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Keeping the above-mentioned problems of definition in mind, it is not surprising that the reported incidence of CI-AKI varies widely across the literature, depending on the definitions used, the patient population, and the baseline risk factors.
The. impact of different definitions on the incidence of CI-AKI can be illustrated by the recent results of the Oxilan Registry.391 In this registry, CI-AKI was defined as either a SCr increase > 0.5 mg/dl ( > 44 µmol/l), or a SCr increase > 25%, or a decrease > 25% of eGFR, or the composite of all three definitions. The baseline SCr was 1.12 ± 0.3 mg/dl (99 ± 26.5 mmol/l) and 24% had an eGFR < 60 ml/min. CI-AKI rates were 3.3% (SCr increase > 0.5 mg/dl [> 44 µmol/l]), 10.2% (SCr increase > 25%), 7.6% (eGFR decrease > 25%), and 10.5% (composite), respectively.
It is accepted that, in patients with normal renal function—even in the presence of diabetes—the risk for CI-AKI is low (1–2%).392 However, the incidence may be as high as 25% in patients with pre-existing renal impairment or in presence of certain risk factors, such as the combination of CKD and diabetes, CHF, advanced age, and concurrent administration of nephrotoxic drugs.393 CI-AKI was described as the third most common cause of new AKI in hospitalized patients (after decreased renal perfusion and nephrotoxic medications) and was responsible for 11% of cases.394
The epidemiology of de novo CI-AKI in critically ill patients is not known. In a group of 75 ICU patients with a normal baseline SCr who were exposed to CT scans with an i.v. low-osmolar contrast medium, an increase in SCr >25% was recorded in 18% of the patients. There was no change of the SCr in a control group of patients undergoing CT scans but not receiving contrast media.395 This rather small study shows that in critically ill patients, even with an apparently ‘‘normal’’ renal function, i.v. administration of iodinated contrast media is associated with a significant incidence of CI-AKI.
It could be expected that radiological procedures performed in an emergency would be associated with an increased risk of CI-AKI but, as recently summarized,396 the published evidence to support this premise is rather scarce.397
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