Radiologists' knowledge and perceptions of the impact of contrast-induced nephropathy and its risk factors when performing computed tomography examinations: a survey of European radiologists.

Background: The past decade has seen a proliferation in the number of CT procedures. As increasing numbers of elderly patients with multiple comorbidities undergo contrast media (CM)-enhanced procedures, more patients are at risk for contrast-induced nephropathy (CIN).
Objectives: To understand whether radiologists are sufficiently aware of the incidence, impact and risk factors of CIN, and whether they are taking sufficient measures to prevent CIN among patients undergoing CT.
Materials and Methods: A telephone or online survey was conducted in 2005 with 509 radiologists from 10 European countries. Participants had a minimum of 3 years' experience and performed at least 50 CT scans per week.
Results: Most (88%) radiologists believed that CIN is an important issue. While 45% identify that a patient is experiencing CIN when the serum creatinine level increases >25% (0.5mg/dL) from baseline within 48h, the remainder used criteria that might lead to significant under-diagnosis. Most (72%) radiologists believed that CIN is associated with increased morbidity; 56% did not believe that it is associated with increased mortality. Most respondents agreed that pre-existing renal impairment (97%), dehydration (90%) and diabetes (89%) were risk factors for CIN; however, 26%, 30% and 46%, respectively, did not identify advanced age, CM dose or congestive cardiac failure as risk factors. Only 7% of radiologists thought they were always made aware of CIN associated with their cases and 28% never consulted a nephrologist to discuss patients at risk of CIN or who had developed CIN.
Conclusion: There is highly variable awareness of the definition, impact and risk factors for CIN among European radiologists. Data regarding the importance of CIN in CT are limited. Improved efforts are required to better educate radiologists and referring physicians and to institute appropriate protocols to identify at-risk patients and prevent CIN.