risk factors for radiocontrast-induced nephropathy in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization
- 1 October 2011
- journal article
- Published by Springer Science and Business Media LLC in Clinical and Experimental Nephrology
- Vol. 15 (5), 714-719
- https://doi.org/10.1007/s10157-011-0470-9
Abstract
Transcatheter arterial chemoembolization (TACE) is an effective treatment for unresectable hepatocellular carcinoma (HCC); however, large volumes of radiocontrast agents are used for TACE and may induce renal dysfunction. Most patients with HCC have coexisting liver cirrhosis (LC) at the time of diagnosis. Advanced cirrhosis is characterized by peripheral vasodilatation associated with decreased renal perfusion due to the activation of vasoconstrictor systems. We retrospectively investigated patients with HCC who had undergone TACE to determine the incidence and risk factors for radiocontrast-induced nephropathy (RCIN). A total of 101 patients with HCC who underwent a combined 221 TACE treatment sessions were included. Follow-up serum creatinine levels within 96 h after TACE were confirmed in these patients. RCIN was defined as an increase of at least 25% in baseline serum creatinine levels between 48 and 96 h after TACE. RCIN developed in 20 (9%) of the 221 treatment sessions after TACE. A univariate analysis showed that the Child–Pugh score (6.0 ± 1.3 vs. 6.7 ± 1.9, P = 0.005), ascites (14.4 vs. 40%, P = 0.008), contrast medium volume (257.3 ± 66.8 vs. 275.0 ± 44.0 ml, P = 0.009), total bilirubin (1.3 ± 1.7 vs. 3.4 ± 8.0 mg/dl, P < 0.001), basal serum creatinine levels (0.9 ± 0.3 vs. 1.0 ± 0.5 mg/dl, P < 0.001) and glomerular filtration rate using the modification of diet in renal disease formula (90.5 ± 21.8 vs. 88.4 ± 29.6 ml/min, P = 0.015) were significantly associated with the development of RCIN. A multivariate analysis revealed that the Child–Pugh score was associated with RCIN [odds ratio (OR) 1.5; P = 0.015]. Overall, in-hospital mortality after TACE was 4.07% (with RCIN, 30%; without RCIN, 1.5%; P < 0.001). The multivariate analysis also showed that the Child–Pugh score and the occurrence of RCIN were associated with in-hospital mortality after TACE (OR 2.8; P = 0.001; OR 26.7, P = 0.002, respectively). RCIN after TACE was closely associated with the severity of LC. Effective preventive measures remain to be determined in patients with HCC and advanced LC who are undergoing TACE.Keywords
This publication has 28 references indexed in Scilit:
- Creatinine Kinetics and the Definition of Acute Kidney InjuryJournal of the American Society of Nephrology, 2009
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- Incidence and risk factors for acute renal failure in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective studyLiver International, 2004
- Acute renal failure after transarterial chemoembolization for hepatocellular carcinoma: a retrospective study of the incidence, risk factors, clinical course and long‐term outcomeAlimentary Pharmacology & Therapeutics, 2004
- Assessing renal function in cirrhotic patients: Problems and pitfallsAmerican Journal of Kidney Diseases, 2003
- Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survivalHepatology, 2003
- Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trialThe Lancet, 2002
- Contrast Nephrotoxicity: A Randomized Controlled Trial of a Nonionic and an Ionic Radiographic Contrast AgentNew England Journal of Medicine, 1989
- Contrast Material-Induced Renal Failure in Patients with Diabetes Mellitus, Renal Insufficiency, or BothNew England Journal of Medicine, 1989
- Hospital-acquired renal insufficiency: A prospective studyAmerican Journal Of Medicine, 1983