Análise da vulnerabilidade à nefropatia induzida por contraste iodado em pacientes atendidos em Hospital Universitário Federal

Abstract

Iodinated contrast media (ICM) are widely used in diagnostic imaging due to their ability to enhance anatomical structures. However, their use may lead to adverse effects, with contrast-induced nephropathy (CIN) being one of the most significant complications, particularly in patients with risk factors. Despite medical advances, there are still gaps regarding the risk profile of the Brazilian population undergoing such procedures. This retrospective study evaluated 417 patients who underwent computed tomography (CT) and angiography at Cassiano Antônio Moraes University Hospital (Hucam-UFES), aiming to determine the incidence of CIN and its associated risk factors by comparing serum creatinine levels before and after ICM administration. The results showed a higher occurrence of CIN among female patients, especially those receiving intravenous contrast (26.5% vs. 9.2%; adjusted OR: 4.18). Additionally, patients with chronic kidney disease (CKD) had a significantly increased risk (46.2% vs. 14.4%; adjusted OR: 5.70), particularly when exposed to the intra-arterial route (54.5%; adjusted OR: 6.43). Diabetic patients also showed a higher CIN risk with intra-arterial contrast administration (21.7% vs. 10.5%; adjusted OR: 2.49). Interestingly, arterial hypertension appeared to exert a possible protective effect in patients receiving intravenous contrast, likely due to the nephroprotective role of antihypertensive medications (10.2% vs. 21.1%; adjusted OR: 0.30). In conclusion, factors such as female sex, CKD, and diabetes mellitus (DM) are associated with a higher risk of CIN, especially with intra-arterial contrast administration. These findings highlight the importance of individualized prophylactic protocols based on clinical characteristics and comorbidities to reduce iatrogenic risk in vulnerable populations.