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Observational Study
. 2018 Nov 6;19(1):308.
doi: 10.1186/s12882-018-1091-2.

Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients

Emmanuelle Rouve  1 , Karim Lakhal  2 , Charlotte Salmon Gandonnière  1   3 , Youenn Jouan  1   3 , Laetitia Bodet-Contentin  1   3 , Stephan Ehrmann  4   5
Affiliations
Observational Study

Lack of impact of iodinated contrast media on kidney cell-cycle arrest biomarkers in critically ill patients

Emmanuelle Rouve et al. BMC Nephrol. .

Abstract

Background: Iodinated contrast media may contribute to acute kidney injury. However, several recent works suggest that this toxicity is minimal in the clinical setting. Recently, urinary G1 cell-cycle arrest proteins tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin like growth factor binding protein 7 (IGFBP-7) were identified as highly sensitive and specific biomarkers for early detection of kidney aggression. The impact of contrast administration on those biomarkers has not been specifically evaluated but could provide clues about the toxicity of contrast media. This study aimed at measuring changes in TIMP-2 and IGFBP-7 urinary concentrations before and after a contrast-enhanced computed tomography in critically ill patients.

Methods: 77 patients were included in a prospective observational cohort study. Urinary [TIMP -2]·[IGFBP-7] was measured before, 6 and 24 h after contrast infusion. Urine output and serum creatinine were followed 3 days.

Results: Median [TIMP-2]·[IGFBP-7] was 0.06 [interquartile range 0.04;0.26], 0.07 [0.03;0.34] and 0.10 [0.04;0.37] (ng/mL)2/1000 respectively before, 6 and 24 h after contrast infusion. Individual changes from baseline were - 0.01 [- 0.11;0.11] and 0.00 [- 0.10;0.09] (ng/ml)2/1000 at 6 and 24 h. These changes were not higher among the patients increasing their Kidney Disease Improving Global Outcome (KDIGO) classification within 3 days after contrast infusion (n = 14 [18%] based on creatinine criterion only, n = 42 [55%] based on creatinine and urine output).

Conclusions: Changes in [TIMP-2]·[IGFBP-7] urinary concentration after contrast-enhanced computed tomography were insignificant, suggesting minimal kidney aggression by modern iodinated contrast media.

Keywords: Acute kidney injury; Biomarkers; IGFBP-7; Iobitridol; Iodinated contrast media; Iohexol; Iopromide; TIMP-2.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the ethics board of the French intensive care society (CE SRLF 14–16). In accordance with national regulations, patients and/or relatives were informed about the study and could decline participation, written consent was waived.

Consent for publication

Not applicable

Competing interests

SE received research grants from Fisher & Paykel, Aerogen, Hamilton, Firalis and Consulting/Lecture fees from La diffusion technique française, Aerogen, Baxter, Bayer. KL received lecture fees from Medtronic. Astute medical provided the Nephrocheck® point of care device free of charge and provided assistance for sample analysis. The company was not involved in study design, analysis nor manuscript drafting. Reagents for measurements were bought by the “Association pour la promotion à Tours de la réanimation médicale: APTRM”.

ER, KL, CSG, YJ, LBC have no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Urinary concentrations of [TIMP-2]·[IGFBP-7]. Logarithmic scale on the Y axis. A [TIMP-2]·[IGFBP-7] (NephroCheck®) value higher than 0.3 is considered significant. [TIMP-2]·[IGFBP-7] was not available at 24 h for 5 (6%) patients. No other data were missing. TIMP-2: tissue inhibitor of metalloproteinases-2; IGFBP-7: insulin-like growth factor binding protein-7
Fig. 2
Fig. 2
Distribution of urinary concentrations of [TIMP-2]·[IGFBP-7]. At baseline, i.e., before contrast media infusion, 59 (77%) patients had [TIMP-2]·[IGFBP-7] values ≤0.3; 10 (13%) had values]0.30–1.0]; 3 (4%) had values]1.0–2.0]; 5 (6%) had values > 2.0. Six hours and 24 h after contrast media infusion, distributions were 57 (74%), 12 (15%) 2 (3%), 6 (8%) and 52 (68%), 16 (21%), 4 (5%), 0(0%), respectively. TIMP-2: tissue inhibitor of metalloproteinases-2; IGFBP-7: insulin-like growth factor binding protein-7
See this image and copyright information in PMC

References

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