Soliman MM, Sarkar D, Glezerman I, Maybody M. Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy . World J Nephrol 2020; 9(2): 33-42 [PMID: 33312900 DOI: 10.5527/wjn.v9.i2.33]
Corresponding Author of This Article
Majid Maybody, MD, Associate Professor, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M276C, New York, NY 10065, United States. maybodym@mskcc.org
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Nov 29, 2020; 9(2): 33-42 Published online Nov 29, 2020. doi: 10.5527/wjn.v9.i2.33
Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy
Mohamed M Soliman, Debkumar Sarkar, Ilya Glezerman, Majid Maybody
Mohamed M Soliman, Debkumar Sarkar, Majid Maybody, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Ilya Glezerman, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Author contributions: Soliman MM contributed to analysis and interpretation of data, drafting of manuscript, critical revision; Sarkar D contributed to acquisition of data, analysis and interpretation of data, critical revision; Glezerman I contributed to study conception and design, analysis and interpretation of data, critical revision; Maybody M contributed to study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision.
Supported bythe NIH/NCI Cancer Center, No. P30 CA008748.
Institutional review board statement: The local Institutional Review Board approved this retrospective review (Protocol 16-402) of all patients who underwent hepatic artery embolization (HAE) between January 2010 and January 2011.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Majid Maybody, MD, Associate Professor, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M276C, New York, NY 10065, United States. maybodym@mskcc.org
Received: May 27, 2020 Peer-review started: May 27, 2020 First decision: June 5, 2020 Revised: August 19, 2020 Accepted: September 14, 2020 Article in press: September 14, 2020 Published online: November 29, 2020 Processing time: 181 Days and 17.1 Hours
ARTICLE HIGHLIGHTS
Research background
Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. A higher 1-mo and 1-year mortality rates have been reported in these patients, particularly following arterial angiography.
Research motivation
The cornerstone of CIN management is prevention.
Research objectives
To help with early identification and timely initiation of preventive measures in patients otherwise considered low risk for development of CIN after transarterial hepatic artery embolization.
Research methods
Retrospective review of all patients who underwent hepatic artery embolization between 2010 and 2011 (n = 162) was performed. After removing exclusions, the study group comprised of 84 patients with 106 procedures. CIN was defined as 25% increase above baseline serum creatinine or absolute increase ≥ 0.5 mg/dL within 72 h post-embolization. Post-embolization computed tomographic (CT) was reviewed for renal enhancement patterns and presence of renal artery calcifications. The association between non-contrast CT findings and CIN development was examined by Fisher’s Exact Test.
Research results
CIN occurred in 11/106 (10.3%) procedures (Group A, n = 10). The renal enhancement pattern in patients who did not experience CIN (Group B, n = 74 with 95/106 procedures) was late excretory in 93/95 (98%) and early excretory (EE) in 2/95 (2%). However, in Group A, there was a significantly higher rate of EE pattern (6/11, 55%) compared to late excretory pattern (5/11) (P < 0.001). A significantly higher percentage of patients that developed CIN had renal artery calcifications (6/11 vs 20/95, 55% vs 21%, P = 0.02).
Research conclusions
A hyperdense renal parenchyma relative to surrounding skeletal muscle (EE pattern) and presence of renal artery calcifications on immediate post-HAE non-contrast CT images in patients with low risk for CIN are independently associated with CIN development.
Research perspectives
Prospective studies are required to further assess the findings of this study.
