Incidence and risk factors of contrast-induced nephropathy after transcatheter arterial chemoembolization in hepatocellular carcinoma
- 4 Downloads
Transcatheter arterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC). The purpose of this study was to investigate incidence and risk factors of contrast-induced nephropathy (CIN) after TACE in patients with HCC.
In this single-center retrospective study, we examined 461 consecutive TACE sessions in 260 patients between January 2003 and October 2015. CIN was defined as an increase in serum creatinine levels by ≥ 0.5 mg/dl or ≥ 25% from baseline within 72 h after TACE. We calculated incidence rate of CIN and tried to identify its risk factors by logistic regression analysis.
Twenty-one cases of CIN (5%) were observed in 461 TACE sessions. One patient required subsequent hemodialysis transiently. In univariate analysis, tumor size > 5 cm [odds ratio (OR) 5.76, 95% confidence interval (CI) 2.34–14.14, p < 0.001], chronic kidney disease (OR 2.54, 95% CI 1.05–6.14, p = 0.04), serum hemoglobin level [OR 0.79 (per 1 g/dl increase), 95% CI 0.64–0.98, p = 0.03] and serum albumin level [OR 0.44 (per 1 g/dl increase), 95% CI 0.19–1.02, p = 0.05] were associated with the development of CIN. Stepwise logistic regression methods showed that tumor size > 5 cm (OR 7.81, 95% CI 2.99–20.46, p < 0.001) and serum albumin [OR 0.29 (per 1 g/dl increase), 95% CI 0.11–0.75, p = 0.01] were risk factors of CIN.
In this study, HCC tumor size and lower serum albumin level were independent predictors of CIN after TACE.
KeywordsContrast-induced nephropathy (CIN) Transarterial chemoembolisation (TACE) Hepatocellular carcinoma (HCC).
Compliance with ethical standards
Conflict of interest
The authors have declared that no conflict of interest exists.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (the ethics committee of Mitsui Memorial Hospital Approval No. C30 [Year 2018]) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study is a retrospective observational study using existing data from medical records. IRB waived the requirement for informed consent from the patients according to the ethical guidelines for medical and health research involving human subjects in Japan.
- 5.JSN, JRS, and JCS joint working group. Guidelines on the use of iodinated contrast media in patients with kidney disease 2018: Tokyo Igakusha, Tokyo, Japan; 2018 (In Japanese).Google Scholar
- 7.Huo TI, Wu JC, Huang YH, Chiang JH, Lee PC, Chang FY, et al. Acute renal failure after transarterial chemoembolization for hepatocellular carcinoma: a retrospective study of the incidence, risk factors, clinical course and long-term outcome. Aliment Pharmacol Ther. 2004;19:999–1007.CrossRefGoogle Scholar
- 10.Zhou C, Wang R, Ding Y, Du L, Hou C, Lu D, et al. Prognostic factors for acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma. Int J Clin Exp Pathol. 2014;7:2579–86.Google Scholar
- 13.Hao JF, Zhang LW, Bai JX, Li YJ, Liu JN, Zhang XL, et al. Incidence, risk factors, and prognosis of acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma: a prospective cohort study. Indian J Cancer. 2015;51(Suppl 2):e3–8.Google Scholar
- 15.Hsu CY, Huang YH, Su CW, Chiang JH, Lin HC, Lee PC, et al. Transarterial chemoembolization in patients with hepatocellular carcinoma and renal insufficiency. J Clin Gastroenterol. 2010;44:e171–e177177.Google Scholar
- 19.Siriwardana RC, Niriella MA, Dassanayake AS, Liyanage CA, Upasena A, Sirigampala C, de Silva HJ. Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis—a prospective analysis. BMC Gastroenterol. 2015;15:96.CrossRefGoogle Scholar
- 22.Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR cath-PCI registry. JACC Cardiovasc Interv. 2014;7:1–9.CrossRefGoogle Scholar