A Prospective Observational Study on the Risk of Contrast-Induced Nephropathy Among Patients Undergoing Fundus Fluorescein Angiography
Niño Carlo M. Naidas, MD1, Catherine E. Jordan, MD2, Romulo N. Aguilar, MD1,3, Arlene C. Crisostomo, MD2
1Eye Institute, St. Luke’s Medical Center, E. Rodriguez Sr. Avenue, Quezon City, 1102, Philippines
2Department of Internal Medicine, St. Luke’s Medical Center, E. Rodriguez Sr. Avenue, Quezon City, 1102, Philippines
3Department of Ophthalmology and Visual Sciences, College of Medicine, University of the Philippines, Manila, Philippines
Research grant was provided by the Research and Biotechnology Group.
Project No. 18 – 016
Correspondence: Niño Carlo M. Naidas, MD
Eye Institute, St. Luke’s Medical Center, E. Rodriguez Sr. Avenue, Quezon City, 1102, Philippines
Disclosure: The authors have no proprietary or commercial interest in any materials discussed in this article.
Objective: To determine the incidence of contrast-induced nephropathy (CIN) among patients undergoing fundus fluorescein angiography (FFA)
Methods: One hundred fifty-nine (159) patients from the Ophthalmology out-patient department were enrolled in this prospective, observational study. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured within 7 days before and 48 to 72 hours after FFA. Subjects were stratified into low-, intermediate-, and high-risk groups for developing CIN according to baseline eGFR. CIN was defined by an increase in SCr by more than 25% or by 0.5 mg/dL within 72 hours of intravascular administration of contrast media. The incidence of CIN, changes in SCr levels, and changes in eGFR were analyzed.
Results: Of the 144 subjects who completed the study, 106 (73.6%) were females, 105 (72.9 %) were diabetics, and 57 (39.6%) had elevated baseline SCr. Four (4 or 2.8%) patients developed CIN after FFA, all of whom had normal baseline SCr and were stratified as low-risks. Overall, there were no significant changes in the means of SCr (1.18 ± 0.56 vs 1.16 ± 0.52, p = 0.13) and eGFR (64.53 ± 26.05 vs 64.94 ± 24.88, p = 0.64) before and after FFA. In the low-risk group, the means of SCr and eGFR remained unchanged after FFA (p = 0.06 and p = 0.15, respectively). In the intermediate-risk group, no significant change was appreciated in SCr levels (p = 0.07) however a significant improvement in eGFR (p = 0.006) was seen. Interestingly, a significant decrease in SCr levels (p = 0.004) as well as a significant improvement in eGFR (p = 0.02) was noted after FFA in the high-risk group.
Conclusion: The incidence of CIN among patients undergoing FFA in our cohort was 2.8%. There was no prolonged or serious worsening of renal function based on SCr and eGFR before and after FFA overall, and among low-, moderate-, and high-risk groups.
Keywords: fluorescein angiography, contrast-induced nephropathy, acute kidney injury, incidence, contrast media, creatinine, estimated glomerular filtration rate.